Intrinsic spinal cord tumor resection

SPINAL CORD TUMORS are more frequently detected than in the past, because of progress in neuroradiology. Many neurosurgeons must now decide how to treat such lesions. The recent neurosurgical literature contains many case reports, few series, and different strategies. This article describes the surgical method I have developed in a period of 15 years, with Georges Fischer in Lyon, on the basis of experience with more than 260 patients and 300 operations. The standard treatment is complete resection whenever possible, but we must learn when and where to stop to preserve the quality of life. I have several useful strategies, which are explained in this report. For gliomas (ependymomas and astrocytomas), I favor a midline approach; for most vascular tumors (such as hemangioblastomas and cavernomas), however, I prefer to proceed from the point at which the lesion is observed through the microscope and to dissect the lesion in one piece. Meticulous nonbleeding surgery and experience are the keys to success.