Endoscopic-Assisted Microsurgical Resection of a Recurrent Conus Medullaris Dermoid Tumor

Surgery for intramedullary spinal cord tumors presents multiple unique challenges, including the need to operate through a very narrow myelotomy window. In this operative video, we demonstrate the use of the surgical endoscope in an operation performed on a 35-year-old woman. She has a history of conus medullaris dermoid tumor resection, and she presented to us with worsening lower extremity sensory and motor symptoms. Magnetic resonance imaging showed a 4-cm recurrence of her tumor. After consenting to surgery, she underwent reoperative posterior lumbar approach to resection of her tumor. In our video we demonstrate our use of a surgical endoscope, which allowed us to minimize the extent of our myelotomy and resect tumor rostral and caudal to our myelotomy, thus minimizing the risk of damage to normal spinal cord that is displaced by tumor (Video 1).