Surgical Management of Spinal Cord Compression from Plexiform Neurofibromas in Patients with Neurofibromatosis 1

Surgical Management of Spinal Cord Compression from Plexiform Neurofibromas in Patients with... AbstractOBJECTIVEPlexiform neurofibromas with sizable intraspinal extensions and resultant spinal cord compromise pose challenging management problems, because these lesions may involve multiple nerves and engulf adjacent vascular and visceral structures. In this report, we review our experience with the surgical treatment of these lesions.METHODSPatients were identified by a detailed review of hospital medical records and the database of our multidisciplinary neurofibromatosis clinic. Ten patients had large plexiform neurofibromas that extended intraspinally, producing a combination of myelopathy and radiculopathy. Two patients exhibited single-level intraspinal growth, and eight showed multilevel involvement. Four patients showed bilateral plexiform neurofibromatous growth intraspinally, with “hourglass” compression of the spinal cord. Operative approaches and outcomes were reviewed in detail.RESULTSGross total resection of the symptomatic intraspinal tumor component was achieved for nine patients. The management of the extraspinal component was individualized, depending on the pattern and extent of involvement of the surrounding structures. Nine patients experienced complete recovery of neurological function postoperatively; the remaining patient demonstrated significant functional improvement. With a median follow-up period of 4 years, only one patient has developed recurrent intraspinal compression, in this case from tumor involvement by the same plexiform lesion at a lower spinal level. Two patients treated early in the series using standard laminectomy approaches developed significant kyphotic deformities, necessitating subsequent fusion. Based on these initial results, osteoplastic laminotomy techniques were used in the last five cases, allowing anatomic reconstruction of the involved levels; none of these latter patients has developed significant kyphosis, with a median follow-up period of 3 years.CONCLUSIONRadical resection of intraspinal tumor components in patients with neurofibromatosis 1 and large plexiform neurofihromas can help to preserve excellent neurological function. Technical factors in the management of these lesions are presented. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Surgical Management of Spinal Cord Compression from Plexiform Neurofibromas in Patients with Neurofibromatosis 1

Surgical Management of Spinal Cord Compression from Plexiform Neurofibromas in Patients with Neurofibromatosis 1

C L I N I C A L S T U D IE S Surgical Management of Spinal Cord Compression from Plexiform Neurofibromas in Patients with Neurofibromatosis 1 Ian F. Pollack, M.D., Ahmet Colak, M.D., Charles Fitz, M.D., Eugene Wiener, M.D., Morey Moreland, M.D., John J. Mulvihill, M.D. Departments of Neurosurgery (IFP, AC), Radiology (CF), Surgery (EW), and Orthopedics (MM), Children's Hospital of Pittsburgh, and the Department of Human Genetics (J)M), University of Pittsburgh Graduate School of Public Health, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania OBJECTIVE: Plexiform neurofibromas with sizable intraspinal extensions and resultant spinal cord compromise pose challenging management problems, because these lesions may involve multiple nerves and engulf adjacent vascular and visceral structures. In this report, we review our experience with the surgical treatment of these lesions. M ETHO DS: Patients were identified by a detailed review of hospital medical records and the database of our multidisciplinary neurofibromatosis clinic. Ten patients had large plexiform neurofibromas that extended in- traspinally, producing a combination of myelopathy and radiculopathy. Two patients exhibited single-level intraspinal growth, and eight showed multilevel involvement. Four patients showed bilateral plexiform neurofi- bromatous growth intraspinally, with "hourglass" compression of the spinal cord. Operative approaches and outcomes were reviewed in detail. RESULTS: Gross total resection of the symptomatic intraspinal tumor component was achieved for nine patients. The management of the extraspinal component was individualized, depending on the pattern and extent of involve­ ment of the surrounding structures. Nine patients experienced complete recovery of neurological function postoperatively; the remaining patient demonstrated significant functional improvement. With a median follow-up period of 4 years, only one patient has developed...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199808000-00038
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVEPlexiform neurofibromas with sizable intraspinal extensions and resultant spinal cord compromise pose challenging management problems, because these lesions may involve multiple nerves and engulf adjacent vascular and visceral structures. In this report, we review our experience with the surgical treatment of these lesions.METHODSPatients were identified by a detailed review of hospital medical records and the database of our multidisciplinary neurofibromatosis clinic. Ten patients had large plexiform neurofibromas that extended intraspinally, producing a combination of myelopathy and radiculopathy. Two patients exhibited single-level intraspinal growth, and eight showed multilevel involvement. Four patients showed bilateral plexiform neurofibromatous growth intraspinally, with “hourglass” compression of the spinal cord. Operative approaches and outcomes were reviewed in detail.RESULTSGross total resection of the symptomatic intraspinal tumor component was achieved for nine patients. The management of the extraspinal component was individualized, depending on the pattern and extent of involvement of the surrounding structures. Nine patients experienced complete recovery of neurological function postoperatively; the remaining patient demonstrated significant functional improvement. With a median follow-up period of 4 years, only one patient has developed recurrent intraspinal compression, in this case from tumor involvement by the same plexiform lesion at a lower spinal level. Two patients treated early in the series using standard laminectomy approaches developed significant kyphotic deformities, necessitating subsequent fusion. Based on these initial results, osteoplastic laminotomy techniques were used in the last five cases, allowing anatomic reconstruction of the involved levels; none of these latter patients has developed significant kyphosis, with a median follow-up period of 3 years.CONCLUSIONRadical resection of intraspinal tumor components in patients with neurofibromatosis 1 and large plexiform neurofihromas can help to preserve excellent neurological function. Technical factors in the management of these lesions are presented.

Journal

NeurosurgeryOxford University Press

Published: Aug 1, 1998

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