Introduction: Intradural spinal cord tumors are challenging secondary to local anatomy and close proximity of critical structures, making adequate intraoperative navigation vital. In this abstract we describe three cases in which intraoperative computed tomography(iCT) was coregistered with magnetic resonance and diffusion tensor imaging(MRI/DTI) for guidance in the resection of intraspinal tumors. To our knowledge, this technique has rarely been employed in intradural tumor resection, and never before in the treatment of intramedullary disease.
Methods: Co-registered navigation was employed in the resection of two extramedullary lesions and one intramedullary cervicomedullary tumor. Following open midline exposure of bony anatomy, iCT was obtained and co-registered to pre-operative MRI sequences to allow for optical tracking navigation via a stealth station. In the intramedullary tumor, DTI was used for enhanced identification of relevant anatomy. Navigational accuracy for all cases was confirmed to be acceptable at the level of the posterior bony elements, the dura, and the tumor-parenchyma interface.
Results: The co-registration of MR and iCT images allowed for enhanced navigation during resection. During removal of a cervicomedullary ependymoma with marked distortion of longitudinal tracts, iCT/DTI navigation allowed for accurate visualization of critical structures and facilitated delineation of tumor margins. All patients tolerated the procedures well with stable post-operative courses.
Conclusions: Combined iCT/MRI guidance is routinely employed in the resection in cranial lesions but is more technically difficult in spinal pathology. We describe the use of combined iCT and pre-operative MRI/DTI neuronavigational guidance as an effective approach in the resection of intradural and intramedullary tumors.
Patient Care: Provide a an effective and accurate modality for the safe resection of intramedullary spinal cord tumors.
Learning Objectives: By conclusion of this session, participants should be able to 1) Describe the importance of long tract visualization in intramedullary spinal cord tumor resection, 2) identify the challenges inherent to spinal anatomy and physiology in obtaining accurate MR imaging sequences relevant to intraoperative guidance, and 3) discuss the potential advantages of CT and MR co-registration for navigational imaging in intradural spinal cord tumor resection.