Diagnosis
MRI findings are consistent with an intradural intramedullary lesion of the spinal cord at the level of T7–T8 vertebrae. Thoracic spine osteochondrosis.
Patient:
Female, 35 years old, Russia
Physician:
Professor Martin Scholz, Head of the Department of Neurosurgery, Sana Kliniken Duisburg
Patient’s Complaints
Mild chest pain during inhalation. Pain intensity — 3 out of 10. MRI of the thoracic spine reveals an intradural intramedullary lesion of oval shape with smooth but indistinct margins. Signs of spinal cord thickening and deformation of the surrounding cerebrospinal fluid spaces are present.
Response from neurosurgeon Professor Martin Scholz
The MRI scans of the thoracic spine show an intradural intramedullary spinal cord tumor. It is unlikely to be malignant. Most probably this is a Grade II ependymoma or an astrocytoma. In this case, surgery is feasible — difficult, but entirely possible.
Our approach would include dorsal reconstructive laminoplasty — widening of the spinal canal via a dorsal approach. First, the vertebral arch is removed and then reattached after the procedure. This is followed by microscopic microsurgical myelotomy and tumor resection under continuous intraoperative neurophysiological monitoring.
Patient’s Questions
- What are the risks associated with tumor removal?
- How many such surgeries do you perform per year?
- Considering the absence of significant neurological deficits, when should surgery be performed?
Doctor’s Responses
- Risks related to spinal cord intervention are often exaggerated outside the medical field. In reality, spinal cord injury during surgery occurs very rarely (<1%). Nerve damage or postoperative bleeding inside the spinal canal are also uncommon (<1–2%).
- We perform around 35–40 surgeries per year for intradural spinal cord tumors. Intramedullary tumors specifically — 10–15 surgeries annually. With over 30 years of experience in removing intramedullary tumors, I rely on continuous neurophysiological monitoring to minimize neurological risks.
- During the surgery, we will monitor somatosensory and motor evoked potentials. As long as the signals remain stable, the functional integrity of sensory and motor pathways is preserved, allowing safe continuation of tumor resection and, if possible, complete removal.
- Surgery is best performed before significant neurological symptoms appear. If numbness or other deficits develop, postoperative prognosis becomes less favorable.
Estimated Treatment Cost: €28,000
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The treatment examples provided on this website are NOT medical advice and are for informational purposes only.