Color Atlas of Spinal Cord Surgery

About this book

This atlas provides a selection of operations for intra- and extradural pathologies of the spinal cord and its nerve roots. Pathologies involving the spinal cord threaten the patients´ mobility, independence or even life. Fortunately, the overwhelming majority are of benign nature, so that surgery plays an important role or even represents their treatment of choice. With modern imaging and microsurgical techniques neurological functions can be maintained or even improved for the majority of patients.

The content is presented in a standardized fashion: the preoperative history is followed by preoperative images leading to a preoperative diagnosis and surgical strategy. The intraoperative images intend to illustrate individual surgical steps one after the other to guide the reader through each of these operations. Each case is concluded with postoperative images and information on clinical outcome.

The atlas features extradural soft tissue tumors, intradural extramedullary and intramedullary tumors, malformations of the craniocervical junction and spinal canal, spinal arteriovenous malformations and pathologies of spinal meninges. The operations selected are meant to provide an overview covering different aspects of each pathology. With more than 1400 intraoperative images this atlas may serve as a reference for neurosurgeons dealing with spinal cord pathologies.

About the author

Jörg Klekamp studied medicine at the Hannover Medical School in Germany. After a postdoctoral research project on human brain development in the Department of Neuropathology at Sydney University, Australia, he started his neurosurgical training under supervision of Prof. Madjid Samii in Hannover, Germany. He devoted his neurosurgical career to spinal cord pathologies and has published several articles in respected international peer review journals on syringomyelia, spinal tumors and malformations of the craniocervical junction and spinal canal over the past 30 years. He is the author of  monographs on syringomyelia and spinal tumors and provided book chapters for german as well as international text books on these topics.

Contents

1. 1  Anatomy. . . . . . . . . . . . . . . . . . . . .

   1. 1.1  Cervical Spine . . . . . . . . . . . .

   2. 1.2  Thoracic Spine . . . . . . . . . . . .

   3. 1.3  Lumbar Spine and Sacrum. . .

   4. 1.4  Spinal Meninges. . . . . . . . . . .

   5. 1.5  Spinal Cord and Nerve Roots

   References. . . . . . . . . . . . . . . . . . . .

2. 2  Standard Approaches . . . . . . . . . .

   1. 2.1  Posterolateral Approach . . . . .

   2. 2.2  Posterior Midline Approach. .

3. 3  Spinal Tumors . . . . . . . . . . . . . . . .

3.1 Extradural Tumors . . . . . . . . .

1. 3.1.1  Surgical Technique. . .

2. 3.1.2  Nerve Sheath Tumors.

. ............ . ............ . ............ . ............ . ............ . ............ . ............

. ............ . ............ . ............

. ............ . ............ . ............ . ............

....................... ... 1 . ......................... 1 ....................... ... 5 . ......................... 6 . ......................... 9 . ......................... 10 ....................... ... 12

. ......................... 15 . ......................... 15 ....................... ... 16

. ......................... 19 ....................... ... 19 . ......................... 19 ....................... ... 19 . ......................... 46 . ......................... 52 . ......................... 52 ....................... ... 53 . ......................... 79 . ......................... 103 . ......................... 120 . . . . . . . . . . . . . . . . . . . . . . .. . . 126 . ......................... 126 . ......................... 127 . ......................... 150 . ......................... 163 ....................... ... 171 . ......................... 176 . ......................... 179 . ......................... 189 . ......................... 195

. ......................... 217 . . . . . . . . . . . . . . . . . . . . . . .. . . 217 . ......................... 217 . ......................... 220 . ......................... 256 Hamartomas. . . . . . . . . . . . . . . . 266 . ......................... 266 . . . . . . . . . . . . . . . . . . . . . . .. . . 267 . ......................... 275

3.1.3 Malignant Soft Tissue Tumors . . . . . . . 3.2 Extramedullary Tumors . . . . . . . . . . . . . . . . . .

1. 3.2.1  Surgical Technique. . . . . . . . . . . . . . . .

2. 3.2.2  Nerve Sheath Tumors. . . . . . . . . . . . . .

3. 3.2.3  Meningiomas . . . . . . . . . . . . . . . . . . . .

4. 3.2.4  Ependymomas of the Filum Terminale

3.2.5 Angioblastomas . . . . . . 3.3 Intramedullary Tumors. . . . . . .

1. 3.3.1  Surgical Technique. . . .

2. 3.3.2  Ependymomas . . . . . . .

3. 3.3.3  Pilocytic Astrocytomas

4. 3.3.4  Fibrillary Astrocytomas

5. 3.3.5  Anaplastic Astrocytoma

6. 3.3.6  Glioblastoma . . ..... .

7. 3.3.7  Gangliogliomas ..... .

8. 3.3.8  Metastases . . . . ..... .

9. 3.3.9  Angioblastomas ..... .

4 Malformations . . . . . . . . . . . ..... .

1. 4.1  Malformations at the Craniocervical Junction.

   1. 4.1.1  Surgical Technique. . . . . . . . . . . . . . . .

   2. 4.1.2  Chiari I Malformation . . . . . . . . . . . . .

   3. 4.1.3  Chiari II Malformation. . . . . . . . . . . . .

2. 4.2  Malformations in the Spinal Canal and Spinal

   1. 4.2.1  Surgical Technique. . . . . . . . . . . . . . . .

   2. 4.2.2  Filum Terminale Pathologies . . . . . . . .

   3. 4.2.3  Split Cord Malformations . . . . . . . . . .

. ........... . ........... . ........... . ........... . ........... . ........... . ........... . ........... . ........... . ........... . ...........

. ...........

4. 4.2.4  Dermal Sinus . . . . . . . . . . . . .

5. 4.2.5  Neurenteric Cysts. . . . . . . . . .

6. 4.2.6  Glioependymal Cysts. . . . . . .

7. 4.2.7  Epidermoid Cysts. . . . . . . . . .

8. 4.2.8  Dermoid Cysts . . . . . . . . . . . .

9. 4.2.9  Lipomas . . . . . . . . . . . . . . . . .

References. . . . . . . . . . . . . . . . . . . . . . . . . .

Arteriovenous Malformations . . . . . . . . .

1. 5.1  Surgical Technique. . . . . . . . . . . . . . .

2. 5.2  Cavernomas . . . . . . . . . . . . . . . . . . . .

3. 5.3  Arteriovenous Fistulas . . . . . . . . . . . .

Pathologies of Spinal Meninges . . . . . . . .

1. 6.1  Pathologies of the Spinal Dura Mater

   1. 6.1.1  Surgical Technique. . . . . . . . .

   2. 6.1.2  Dura Diverticula. . . . . . . . . . .

   3. 6.1.3  Dura Dissections . . . . . . . . . .

   4. 6.1.4  Dura Ectasias . . . . . . . . . . . . .

   5. 6.1.5  Spinal Cord Herniations. . . . .

2. 6.2  Pathologies of the Spinal Arachnoid .

   1. 6.2.1  Surgical Technique. . . . . . . . .

   2. 6.2.2  Primary Arachnopathies. . . . .

   3. 6.2.3  Posttraumatic Arachnopathies

   4. 6.2.4  Postsurgical Arachnopathies .

   5. 6.2.5  Postmeningitic Arachnopathy

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 434 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 442 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 459 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 482 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 508 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520

6.2.6 Posthemorrhagic Arachnopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 527