• Kazutoshi Hida, Yoshinobu Iwasaki, Toshitaka Seki, and Shunsuke Yano.
• Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. kazuhida@med.hokudai.ac.jp
• Neurosurgery. 2006 Apr 1; 58 (4 Suppl 2): ONS-E373; discussion ONS-E373.

Objective And ImportanceSurgery for excision of intramedullary spinal cord tumors without increasing neurological deficit is one of the more difficult operations in spinal surgery. In particular, infiltrating astrocytomas without a clear cleavage between the tumor and normal spinal cord parenchyma are difficult to remove totally without producing additional neurological impairment. In this study, we describe a two-stage resection facilitating total resection of intramedullary tumors.Clinical PresentationThree cases of spinal cord astrocytomas were treated using a two-staged method.TechniqueThe first surgery included myelotomy, biopsy and duroplasty. A thin expanded polytetrafluoroethylene sheet was placed between the dorsal surface of the spinal cord and dura mater to prevent adhesions. Two or 3 weeks after surgery, a second surgery was performed to remove the now exophytic tumor.ResultsMagnetic resonance imaging scans showed exophytic extrusion of the tumor in all three cases before the second operation. In each patient, we were able to carry out gross total removal of the tumors without additional neurological deficit except for transient joint position sense loss in one case. All three patients remain neurologically stable without evidence of tumor recurrence more than 3 years after surgery.ConclusionA two-stage operation may enhance the surgeon's ability to completely resect extensive low-grade spinal cord astrocytomas and, at the same time preserve neurological function.

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