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William O. Bell, Roger J. Packer, Kathy R. Seigel, Lucy B. Rorke, Leslie N. Sutton, Derek A. Bruce and Luis Schut

L eptomeningeal spread of primary central nervous system (CNS) tumors is a well-known phenomenon; 5, 6, 12, 17, 29, 30, 40 this is particularly true in spread of primitive neuroectodermal tumors such as medulloblastomas, ependymoblastomas, central neuroblastomas, ependymomas, and germ-cell tumors. 6, 30 Leptomeningeal spread of primary intramedullary spinal cord tumors is less frequent. 9, 23 Over the last 6 years at Children's Hospital of Philadelphia we have treated three patients with intramedullary spinal cord tumors that subsequently infiltrated the

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Michael Salcman, Ernesto Botero, Krishna C. V. Rao, Richard D. Broadwell and Eric Scott

D espite the existence of a number of experimental brain-tumor models, no satisfactory model of an intramedullary spinal cord tumor appears to be available. The small size of the common host animals, whether mouse, rat, 1, 4, 12, 14 or rabbit, 2 has forestalled the development of parenchymal cord tumors, although some models of meningeal carcinomatosis have been produced. The advent of computerized tomography (CT) and our need to study microwave fields and pharmacokinetics in a large animal led us to reevaluate and extend the canine glioma model of Wodinsky

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Defining future directions in spinal cord tumor research

Proceedings from the National Institutes of Health workshop

Elizabeth B. Claus, May Abdel-Wahab, Peter C. Burger, Herbert H. Engelhard, David W. Ellison, Nicholas Gaiano, David H. Gutmann, Daniel A. Heck Jr., Eric C. Holland, George I. Jallo, Carol Kruchko, Larry E. Kun, Bernard L. Maria, Zoran Rumboldt, Daniela Seminara, Giovanna M. Spinella, Linda Stophel, Robert Wechsler-Reya, Margaret Wrensch and Richard J. Gilbertson

R are cancers reduce the quality and quantity of life and present an enormous challenge to patients and their physicians. The low incidence of these tumors hinders the conduct of clinical trials and laboratory studies that might define the disease more clearly and identify effective therapies. Consequently, progress in the treatment of rare tumors often proceeds slowly and typically relies on the extrapolation of results from studies of more common cancers. Spinal cord tumors are high on the list of rare cancers for which there is an urgent need for better

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Paul R. Cooper and Fred Epstein

T he optimum treatment of patients with intramedullary spinal cord tumors is unclear. Evaluation of the effect of therapy on these tumors is difficult because they are unusual lesions, 1, 10, 11, 18 and most series are small or have been accumulated over a period of many years by a large number of surgeons employing heterogeneous techniques and operative philosophies. 1, 6, 15, 17, 19 Moreover, in many series, patients were treated before the advent of modern diagnostic techniques and surgical adjuncts. The success of aggressive operative removal of

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Aaron A. Cohen-Gadol, Dennis D. Spencer and William E. Krauss

pachymeningitis. It was not until after his admission to the hospital, and a more careful study of the case with Dr. H. M. Thomas, that tumor was suspected. I urged early operation, feeling sure that the condition would not be made worse. 3 This patient's preoperative neurological deficits resolved after surgery. Cushing's initial successful attempts encouraged him to undertake spinal cord tumor excisions throughout his career. In our review of the 1870 patient records available at the Cushing Tumor Registry housed at the Yale Department of Neurosurgery, we found 60 cases

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Yukihiro Matsuyama, Yoshihito Sakai, Yoshito Katayama, Shiro Imagama, Zenya Ito, Norimitsu Wakao, Koji Sato, Mitsuhiro Kamiya, Yasutsugu Yukawa, Tokumi Kanemura, Makoto Yanase and Naoki Ishiguro

I ntramedullary spinal cord tumors are very rare, accounting for 2–4% of CNS tumors. 1 , 3 , 9 , 10 , 13 Unlike brain tumors, most cases, with a few exceptions, are pathologically benign, but surgical treatment is difficult. Since Epstein et al. 6 , 7 reported the outcomes of active resection of IMSCT in 1980, modern microscopic techniques have developed and many facilities have reported surgical outcomes. Neurological manifestations were aggravated postoperatively in > 30% of the cases in many reports, 4 , 5 , 8 , 11 , 12 , 19 , 26 , 27 showing that

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Catriona O'Sullivan, R. Derek Jenkin, Mary A. Doherty, Harold J. Hoffman and Mark L. Greenberg

F rom 1979 to 1983 in Ontario, Canada, the average annual incidence of malignant tumors of the brain and central nervous system (CNS) was 680 (7.9 per 100,000) for patients of all ages and 69 (2.6 per 100,000) for patients under 20 years of age. 7 Primary spinal cord tumors in children are rare, with an approximate annual incidence of one per 1 million children. In patients under 15 years of age, the ratio of brain to spinal tumors ranges from 8:1 to 22:1. 17, 36 From 1958 to 1990 at the University of Toronto institutions, primary spinal cord tumors

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Beate Poblete, Christoph Konrad and Karl F. Kothbauer

R esection of spinal cord tumors frequently requires a multilevel laminectomy. 3 , 16 This sometimes extensive approach results in a considerable wound surface and detachment of the spinal muscles in a movement-active muscle group. Postoperative pain may therefore be considerable, and satisfactory pain control, a prerequisite for early mobilization and fast recovery, 18 , 32 , 33 is frequently difficult to achieve. Therefore, alternatives and improvements to the standard analgesia regimen of acetaminophen, metamizol, and patient-controlled analgesia with

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Vedantam Rajshekhar, Parthiban Velayutham, Mathew Joseph and K. Srinivasa Babu

cord tumors to determine the influence of preoperative patient factors on the feasibility of MMEP monitoring. We also studied other aspects of MMEP monitoring such as which muscle in the lower limbs yielded MEPs most consistently, and assessed whether monitoring more than 1 muscle in the lower limbs would enhance the chances of obtaining MMEPs. Methods Patient Population One hundred fifteen consecutive patients undergoing surgery for spinal cord tumors between March 2004 and June 2007 were considered for this prospective study after approval by the

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Ashok R. Asthagiri, Gautam U. Mehta, John A. Butman, Martin Baggenstos, Edward H. Oldfield and Russell R. Lonser

%) are located dorsal to the dentate ligament and are most frequently found within the dorsal root entry zone (66%). 15 , 19 Because spinal cord hemangioblastomas are most frequently located within or on the dorsal aspect of the spinal cord, they are resected via a posterior approach that includes laminectomies. Although the features associated with cervical instability after laminectomy in patients undergoing resection of sporadic spinal cord tumors are becoming better defined, little is known about long-term spinal stability in patients with multiple neoplasia