Removing a spinal tumor can be like defusing a bomb. The stakes are high. And surgeons must have the ability to both plan carefully and also handle whatever setup they encounter.
In a recent spine surgery video, Dr. Paul McCormick helps other neurosurgeons develop those abilities.
In the video, Dr. McCormick removes a tumor from the spinal cord of a 17-year-old boy. Images like MRIs and X-rays have revealed the tumor’s exact location and allowed Dr. McCormick to plan a careful approach to the problem. But there are some things the images can’t show– like exactly what type of tumor it is, and what techniques he’ll need to remove it.
Dr. McCormick takes a biopsy, or tissue sample, during the surgery. Doctors called pathologists will examine the biopsy under a microscope. Then they can make the definitive diagnosis. So during the surgery itself, Dr. McCormick will need to use his experience and surgical know-how to remove whatever type of tumor the surgery reveals.
Getting to the tumor requires careful planning, which Dr. McCormick describes in the video. Approaching through the front of the spinal column, he removes part of a vertebrae. Then he can see the spinal cord itself. In the video, he displays a diagram to describe the exact location that will be best for operating on the delicate spinal cord in this case.
Ever so slowly, he opens the membranes around the spinal cord. Using micro-surgical instruments, and working through a surgical microscope, he gradually makes the incision long enough, deep enough, and wide enough to expose the tumor. Now, for the first time, he can get a real look at it.
Cells of a pilocytic astrocytoma
He describes the tumor’s features: its consistency, its edges, and its blood vessels. All are consistent with the diagnosis of pilocytic astrocytoma.
In the video, Dr. McCormick contrasts an astrocytoma with another tumor that can grow in the same location, called an ependymoma. (See our story about Dr. McCormick’s interesting ependymoma surgery video here.) Compared to an ependymoma, this tumor’s margins are less clearly defined. That means that in this tumor, it is harder to tell where tumor tissue ends, and normal tissue begins. This will affect how he removes the tumor.
“Because of the large size of the tumor and lack of distinctive tumor margins, an inside-out tumor resection will be performed,” he explains. That means he’ll start near the center of the tumor–on the inside–and carefully work his way out.
As he begins to manipulate the tumor, cerebrospinal fluid suddenly fills the operating space. Dr. McCormick explains that this fluid had been trapped by the tumor and has now been freed. He simply uses surgical instruments to clear the area once again and then proceeds with the surgery.
Dr. McCormick progressively removes the tumor, from the inside out. When the tumor has been completely taken out, he points to more features of the margins for his audience.
Dr. McCormick’s planning and know-how have paid off. This patient did very well after surgery. For the first three days, he stayed supine (lying face-up). He wore a collar for six weeks but needed no other rehab. His spinal cord lost no function during the surgery, and three years later, his neck and spinal cord are stable.
You can watch the video here. But be aware: the video contains close-up surgical footage, and should only be watched by interested adults.
Learn more about Dr. McCormick on his bio page here.
IMAGE CREDITS:
“Pilocytic astrocytoma” by Nephron (Own work) [CC BY-SA 3.0 or GFDL], via Wikimedia Commons
“Cutting which wire disables the bomb” by Wonderlane / [Flickr]
