الفهرس 
Spinal MeningesOnly 14 pages are availabe for public view
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Abstract
Spinal tumors are classified into extradural, intradural extra medullary and intradural intramedullary. MRI is considered the most appropriate diagnostic tool in identification of the tumor before surgery.(3) Surgery is the treatment of choice in management intradural spinal cord lesions. IONM techniques have made it possible to perform aggressive and challenging procedures while minimizing neurological squeals.(4) This study was conducted on twenty patients subjected to microsurgical resection of intradural spinal cord tumors guided with one or all modalities of IONM in the department of Neurosurgery, Tanta university hospitals. All patients were subjected to history taking, complete physical and neurological examination (including Pain scale (VAS), (Nurick) scale and (the Royal Medical Research Council of Britain scale), radiological and laboratory investigations, at preoperative and at follow up. In the present study, out of 20 patients, 9 were males and 11 were females. The patients’ age ranged from 6 to 69 years old with mean age 38years. Pain was the most common clinical presentation and usually the first symptom (85%), followed by sensory deficit (75%). Motor weakness represents (40%) of the clinical presentation. Sphincter problems were the least clinical presentation in our study (30%). All patients were operated under total intravenous anaesthia (propofol and fentanyl). Halogenated and muscle relaxants anesthetic agents were contraindicated. Short acting muscle relaxant agents only were used during intubation and muscle dissection. All patients were in the prone position. And exposure of the tumor is done exclusively from the posterior position. Laminectomy was done for 18 patients while hemilaminectomy was done just for two patients. In our study, (35%) were monitored by EMG only mostly were lumbar lesions. (10%) were monitored by SEP only. They were dorsally located without compression on motor tracts. (55%) were monitored by two or more modalities. In our study, 90% of the patients show alarms even one at least during intraoperative monitoring. (75%) of them show alarms indicate reversible injuries. Only (15%) of them show alarms indicate irreversible injuries. Tumor resection is limited and controlled by IONM alarms either reversible or irreversible. Complete resection ratio increased in IDEM lesions over IM lesions due to the infiltrative character of these lesions. (60%) of the patients underwent total resection of the lesion. Those were most cases of IDEM lesions. (30%) of them underwent subtotal resection of the lesion. (10%) only were operated for biopsy of the lesion. Both were IDIM astrocytoma. In our study, Most of the complications were minor, transient, and mostly resolved in few days to weeks. They include CSF leak, infection (skin infection, UTI and only one developed pneumonia and meningitis), transient incontinence, Lower limb edema, superficial DVT and psychosis. Unfortunately one patient developed respiratory failure, ventilation associated pneumonia, meningitis and septicemia leading to death. Most cases symptoms improved post operative (VAS) score decreases from average 8.0 ± 1.2 ranges (7-10) pre operative to an average of 1.2±0.8 range (0-2) at the follow up. The average Nurick’s scale improved from 3.0 to1.3 (range 1-5) pre operatively to 1.0±0.0 at follow up.