Transoral resection of axial lesions augmented by intraoperative magnetic resonance imaging

Taro Kaibara, R. John Hurlbert, Garnette R. Sutherland

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Transoral decompression of the cervicomedullary junction may be compromised by a narrow corridor in which surgery is performed, and thus the adequacy of surgical decompression/resection may be difficult to determine. This is problematic as the presence of spinal instrumentation may obscure the accuracy of postoperative radiological assessment, or the patient may require reoperation. The authors describe three patients in whom high-field intraoperative magnetic resonance (MR) images were acquired at various stages during the transoral resection of C-2 disease that had caused craniocervical junction compression. All three patients harbored different lesions involving the cervicomedullary junction: one each of plasmacytoma and metastatic breast carcinoma involving the odontoid process and C-2 vertebral body, and basilar invagination with a Chiari I malformation. All patients presented with progressive myelopathy. Surgical planning MR imaging studies performed after the induction of anesthesia demonstrated the lesion and its relationship to the planned surgical corridor. Transoral exposure was achieved through placement of a Crockard retractor system. In one case the soft palate was divided. Interdissection MR imaging revealed that adequate decompression had been achieved in all cases. The two patients with carcinoma required placement of posterior instrumentation for stabilization. Planned suboccipital decompression and placement of instrumentation were averted in the third case as the intraoperative MR images demonstrated that excellent decompression had been achieved. Intraoperatively acquired MR images were instrumental in determining the adequacy of the decompressive surgery. In one of the three cases, examination of the images led the authors to change the planned surgical procedure. Importantly, the acquisition of intraoperative MR images did not adversely affect operating time or neurosurgical techniques, including instrumentation requirements.

Original languageEnglish (US)
Pages (from-to)239-242
Number of pages4
JournalJournal of neurosurgery
Volume95
Issue number2 SUPPL.
StatePublished - Dec 1 2001
Externally publishedYes

Fingerprint

Decompression
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Odontoid Process
Surgical Decompression
Soft Palate
Plasmacytoma
Spinal Cord Diseases
Reoperation
Anesthesia
Breast Neoplasms
Carcinoma

Keywords

  • Cervicomedullary junction
  • Intraoperative monitoring
  • Magnetic resonance imaging
  • Transoral approach

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Clinical Neurology

Cite this

Transoral resection of axial lesions augmented by intraoperative magnetic resonance imaging. / Kaibara, Taro; Hurlbert, R. John; Sutherland, Garnette R.

In: Journal of neurosurgery, Vol. 95, No. 2 SUPPL., 01.12.2001, p. 239-242.

Research output: Contribution to journalArticle

Kaibara, Taro ; Hurlbert, R. John ; Sutherland, Garnette R. / Transoral resection of axial lesions augmented by intraoperative magnetic resonance imaging. In: Journal of neurosurgery. 2001 ; Vol. 95, No. 2 SUPPL. pp. 239-242.
@article{b1d88eb4d4ca4986a35e3e78ffc7291e,
title = "Transoral resection of axial lesions augmented by intraoperative magnetic resonance imaging",
abstract = "Transoral decompression of the cervicomedullary junction may be compromised by a narrow corridor in which surgery is performed, and thus the adequacy of surgical decompression/resection may be difficult to determine. This is problematic as the presence of spinal instrumentation may obscure the accuracy of postoperative radiological assessment, or the patient may require reoperation. The authors describe three patients in whom high-field intraoperative magnetic resonance (MR) images were acquired at various stages during the transoral resection of C-2 disease that had caused craniocervical junction compression. All three patients harbored different lesions involving the cervicomedullary junction: one each of plasmacytoma and metastatic breast carcinoma involving the odontoid process and C-2 vertebral body, and basilar invagination with a Chiari I malformation. All patients presented with progressive myelopathy. Surgical planning MR imaging studies performed after the induction of anesthesia demonstrated the lesion and its relationship to the planned surgical corridor. Transoral exposure was achieved through placement of a Crockard retractor system. In one case the soft palate was divided. Interdissection MR imaging revealed that adequate decompression had been achieved in all cases. The two patients with carcinoma required placement of posterior instrumentation for stabilization. Planned suboccipital decompression and placement of instrumentation were averted in the third case as the intraoperative MR images demonstrated that excellent decompression had been achieved. Intraoperatively acquired MR images were instrumental in determining the adequacy of the decompressive surgery. In one of the three cases, examination of the images led the authors to change the planned surgical procedure. Importantly, the acquisition of intraoperative MR images did not adversely affect operating time or neurosurgical techniques, including instrumentation requirements.",
keywords = "Cervicomedullary junction, Intraoperative monitoring, Magnetic resonance imaging, Transoral approach",
author = "Taro Kaibara and Hurlbert, {R. John} and Sutherland, {Garnette R.}",
year = "2001",
month = "12",
day = "1",
language = "English (US)",
volume = "95",
pages = "239--242",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "2 SUPPL.",

}

TY - JOUR

T1 - Transoral resection of axial lesions augmented by intraoperative magnetic resonance imaging

AU - Kaibara, Taro

AU - Hurlbert, R. John

AU - Sutherland, Garnette R.

PY - 2001/12/1

Y1 - 2001/12/1

N2 - Transoral decompression of the cervicomedullary junction may be compromised by a narrow corridor in which surgery is performed, and thus the adequacy of surgical decompression/resection may be difficult to determine. This is problematic as the presence of spinal instrumentation may obscure the accuracy of postoperative radiological assessment, or the patient may require reoperation. The authors describe three patients in whom high-field intraoperative magnetic resonance (MR) images were acquired at various stages during the transoral resection of C-2 disease that had caused craniocervical junction compression. All three patients harbored different lesions involving the cervicomedullary junction: one each of plasmacytoma and metastatic breast carcinoma involving the odontoid process and C-2 vertebral body, and basilar invagination with a Chiari I malformation. All patients presented with progressive myelopathy. Surgical planning MR imaging studies performed after the induction of anesthesia demonstrated the lesion and its relationship to the planned surgical corridor. Transoral exposure was achieved through placement of a Crockard retractor system. In one case the soft palate was divided. Interdissection MR imaging revealed that adequate decompression had been achieved in all cases. The two patients with carcinoma required placement of posterior instrumentation for stabilization. Planned suboccipital decompression and placement of instrumentation were averted in the third case as the intraoperative MR images demonstrated that excellent decompression had been achieved. Intraoperatively acquired MR images were instrumental in determining the adequacy of the decompressive surgery. In one of the three cases, examination of the images led the authors to change the planned surgical procedure. Importantly, the acquisition of intraoperative MR images did not adversely affect operating time or neurosurgical techniques, including instrumentation requirements.

AB - Transoral decompression of the cervicomedullary junction may be compromised by a narrow corridor in which surgery is performed, and thus the adequacy of surgical decompression/resection may be difficult to determine. This is problematic as the presence of spinal instrumentation may obscure the accuracy of postoperative radiological assessment, or the patient may require reoperation. The authors describe three patients in whom high-field intraoperative magnetic resonance (MR) images were acquired at various stages during the transoral resection of C-2 disease that had caused craniocervical junction compression. All three patients harbored different lesions involving the cervicomedullary junction: one each of plasmacytoma and metastatic breast carcinoma involving the odontoid process and C-2 vertebral body, and basilar invagination with a Chiari I malformation. All patients presented with progressive myelopathy. Surgical planning MR imaging studies performed after the induction of anesthesia demonstrated the lesion and its relationship to the planned surgical corridor. Transoral exposure was achieved through placement of a Crockard retractor system. In one case the soft palate was divided. Interdissection MR imaging revealed that adequate decompression had been achieved in all cases. The two patients with carcinoma required placement of posterior instrumentation for stabilization. Planned suboccipital decompression and placement of instrumentation were averted in the third case as the intraoperative MR images demonstrated that excellent decompression had been achieved. Intraoperatively acquired MR images were instrumental in determining the adequacy of the decompressive surgery. In one of the three cases, examination of the images led the authors to change the planned surgical procedure. Importantly, the acquisition of intraoperative MR images did not adversely affect operating time or neurosurgical techniques, including instrumentation requirements.

KW - Cervicomedullary junction

KW - Intraoperative monitoring

KW - Magnetic resonance imaging

KW - Transoral approach

UR - http://www.scopus.com/inward/record.url?scp=0035490988&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035490988&partnerID=8YFLogxK

M3 - Article

C2 - 11599844

AN - SCOPUS:0035490988

VL - 95

SP - 239

EP - 242

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 2 SUPPL.

ER -