Surgery performed by Prof. Mastronardi and Dr. Michelini
In this case uploaded to SurgSchool, the number one app for online surgeries’s most emblematic landmarks, the Professor Luciano Mastronardi and Dr. Silvia Michelini present a high-precision microsurgical intervention for the complete resection of a cervical intramedullary ependymoma, using sodium fluorescein as an intraoperative guide.
The use of sodium fluorescein In neurosurgery it has been shown to improve the visualization of tumor margins, facilitating a gross total removal and reducing the risk of damage to the spinal cord. In this case, neurosurgeons demonstrate how this technique clearly distinguishes tumor tissue from healthy parenchyma, optimizing the safety and effectiveness of surgery.
Clinical case
This is a patient of 54 years with pain in the neck and right arm, in whom the magnetic resonance revealed a intramedullary expansive lesion at the C7–D1 level, with homogeneous enhancement after contrast. Given the clinical progression, it was decided to perform a C7–D1 posterior laminotomy with microsurgical approach and intraoperative neurophysiological monitoring (motor and somatosensory potentials).
Prior to dural opening, the following were administered: 5 mg/kg fluorescein sodium intravenously. Under the operating microscope and by means of a dedicated filter for fluorescein, the surgeons were able to precisely delimit the tumor mass, which showed a bright yellow color compared to normal bone marrow tissue.
Surgical technique
After completing the medial durotomy and the opening of the arachnoid, the slightly swollen spinal cord was identified. Using monopolar stimulation and dorsal mapping, the middle raphe to carry out a 5–7 mm longitudinal myelotomy.
The tumor, oval in shape and poorly vascularized, was meticulously dissected. Fluorescein allowed clear differentiation of the cleavage planes, especially in the ventral portion, where the adherence was strongest. microsurgical dissection and mitral aspiration, the achievement was achieved complete removal of the ependymoma without added neurological deficit.
Results and evolution
La neurophysiological monitoring The patient showed intraoperative stability, with only a slight decrease in the amplitude of somatosensory potentials in the right upper limb. The patient was mobilized on the first postoperative day and discharged a week later. without motor or sensory deficits.
Histological study confirmed the diagnosis of intramedullary ependymoma cervical. Since a total resection, adjuvant radiotherapy was not indicated, in accordance with current international recommendations.
This case exemplifies how the sodium fluorescein It is consolidated as a valuable and accessible tool in the intramedullary tumor surgery, allowing precise delimitation of the margins and safe resection of the lesion.
The technique presented by the Prof. Mastronardi and Dr. Michelini reflects the surgical excellence and integration of technological advances that characterize the contents of SurgSchool, the number one platform for online surgical training.
Access the complete surgery in SurgSchool
This case is available in the app SurgSchool, with high-definition video, surgeon commentary, and a didactic approach so that neurosurgeons and residents can learn the most advanced techniques in spinal surgery.
