Problems Involved in Indications for Operative Treatment in Intramedullary Lesions

Czech version

Authors: M. Smrčka ¹; A. Šprláková ²; V. Smrčka ¹; M. Keřkovský ²
Authors‘ workplace: LF MU a FN Brno Neurochirurgická klinika ¹; LF MU a FN Brno Radiologická klinika ²
Published in: Cesk Slov Neurol N 2010; 73/106(4): 393-397
Category: Review Article

Overview

The diagnostics of intramedullary lesions remain difficult even in these days of MRI. Verification of the aetiology of the pathological process is very important from a neurosurgical point of view, because it plays a substantial part in indications for operative treatment. It is vital that such indication be clearly established, since operations for intramedullary lesion involve a high risk of iatrogenic damage to the patient. In general, tumour and vascular malformations are considered sufficient reasons for operation. On the other hand, conservative treatment is usually preferred for non-tumorous expansions. Differential diagnosis with the aid of MRI is difficult, not only in terms of the type of the tumour but further in terms of distinguishing between tumorous and non-tumorous lesions (inflammation, ischemia, demyelinisation). Sometimes even the patient’s history and neurological examination cannot help. The authors of this article illustrate this difficult topic by means of several case reports. They recommend that, should some doubt exist about the aetiology of the process, operative treatment (including biopsy) always be delayed, and a follow-up MRI performed after some time. In the end, the natural course of the disease will usually indicate how best to proceed.

Key words:
intramedullary tumour – magnetic resonance imaging – surgery

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