Resection Of Intra-medullary Spinal Cord Tumors Under Awake Anesthesia

Objective:To observe advantages and disadvantages of the resection of intramedullary spinal cord tumor under awake anesthesia.Intramedullary tumors are rare and benign but,surgical resection with gross total resection(GTR)is associated with increased overall survival and progression free survival as well.Surgical resection under general anesthesia is sometimes associated with post-operative complications and we wanted to explore an alternative approach to minimize the rate of these complications.Methods:Two patients with intramedullary spinal cord(cervical)tumor underwent resection of tumor under awake anesthesia and NPM.Both were followed up post-operatively for any motor deficits.Both patients were counselled and trained pre-operatively.Results:Patients who underwent tumor resection under awake anesthesia(Asleep-Awake-Asleep)combined with intraoperative Neurophysiological Monitoring(NPM)had no motor deficits postoperatively.More accurate and non-delayed responses were observed in the awake cycle of anesthesia and helped in guiding the surgery,thus avoiding injuries to the spinal cord.Conclusion:Intramedullary spinal cord tumors are not common,but only gross total resection(GTR)can provide complete remission of symptoms and progression-free survival.However,GTR sometimes results in motor function deficits postoperatively,particularly when the cervical cord is involved,and especially if surgery is done under general anesthesia with intraoperative neurophysiological monitoring(NPM)alone,because of delayed sensory evoked potential(SEP)and motor evoked potential(MEP)responses.We present two cases that underwent GTR of cervical intramedullary spinal cord tumors under an asleep-awake-asleep(AAA)cycle of anesthesia,combined with intraoperative NPM in which no post-operative motor deficits were observed on 6-months follow up.