Introduction

The first successful resection of an intramedullary spinal cord tumor was performed in 1907 in Vienna, by Anton von Eiselsberg [1]. The first publication appeared in 1911 in New York, by Charles Elsberg [2]. He developed a strategy for a two-stage operation: a myelotomy was performed at the first surgery and, by the second surgery (about a week later), the tumor had already partly extruded itself from the cord substance, facilitating further resection. The first intradural extramedullary tumor resections are credited to William Macewen in 1883 and Victor Horsley [3].

After the work of these pioneers, the neurological risk of surgery for intramedullary neoplasms was considered unacceptably high. This led to the development of a conservative treatment concept with biopsy, dural decompression and subsequent radiation therapy, regardless of the histological diagnosis. Intradural-extramedullary tumors were commonly regarded as surgically resectable tumors.

The microscope and microsurgery have revolutionized all neurosurgery and also opened the door to innovation in the treatment of spinal cord tumors. CT and particularly MRI have dramatically improved pre-operative planning and significantly contributed to the development of modern treatment strategies of both intra- and extramedullary spinal cord tumors. In particular, the conservative treatment strategy for intramedullary tumors changed to an aggressive approach. Since the large majority of these tumors are histologically benign, complete or near complete, resection results in long-term progression-free survival, with acceptable neurological morbidity [4-7]. More recently, the application of intraoperative neurophysiological monitoring techniques has made a significant impact on the treatment management of both intra- and extramedullary tumors [8,9].

This chapter describes the treatment approach to patients with intradural spinal tumors.

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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