{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T18:15:25Z","timestamp":1793297725650,"version":"4.5.0"},"reference-count":52,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Intramedullary spinal cord tumors (IMSCTs) are rare tumors with heterogeneous presentations and natural histories that complicate their management. Standardized guidelines are lacking on when to surgically intervene and the appropriate aggressiveness of resection, especially given the risk of new neurological deficits following resection of infiltrative tumors. Here, the authors present the results of a modified Delphi method using input from surgeons experienced with IMSCT removal to construct a framework for the operative management of IMSCTs based on the clinical, radiographic, and tumor-specific characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A modified Delphi technique was conducted using a group of 14 neurosurgeons experienced in IMSCT resection. Three rounds of written correspondence, surveys, and videoconferencing were carried out. Participants were queried about clinical and radiographic criteria used to determine operative candidacy and guide decision-making. Members then completed a final survey indicating their choice of observation or surgery, choice of resection strategy, and decision to perform duraplasty, in response to a set of patient- and tumor-specific characteristics. Consensus was defined as \u2265 80% agreement, while responses with 70%\u201379% agreement were defined as agreement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Thirty-six total characteristics were assessed. There was consensus favoring surgical intervention for patients with new-onset myelopathy (86% agreement), chronic myelopathy (86%), or progression from mild to disabling numbness (86%), but disagreement for patients with mild numbness or chronic paraplegia. Age was not a determinant of operative candidacy except among frail patients, who were deemed more suitable for observation (93%). Well-circumscribed (93%) or posteriorly located tumors reaching the surface (86%) were consensus surgical lesions, and participants agreed that the presence of syringomyelia (71%) and peritumoral T2 signal change (79%) were favorable indications for surgery. There was consensus that complete loss of transcranial motor evoked potentials with a 50% decrease in the D-wave amplitude should halt further resection (93%). Preoperative symptoms seldom influenced choice of resection strategy, while a distinct cleavage plane (100%) or visible tumor-cord margins (100%) strongly favored gross-total resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The authors present a modified Delphi technique highlighting areas of consensus and agreement regarding surgical management of IMSCTs. Although not intended as a substitute for individual clinical decision-making, the results can help guide care of these patients. Additionally, areas of controversy meriting further investigation are highlighted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2023.8.spine23190","type":"journal-article","created":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T21:53:25Z","timestamp":1697234005000},"page":"1-10","source":"Crossref","is-referenced-by-count":12,"title":["Treatment of intramedullary spinal cord tumors: a modified Delphi technique of the North American Spine Society Section of Spine Oncology"],"prefix":"10.3171","volume":"40","author":[{"given":"Andrew M.","family":"Hersh","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zach","family":"Pennington","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lubelski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aladine A.","family":"Elsamadicy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Dea","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, British Columbia, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atman","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford Medicine, Palo Alto, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziya L.","family":"Gokaslan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brown University, Providence, Rhode Island;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Rory","family":"Goodwin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesley","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George I.","family":"Jallo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajit","family":"Krishnaney","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilya","family":"Laufer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Fu Larry","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Macki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California San Francisco School of Medicine, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankit I.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Illinois at Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Ozturk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John H.","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hesham","family":"Soliman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Sciubba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"},{"name":"Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"J Neurooncol","first-page":"117","article-title":"Predictors of survival and time to progression following operative management of intramedullary spinal cord astrocytomas","volume":"158","author":"Hersh AM","year":"2022","unstructured":"Hersh AM, Antar A, Pennington Z,  Predictors of survival and time to progression following operative management of intramedullary spinal cord astrocytomas. 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Korean J Spine. 2014;11(3):121\u2013126."},{"issue":"2","key":"b20","series-title":"Neurospine","first-page":"441","article-title":"Current trends in the surgical management of intramedullary tumors: a multicenter study of 1,033 patients by the Neurospinal Society of Japan","volume":"19","author":"Endo T","year":"2022","unstructured":"Endo T, Inoue T, Mizuno M,  Current trends in the surgical management of intramedullary tumors: a multicenter study of 1,033 patients by the Neurospinal Society of Japan. Neurospine. 2022;19(2):441\u2013452."},{"issue":"12","key":"b21","series-title":"J Neurosurg Case Lessons","first-page":"CASE21702","article-title":"Primary intramedullary spinal cord pilocytic astrocytoma with anaplasia in an adult: illustrative case","volume":"3","author":"Kawasaki T","year":"2022","unstructured":"Kawasaki T, Takayama M, Kobayashi T,  Primary intramedullary spinal cord pilocytic astrocytoma with anaplasia in an adult: illustrative case. 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World Neurosurg. 2016;95:108\u2013116."},{"issue":"6","key":"b40","series-title":"Neurosurgery","first-page":"1129","article-title":"Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study","volume":"58","author":"Sala F","year":"2006","unstructured":"Sala F, Palandri G, Basso E,  Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study. Neurosurgery. 2006;58(6):1129\u20131143."},{"key":"b41","series-title":"World Neurosurg","first-page":"498","article-title":"Intraoperative neuromonitoring in patients with intramedullary spinal cord tumor: a systematic review, meta-analysis, and case series","volume":"125","author":"Rijs K","year":"2019","unstructured":"Rijs K, Klimek M, Scheltens-de Boer M, Biesheuvel K, Harhangi BS. Intraoperative neuromonitoring in patients with intramedullary spinal cord tumor: a systematic review, meta-analysis, and case series. World Neurosurg. 2019;125:498\u2013510.e2."},{"issue":"5","key":"b42","series-title":"Neurosurg Focus","first-page":"E21","article-title":"Delayed variations in the diagnostic accuracy of intraoperative neuromonitoring in the resection of intramedullary spinal cord tumors","volume":"50","author":"Kimchi G","year":"2021","unstructured":"Kimchi G, Knoller N, Korn A,  Delayed variations in the diagnostic accuracy of intraoperative neuromonitoring in the resection of intramedullary spinal cord tumors. 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