AO Foundation Course—Fundamentals of Soft-Tissue Management
September 28 — September 29
3rd Theoretical & Practical International Course in Peripheral Nerve & Brachial Plexus Surgery
(24/9/2018 – 26/9/2018)
Bad Soden (Frankfurt am. Main), Giessen, Germany
Transtemporal approaches and Intensive EC-IC Bypass Course
September 23 — September 24
Usti nad Labem, Czech Republic
The Cerebral White Matter: functional anatomy and surgical applications (Hands-On)
September 21-22, 2018
September 20 — September 22
The European School of Oncology was founded by Umberto Veronesi and Laudomia Del Drago in 1982, with the aim of contributing to the reduction of deaths from cancer due to late diagnosis and/or inadequate treatment. By improving the skills of all health professionals dealing with cancer patients, ESO helps shorten the time needed to transfer knowledge from research centres to daily practice, combining advanced technology with humanism in care.
ESO’s mission is reflected in its motto “Learning to Care”, which emphasises the importance of the learning process, and the goal of caring for the patient in a holistic sense, in contrast to focusing purely on treating the disease.
Due to its financial independence, ESO has the rare privilege of being able to set its own priorities. It therefore pays particular attention to developing the transfer of knowledge in areas that are least supported by industry, such as surgery and in rare pathologies (including childhood tumours), and in countries and regions with limited economic resources.
Spinal Schwannoma Classification
Preoperative planning remains crucial for successful Spinal Schwannoma treatment and relies to a great extent on proper tumor classification. The literature includes multiple classification systems for spinal schwannomas, each of which is associated with both positive and negative ramifications for preoperative planning 1) 2) 3). 4).
Consequently, there is a lack of consensus concerning the optimal system of classification for schwannomas 5).
The literature includes numerous schwannoma classification systems. Jinnai and Koyama 6) classified schwannomas into five groups based on the relationship between the tumor and the dura mater and/or intervertebral foramen. This classification system is useful, as it takes into consideration tumor localization relative to the dura, but it does not take into account volume, which is important for preoperative surgical planning.
Park et al. 8) reported the use of a new classification system, and Type VI and Type VII were added. But the classification system as defined by Park et al. were inadequate because both the figures and the tumors were not clearly described in their manuscript.
A case could not be classified based on Sridhar’s spinal schwannoma classification system. Thus, as shown in a case, of Kotil type VIII must be added to the modified Sridhar classification (Kotil classification) system of benign spinal schwannomas 9).
Sun and Pamir however, think classification of seven distinct types of schwannomas using Sridhar et al.’s system is not practical because the characteristics of seven tumors types are difficult to remember. Another drawback of their system is that tumor volume is only considered for dumbbell-shaped tumors, and craniocaudal dimension is not a consideration, which limit the diagnostic value and consistency of the classification system 10).
Asazuma et al. 11) devised a schwannoma classification system for cervical dumbbell- shaped tumors that consisted of nine categories. An important drawback of their classification system is that it cannot be used for thoracic or lumbar schwannomas, which are as common as cervical schwannomas.
Asazuma et al. classification system for dumbbell spinal schwannoma:
Type 1 intradural extradural restricted to the spinal canal. The constriction occurs at the dura.
Type II are all extradural, and are subclassified as:
IIa do not expand beyond the neural foramen.
IIb inside spinal canal + paravertebral.
IIc foraminal + paravertebral.
Type IIIa are intradural and extradural foraminal, IIIb are intradural and extradural paravertebral.
Type IV are extradural and intravertebral.
Type V are extradural and extralaminar with laminar invasion.
Type VI show multidirectional bone erosion.
Craniocaudal spread: IF & TF designate the number of intervertebral foramina and transverse foramina involved, respectively (e.g. IF stage 2 = 2 foramens).
Schwannomas involving C1 & C2: May involve vertebral arteries and require additional caution.
Sun and Pamir Classification
It is based on consideration of tumor volume and localization relative to the dura and spinal canal. For approximate calculation of tumor volume, spinal schwannomas were considered ellipsoid bodies, and tumor volume was calculated using the following formula:
Tumor volume = 4 / 3 π × (craniocaudal length / 2) × (transverse diameter / 2)2 .
Tumors were then assigned to 1–3 volume groups (group A, B, and C) and designated as 1 of 4 types (type I, II, III, and IV) accord- ing to localization (i.e., group B type II tumor). Tumor volume <2 cm3 was considered group A, 2–4 cm3 group B, and >4 cm3 group C. Tumor typing was as follows: localized exclusively intra- durally: type I; intradural localization with extradural extension to the nerve root foramina, but restricted to the spinal canal: type II; intradural dumbbell-shaped tumor in the spinal canal extending to the extraforaminal region: type III; and localized completely outside the root foramina: type IV
Sridhar et al.’s 12) classification system is arguably the most similar of the previously reported systems to the novel classification system described by Sun and Pamir however, they think classification of seven distinct types of schwannomas using Sridhar et al.’s system is not practical because the characteristics of seven tumors types are difficult to remember. Another drawback of their system is that tumor volume is only considered for dumbbell-shaped tumors, and craniocaudal dimension is not a consideration, which limit the diagnostic value and consistency of the classification system 13).
Based on the findings, Sun and Pamir think that all schwannomas should be classified according to localization and volume, so as to achieve the desired benefit of classification—ease and reliability of preoperative decision making and preparation. In addition, this classification system makes tumor localization easier to understand, as compared to other systems, and is suitable for all schwannoma types.
It is a simple and effective tool that shows extremely helpful for avoiding unnecessary surgical approaches and complications. Due to the system’s simplicity of having only three tumor groups and its reliability—indicated by the associated low postoperative side effect rate, use of this novel classification system should be considered by any surgical department that seeks a standardized schwannoma surgery protocol. 14).
Dumbbell spinal schwannoma
Giant spinal schwannoma
Cervical spinal schwannoma
Thoracic spinal schwannoma
Lumbar spinal schwannoma
Pre-day Courses on Tuesday, 18 September
Pre-day Course I
Anterior Approaches to the Thoracic and Lumbar Spine
Chairs: Pedro Berjano, Milan, Italy and Hossein Mehdian, London, UK
The anterior approach to the spine has been around for the last 50 years. Originally, the surgery involved a large abdominal incision in which the surgeon would cut through the abdominal muscles and the peritoneal cavity to gain access to the spine. Today, however, anterior approaches to the spine can be done with a minimally invasive approach. As with all surgical procedures, the anterior approach to spine carries with it a few risks and potential complications that are unique to this surgical approach.
Pre-day Course II
Emerging Technologies in Spine Surgery
Chairs: Doniel Drazin and J. Patrick Johnson, USA
This course will explore the new advances in the field of emerging technologies in spine surgery and will provide the current state of the art in the use of technology for treating spinal pathology. Topics include and are not limited to intraoperative imaging, navigation, robotics, next generation microscopes and surgical instruments, combinatorial technologies, augmented reality and surgical simulators.
Sections include: Navigation, emerging technologies, and hands-on
Pre-day Course III
Spine Tango Users Meeting (STUM)
Chairs: Anne Mannion and Emin Aghayev, Zurich, Switzerland
The EUROSPINE 2018 pre-day courses were granted the following CME credits (ECMEC®s) by the European Accreditation Council for Continuing Medical Education (EACCME®):
Pre-day Course I, Anterior Approaches to the Thoracic and Lumbar Spine: 4 ECMEC
Pre-day Course II, Emerging Technologies in Spine Surgery: 3 ECMEC
Pre-day Course III, Spine Tango User Meeting (STUM): 3 ECMEC