History

The pioneers of surgery in the early 20th century already understood quite well that surgery is the best initial treatment option for patients with spinal cord tumors. Anton von Eiselsberg in Vienna in 1907 and Charles Elsberg in New York in 1911 were the first to successfully perform such an operation.

In the following decades however it became clear that neither the surgical skill nor the technology was available to remove spinal cord tumors without significant risk of paralysis. Since tumor growth frequently caused a slowly progressive paralysis alternatives were sought. Radiation treatment thus became an option. But it was never shown that radiation treatment for slow growing spinal cord tumors eliminated them or really stopped the progression of neurological dysfunction. Therefore surgery was revived in the 1960's. James Greenwood at Baylor described a technique for removing intramedullary ependymomas. He demonstrated that this was not only feasible but resulted in cure of the tumor with excellent neurological outcomes.

In the 1970's microsurgery and the surgical microscope revolutionized neurosurgery and in the 1980 imaging with MRI became widely available. These two key developments made successful resection of intramedullary tumors of the spinal cord a reality. In the 1990's the surgical experience continued to grow. At the same time new technologies were used. The handheld laser probe allowed precise cutting and dissection. Continuous intraoperative neurophysiological monitoring of evoked potentials, particularly motor evoked potentials (MEP) made it possible to know the functional status of the spinal cord's motor pathways at every point in time during the operation.

Neurosurgeons still have the appropriate respect for the spinal cord as an extremely delicate structure, but it is not any longer inaccessible territory.