Spinal Tumors and Vascular Malformations — WACS Viva & Clinical Scenarios (Spinal Neurosurgery and Spinal Cord Disorders)

Exam-style spinal tumors and vascular malformations viva scenarios with examiner probes and model answers for Neurosurgery candidates.

Scenarios covered

• SCENARIO 1: A 62-year-old male with known metastatic castrate-resistant prostate carcinoma presents to the emergency surgical unit with a 3-week history of progressively worsening mid-thoracic back pain and a 48-hour history of bilateral lower extremity weakness (power MRC grade 3/5) and urinary retention. Contrast-enhanced MRI of the whole neuroaxis reveals a destructive lesion at T7 with circumferential epidural soft tissue extending into the canal causing severe cord compression (Bilsky grade 3). Outline the initial emergency medical stabilization, discuss the application of the Spinal Instability Neop
• SCENARIO 2: An otherwise healthy 45-year-old woman presents with progressive spastic paraparesis, sensory ataxia, and a distinct T10 sensory level. MRI demonstrates a well-circumscribed, homogeneously enhancing, intradural-extramedullary lesion situated ventrolateral to the thoracic cord with a distinct dural tail. Detail the step-by-step surgical plan for a posterior thoracic laminotomy/laminectomy, dural opening, denticulate ligament sectioning, devascularization, tumor debulking, arachnoid plane preservation, and watertight dural repair. Compare this operative strategy with that required for a dumbbell
• SCENARIO 3: Classify intramedullary spinal cord tumors (IMSCTs) by incidence, histology, and neuroimaging features. Detail the operative microsurgical technique for resecting a cervical intramedullary ependymoma from the level of C3 to C6, including the role and interpretation of intraoperative multimodal neuromonitoring (MEPs, SSEPs, and D-wave monitoring), the technique of posterior midline myelotomy, development of the glial-tumor interface, and intraoperative strategies to minimize secondary ischemic and traction injury to the anterior spinal artery and dorsal columns.
• SCENARIO 4: A 58-year-old man presents with insidious, fluctuating lower limb paraparesis that worsens following physical exertion and prolonged walking (neurogenic claudication of Foix-Alajouanine syndrome). T2-weighted MRI demonstrates multilevel lower thoracic cord hyperintensity (edema) with prominent serpentine intradural flow voids along the dorsal surface of the cord. Contrast spine MRI reveals patchy enhancement. Explain the pathophysiological classification of spinal vascular malformations (Anson-Spetzler Types I to IV), detail the diagnostic gold-standard selective digital subtraction catheter s
• SCENARIO 5: Define the Weinstein-Boriani-Biagini (WBB) and Enneking staging systems for primary osseous neoplasms of the mobile spine. Discuss their application in deciding the surgical margin (intralesional debulking versus en bloc spondylectomy) for primary aggressive or malignant tumors, such as chordoma, chondrosarcoma, and giant cell tumor of the lumbar spine.