Thoracic Hemangiopericytoma With Intramedullary Invasion: 2-Dimensional Operative Video.

We present a surgical video highlighting the resection of an intradural thoracic hemangiopericytoma with intramedullary invasion. A 43-yr-old man was referred to the clinic with progressive bilateral lower extremity numbness which had been present for several years, now accompanied by 6 mo of painless, progressive lower extremity weakness. Neuroimaging demonstrated an intradural contrast-enhancing lesion at T6-7. On preoperative imaging, it was difficult to determine whether the tumor only displaced the spinal cord or there was also spinal cord invasion. The patient was taken for surgery in the form of a T5-7 laminectomy for resection of an intradural tumor which also had an intramedullary component. Final pathology was consistent with hemangiopericytoma. After surgery, he had 3/5 strength in the left leg and 1/5 strength in the right leg, but this improved to 2/5 strength in the right leg at the 6-wk follow-up. Hemangiopericytoma is a rare diagnosis accounting for <1% of central nervous system tumors, but it is even more rare in the spine because there are fewer than 100 reported cases. Given the unique nature of the case, there are limited data on optimal treatment paradigms, but surgical resection should be considered for anyone who has severe spinal cord compression with a neurological deficit, and this is often paired with postoperative radiation therapy. The patient provided written informed consent for the surgical procedure and video recording.