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Purpose <p>Intramedullary spinal cord tumors (IMSCTs) pose a high risk of iatrogenic neurologic injury during resection, yet no blood-based assay is available to quantify intra-operative neuroglial damage in real time.</p> Patient and Methods <p>A 36-year-old woman with a C7–T3 WHO grade II ependymoma underwent laminoplasty and microsurgical gross total resection. Peripheral blood was collected at five peri-operative time points. Spinal cord-derived cell free DNA was quantified by droplet-digital PCR, and 119-plex proteomics measured four previously validated proteins (FABP-3, REST, IL-6, NF-H). The Spinal Cord Injury Index (SCII)—a dimensionless composite generated from these analytes—was calculated at each time point.</p> Results <p>SCII increased after initial myelotomy, peaking at myelotomy completion, then returned to pre-myelotomy levels by postoperative day 1. In contrast, glial fibrillary acidic protein and neurofilament-light concentrations were lagging indicators that continued increasing after completion of myelotomy and into postoperative day 1. SCII demonstrated temporal fidelity to the patient’s neurologic trajectory and outcome.</p> Conclusion <p>SCII may allow for high temporal fidelity, molecular monitoring that parallels surgical manipulation and precedes classical protein biomarker elevations, suggesting potential future utility as a real-time liquid biopsy for spinal-cord monitoring during neurosurgical oncology.</p>

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Molecular Monitoring of Neurologic Injury during Intramedullary Spinal Cord Tumor Surgery: A Case Report

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年3月19日

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  • Tej D. Azad,
  • Melanie Alfonzo Horowitz,
  • Kathleen Ran,
  • Marvin Li,
  • Daniel Lubelski,
  • Ali Bydon,
  • Srinivasan Yegnasubramanian,
  • Timothy F. Witham,
  • Nicholas Theodore,
  • Chetan Bettegowda

摘要

Purpose

Intramedullary spinal cord tumors (IMSCTs) pose a high risk of iatrogenic neurologic injury during resection, yet no blood-based assay is available to quantify intra-operative neuroglial damage in real time.

Patient and Methods

A 36-year-old woman with a C7–T3 WHO grade II ependymoma underwent laminoplasty and microsurgical gross total resection. Peripheral blood was collected at five peri-operative time points. Spinal cord-derived cell free DNA was quantified by droplet-digital PCR, and 119-plex proteomics measured four previously validated proteins (FABP-3, REST, IL-6, NF-H). The Spinal Cord Injury Index (SCII)—a dimensionless composite generated from these analytes—was calculated at each time point.

Results

SCII increased after initial myelotomy, peaking at myelotomy completion, then returned to pre-myelotomy levels by postoperative day 1. In contrast, glial fibrillary acidic protein and neurofilament-light concentrations were lagging indicators that continued increasing after completion of myelotomy and into postoperative day 1. SCII demonstrated temporal fidelity to the patient’s neurologic trajectory and outcome.

Conclusion

SCII may allow for high temporal fidelity, molecular monitoring that parallels surgical manipulation and precedes classical protein biomarker elevations, suggesting potential future utility as a real-time liquid biopsy for spinal-cord monitoring during neurosurgical oncology.