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Wang K, Shi L, Su Y, Wang H, Liu L. Clinical features and surgical outcomes of spinal epidural angiolipomas. Acta Neurol Belg 2023; 123:115-120. [PMID: 33948901 DOI: 10.1007/s13760-021-01689-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/23/2021] [Indexed: 11/25/2022]
Abstract
To discuss the clinical features and surgical outcomes of spinal epidural angiolipomas. We retrospectively analyzed the medical records of patients with spinal epidural angiolipomas who were performed microsurgery between January 2003 and December 2017. The diagnosis of spinal angiolipomas was based on pathological criteria. Modified McCormick classification was applied to evaluate neurological function. There were 11 females and 9 males with ages ranged from 38 to 74 years. Fourteen lesions were located in the thoracic region, 4 in the lumbar, 1 in the lumbosacral, and 1 in the thoracolumbar region. Patients presented with nonspecific symptoms and the duration of symptoms ranged from 1 to 168 months with a mean 21.3 months. 11 cases exhibited isointense on T1-weighted imaging(T1WI) and hyperintense on T2-weighted imaging(T2WI). The other 9 cases exhibited hyperintense on T1WI and T2WI imaging. Gross total resection (GTR) was performed in 19 patients, and subtotal resection (STR) was performed in 1 patient. Postoperatively, all patients showed a recovery or improvement of neurological functions except the STR patient. There was no recurrence or regrowth of the residual lesions observed on magnetic resonance images (MRI). Usually, spinal epidural angiolipomas have two types of MRI manifestations depending on the ratio of fat to vessels. Total resection of spinal epidural angiolipoma is possible regardless of it is infiltrative or not. Postoperative radiotherapy is not recommended for subtotal resection patients. A favorable functional outcome can be expected if the patient performed early surgery.
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Affiliation(s)
- Keda Wang
- Department of Neurosurgery, Beijing Jishuitan Hospital, No 31, Xinjiekou East Street, Xicheng, Beijing, 100035, China
| | - Liang Shi
- Department of Neurosurgery, Beijing Jishuitan Hospital, No 31, Xinjiekou East Street, Xicheng, Beijing, 100035, China
| | - Yibing Su
- Department of Neurosurgery, Beijing Jishuitan Hospital, No 31, Xinjiekou East Street, Xicheng, Beijing, 100035, China.
| | - Hanbin Wang
- Department of Neurosurgery, Beijing Jishuitan Hospital, No 31, Xinjiekou East Street, Xicheng, Beijing, 100035, China
| | - Longqi Liu
- Department of Neurosurgery, Beijing Jishuitan Hospital, No 31, Xinjiekou East Street, Xicheng, Beijing, 100035, China
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Yang T, Niu C. Microsurgical treatment for spinal epidural angiolipomas. Acta Neurol Belg 2021; 121:421-427. [PMID: 31309454 DOI: 10.1007/s13760-019-01192-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/08/2019] [Indexed: 12/22/2022]
Abstract
Spinal epidural angiolipomas are rare lesions composed of mature lipomatous and angiomatous elements. In this paper, the authors review a surgical series of ten patients with epidural angiolipomas. All patients had performed preoperative and postoperative magnetic resonance imaging. The diagnosis of angiolipoma was based on pathology. All the follow-up data were obtained during office visits. There were 5 males and 5 females with a mean age of 53.6 years. One tumor was located in the cervicothoracic, six in the thoracic, and three in the lumbar spine. The most common symptom was progressive motor deficit. Gross total resection of the tumor was achieved in nine cases, and subtotal resection was obtained in one case. No recurrence or regrowth of the residual tumor was observed during a follow-up period of 50.8 months. At the last follow-up, 90% of patients experienced improvement in the neurological function. Epidural angiolipomas are benign but clinically progressive lesions. Early surgery should be performed to prevent irreversible neurological deficits. Postoperative radiotherapy is not recommended. The risk of long-term recurrence/regrowth of the lesions is low, and a good clinical outcome after total or subtotal removal can be expected.
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Affiliation(s)
- Tao Yang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, People's Republic of China
| | - ChaoShi Niu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, People's Republic of China.
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Abstract
Spinal angiolipomas (SALs) are extremely rare benign tumors composed of both mature fatty tissue and anomalous vascular channels. We present two cases of SALs and review the clinical presentation, radiological appearance, pathological aspects, and treatment of this distinct clinicopathological mass. The patients’ neurologic symptoms improved postoperatively and follow-up revealed no signs of tumor recurrence or neurological deficit. SAL should be considered as a differential diagnosis in patients with spinal cord compression. Magnetic resonance imaging is important for detecting and characterizing SALs. The gold standard treatment modality should be total resection.
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Affiliation(s)
- RuiDeng Wang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hai Tang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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Spinal angiolipoma: Presentation of two cases and review of the literature for the years 2012–2017. Neurocirugia (Astur) 2020; 31:76-86. [DOI: 10.1016/j.neucir.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/25/2019] [Accepted: 04/17/2019] [Indexed: 12/27/2022]
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Albano S, Ramnot A, Siddiqi J, Mahato D. Medical and Legal Implications of MRI Scout Imaging in a Surgical Patient with Case Presentation. Cureus 2020; 12:e6833. [PMID: 32181076 PMCID: PMC7051123 DOI: 10.7759/cureus.6833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Spinal epidural angiolipoma is an uncommon finding; this case is presented to display the medical and legal implications of MRI scout imaging. In this case, a preceding period of ambiguous and non-focal symptoms led to an MRI of the lumbar spine without contrast with a scout image that captured a thoracic lesion. Review of the scout film led to a subsequent MRI of the thoracic spine with and without contrast that aided clinical decision making leading to surgical resection of the identified lesion and resolution of symptoms for this patient. The use of scout imaging has been described in the literature, but no concise agreement among physicians or professional medical societies exists regarding what utility, if any, may be obtained from the review of scout imaging. A discussion of medical legal implications of MRI scout imaging follows.
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Affiliation(s)
- Stephen Albano
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Ajay Ramnot
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Javed Siddiqi
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
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Zhang X, Wang JJ, Guo Y, Dong S, Shi W, Wang G, Zhang H, Wang G. Sudden Aggravated Radicular Pain Caused by Hemorrhagic Spinal Angiolipomas After Back Massage. World Neurosurg 2019; 134:383-387. [PMID: 31733392 DOI: 10.1016/j.wneu.2019.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Spinal angiolipomas (SALs) are benign tumors that usually present a slow progressive spinal cord or radicular compression. Acute myelopathy or acute aggravated radicular syndrome are exceedingly rare. CASE DESCRIPTION The authors report an original case with sudden aggravated radicular pain caused by hemorrhagic SALs. A 54-year-old woman presented with a 2-month history of mild back pain, and the pain was significantly aggravated after a therapeutic back massage. Neurologic examination showed pain and hyperalgesia between T4 and T7 dermatome, from back to front, just like a band. Spinal magnetic resonance imaging (MRI) showed a dorsally located epidural lesion (T4-T6) and a small intratumoral hemorrhage at the lower part of the tumor. A bilateral T4-T6 laminectomy was performed to achieve total excision of the tumors. Histologic examination showed that the tumors were composed of mature adipose tissue and vascular tissue as angiolipomas. The postoperative course was uneventful with complete neurologic recovery 4 days after the surgery. MRI at 1-year follow-up indicated no recurrence. CONCLUSIONS SALs are unusual benign tumors that are composed of mature fatty tissue and abnormal blood vessels; sudden aggravated spinal cord or radicular compression syndrome is rare. MRI is the best choice in the diagnosis of SALs. Surgery may be performed in different ways depending on the type of SALs, and the prognosis is generally good.
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Affiliation(s)
- Xiaolei Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital; School of Clinical Medcine, Tsinghua University, Beijing, China
| | - James Jin Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital; School of Clinical Medcine, Tsinghua University, Beijing, China
| | - Yi Guo
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital; School of Clinical Medcine, Tsinghua University, Beijing, China
| | - Sheng Dong
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital; School of Clinical Medcine, Tsinghua University, Beijing, China
| | - Wei Shi
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital; School of Clinical Medcine, Tsinghua University, Beijing, China
| | - Guoqin Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital; School of Clinical Medcine, Tsinghua University, Beijing, China
| | - Huifang Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital; School of Clinical Medcine, Tsinghua University, Beijing, China
| | - Guihuai Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital; School of Clinical Medcine, Tsinghua University, Beijing, China.
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Dildar N, Ayaz SB, Aamir MO, Ahmad N. Spontaneous spinal epidural hemorrhage following disseminated intravascular coagulation resulting in paraplegia: a case report. J Spinal Cord Med 2019; 42:265-269. [PMID: 29047318 PMCID: PMC6419632 DOI: 10.1080/10790268.2017.1387717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
CONTEXT Spontaneous spinal epidural hemorrhage (SSEH) mostly presents as low back pain with or without a radiculopathy, and rarely with paraplegia or tetraplegia depending on the site and severity of spinal cord compression. We present here a case who had anemia and developed paraplegia following disseminated intravascular coagulation (DIC) due to a transfusion reaction. FINDINGS A 65-year-old lady presented with sudden onset chest pain radiating to nape of the neck followed by loss of sensations and power in legs few hours after a blood transfusion. Her past history was negative for diabetes mellitus, hypertension, coronary artery disease, or a bleeding disorder. Her blood pressure was 90/57 mmHg and she had a normal pulse, respiratory rate, and temperature. On neurological examination, she had no motor power and unevokable muscle stretch reflexes in the lower limbs. The sensations were intact till T3 dermatome. The laboratory evaluation was suggestive of DIC. The magnetic resonance imaging showed a non-enhancing abnormal signal intensity area in the posterior epidural space, extending from CV4 to LV4 causing cervico-dorsal cord compression associated with cord edema. Following diagnosis, urgent decompressive surgery was carried out due to deteriorating neurological status. The patient was transfused with five bags of red cell concentrate, two bags of platelets, and four bags of fresh frozen plasma during the operation. The patient regained consciousness following operation, however, the neurological status did not improve. She, unfortunately, died on the third post-op day due to cardiac arrest. CONCLUSION SSEH is a rare cause of paraplegia. Early radiological diagnosis is crucial for timely neurosurgical management and saving patient from permanent neurological deficit or a fatal outcome.
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Affiliation(s)
- Nazia Dildar
- Consultant radiologist, department of radiology and diagnostic imaging, Combined Military Hospital, Quetta, and Quetta Institute of Medical Sciences, Quetta87300Baluchistan, Pakistan
| | - Saeed Bin Ayaz
- Consultant Rehabilitation Medicine, Department of Rehabilitation Medicine, Combined Military Hospital, Quetta, and Quetta Institute of Medical Sciences, Quetta87300Baluchistan, Pakistan,Correspondence to: Saeed Bin Ayaz, MBBS, FCPS, MSc; Consultant Physiatrist, Department of Rehabilitation Medicine, Combined Military Hospital, Quetta87300, Baluchistan, Pakistan.
| | - Muhammad Omer Aamir
- Consultant radiologist, department of radiology and diagnostic imaging, Combined Military Hospital, Quetta, and Quetta Institute of Medical Sciences, Quetta87300Baluchistan, Pakistan
| | - Nadeem Ahmad
- Consultant Rehabilitation Medicine, Department of Rehabilitation Medicine, Combined Military Hospital, Quetta, and Quetta Institute of Medical Sciences, Quetta87300Baluchistan, Pakistan
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Hemorrhagic Sudden Onset of Spinal Epidural Angiolipoma. Case Rep Orthop 2018; 2018:5231931. [PMID: 30057841 PMCID: PMC6051123 DOI: 10.1155/2018/5231931] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 06/24/2018] [Indexed: 11/20/2022] Open
Abstract
Angiolipomas are relatively rare benign tumors. Spinal angiolipomas that generally induce slow progressive cord compression are most commonly found in the thoracic region. A 49-year-old female with obesity presented with a 1-week history of progressively worsening back pain, paresthesia of lower limbs, and gait disturbance. When thoracic magnetic resonance imaging (MRI) revealed a dorsal epidural mass at the Th5–Th8 level, the patient underwent a laminectomy for gross total excision of the lesion. Both mature fatty tissue and abnormal proliferating vascular elements with thin or expanded walls were observed in the resected tumor. Nonfiltrating spinal angiolipoma was diagnosed and confirmed by pathology. After the operation, sensory loss, numbness, and gait disturbance were improved following the disappearing severe back pain. Following examinations indicated the absence of recurrence within 1 year. The angiolipomas of the spine are rare causes of spinal cord compression that generally induce slow progressive cord compression, but sudden onset or rapid worsening of neurological deterioration is observed in hemorrhagic spinal angiolipoma.
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Lacour M, Gilard V, Marguet F, Curey S, Perez A, Derrey S. Sudden paraplegia due to spontaneous bleeding in a thoracic epidural angiolipoma and literature review. Neurochirurgie 2018; 64:73-75. [PMID: 29472020 DOI: 10.1016/j.neuchi.2017.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/06/2017] [Accepted: 08/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Spinal angiolipomas are rare epidural tumours that are usually revealed by chronic symptoms of medullar irritation. We report a case of acute paraplegia caused by spontaneous bleeding revealing a thoracic angiolipoma. CASE DESCRIPTION A 17-year-old male patient with no previous medical history was admitted for acute onset of paraplegia with bladder retention and loss of sensation in the lower limbs, preceded by dorsal pain during the three previous days. MRI showed an enhanced T1-weighted image of a T7-T12 epidural lesion. The T1-weighted isosignal and the T2-weighted hyposignal suggested haemorrhagic complications. Due to a mass effect on the spinal cord, an emergency laminectomy was performed. Histopathological examination of the lesion revealed an angiolipoma with spontaneous bleeding. Clinical outcome was favourable after two months. CONCLUSION This case is one of the first to be reported, although the clinical presentation is similar to that of other rare reported cases of paraplegia due to spinal compression by tumoural bleeding.
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Affiliation(s)
- M Lacour
- Department of Neurology, Rouen University Hospital, 76031 Rouen, France
| | - V Gilard
- Department of Neurosurgery, Rouen University Hospital, 76031 Rouen, France
| | - F Marguet
- Department of Pathology, Normandie Univ, UNIROUEN, Inserm UMR 1073, Rouen University Hospital, 76031 Rouen, France
| | - S Curey
- Department of Neurosurgery, Rouen University Hospital, 76031 Rouen, France
| | - A Perez
- Department of Neurosurgery, Rouen University Hospital, 76031 Rouen, France
| | - S Derrey
- Department of Neurosurgery, Rouen University Hospital, 76031 Rouen, France; Department of Neurosurgery, Normandie Univ, UNIROUEN, Inserm UMR 1073 Rouen University Hospital, 76031 Rouen, France.
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10
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Four cases of spinal epidural angiolipoma. J Clin Neurosci 2018; 48:243-244. [DOI: 10.1016/j.jocn.2017.10.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 10/22/2017] [Indexed: 11/18/2022]
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Wang FF, Wang S, Xue WH, Cheng JL. Epidural spinal angiolipoma: a case series. BMC Res Notes 2017; 10:128. [PMID: 28320469 PMCID: PMC5359808 DOI: 10.1186/s13104-017-2432-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 02/16/2017] [Indexed: 12/27/2022] Open
Abstract
Background Spinal angiolipomas (SAL) are rare benign tumors, commonly presenting with slow progressive spinal cord compression. There are only about 170 cases identified so far. Magnetic resonance imaging (MRI) has become the modality of choice for SAL. The purpose of this article is to report three cases of SAL and their characteristic MRI features. Case presentation Three cases of epidual spinal angiolipoma from ethnic Han Chinese patients are presented here, including one lumbar and two thoracic tumors. MRI imaging findings were reviewed. Conclusions Multiple MRI technology for characterization of SAL provides useful information for differential diagnosis and therapeutic management.
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Affiliation(s)
- Fei Fei Wang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, 1 Jian She E Road, Zhengzhou, 450052, China
| | - Song Wang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, 1 Jian She E Road, Zhengzhou, 450052, China
| | - Wen Hua Xue
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, 1 Jian She E Road, Zhengzhou, 450052, China
| | - Jing Liang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, 1 Jian She E Road, Zhengzhou, 450052, China.
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Shweikeh F, Sangtani A, Steinmetz MP, Zahos P, Chopko B. Spinal angiolipomas: A puzzling case and review of a rare entity. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:91-96. [PMID: 28694590 PMCID: PMC5490357 DOI: 10.4103/jcvjs.jcvjs_23_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Patients with spinal epidural abscesses (SEAs) may have a variable presentation. Such an infection has a typical appearance on magnetic resonance imaging (MRI) and enhances with gadolinium. We present a case that was a diagnostic challenge where pre- and intra-operative findings resulted in conflicting impressions. The mimicker was a spinal angiolipoma (SAL). The authors then provide a thorough review of this rare spinal neoplasm. A 55-year-old man presented with back pain, paresis, paresthesia, and urinary retention. MRI was indicative of a longitudinal epidural thoracic mass with a signal homogeneous to nearby fat, curvilinear vessels, and lack of enhancement. Although at emergent surgery, the lesion was found to contain abundant purulent material. Microbiology was positive for methicillin-resistant Staphylococcus aureus and consistent with SEA without evidence of neoplasia. While the imaging features were suggestive of an angiolipoma, the findings at surgery made SEA more likely, which were validated histopathologically. The diagnosis of SEA is often clear-cut, and the literature has reported only a few instances in which it masqueraded as another process such as lymphoma or myelitis. The case highlights SEA masquerading as an angiolipoma, and further demonstrates to clinicians that obtaining tissue diagnosis plays a crucial role diagnostically and therapeutically. SALs, on the other hand, are slow-growing tumors that can be infiltrating or noninfiltrating. They typically present with chronic symptoms and T1-MRI shows an inhomogeneous picture. Complete surgical excision is standard of care and patients tend to do well afterward.
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Affiliation(s)
- Faris Shweikeh
- Summa Health System, Northeast Ohio Medical University, Rootstown, USA.,College of Medicine, Northeast Ohio Medical University, Rootstown, USA
| | - Ajleeta Sangtani
- College of Medicine, Northeast Ohio Medical University, Rootstown, USA
| | - Michael P Steinmetz
- Department of Neurosurgery, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Peter Zahos
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Bohdan Chopko
- College of Medicine, Northeast Ohio Medical University, Rootstown, USA.,Department of Neurosurgery, Stanford University, Palo Alto, CA, USA
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Bouali S, Maatar N, Bouhoula A, Abderrahmen K, Said IB, Boubaker A, Kallel J, Jemel H. Spinal epidural angiolipomas: Clinical characteristics, management and outcomes. Asian J Neurosurg 2016; 11:348-351. [PMID: 27695535 PMCID: PMC4974956 DOI: 10.4103/1793-5482.180901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The spinal epidural angiolipomas are rare expansive processes made of mature lipomatous and angiomatous elements. They often have a benign character. Their etiology, pathogenesis remains uncertain, and it is a cause of spinal cord compression. The magnetic resonance imaging is the most important neuroradiological examination. Histological examination is the only examination to confirm the diagnosis. Surgery is the treatment of choice. METHODS A retrospective study of all patients operated on for a spinal epidural angiolipoma at the Department of Neurosurgery at the National Institute of Neurology of Tunis between January 2000 and December 2014 (15 years) was performed. The aim of this study is to describe the clinical, radiological, histological characteristics and the treatment of this tumor. RESULTS A total of nine patients were operated from January 01, 2000 to November 30, 2014. The average age of our patients was 51 years with ages that ranged from 29 to 65 with a male predominance. The period between onset of symptoms and diagnosis ranged from 24 months with an average 12 months. Posterior localization of the tumor was seen in all patients. Surgical resection was performed for all cases. The postoperative course has been satisfactory, with a complete recovery of neurological functions in all patients. CONCLUSIONS The spinal epidural angiolipomas is rare expansive process causing spinal cord compression. Treatment is exclusively surgical resection. The functional outcome of spinal epidural angiolipomas is particularly favorable with a complete neurological recovery is if the patient was quickly operated.
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Affiliation(s)
- Sofiene Bouali
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Nidhal Maatar
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Asma Bouhoula
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Khansa Abderrahmen
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Imed Ben Said
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Adnen Boubaker
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Jalel Kallel
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Hafedh Jemel
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
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Benvenutti-Regato M, De la Garza-Ramos R, Caro-Osorio E. Thoracic epidural spinal angiolipoma with coexisting lumbar spinal stenosis: Case report and review of the literature. Int J Spine Surg 2015; 9:67. [PMID: 26767159 PMCID: PMC4710163 DOI: 10.14444/2067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Spinal angiolipomas (SALs) are uncommon benign lesions that may present insidiously with back pain or acutely with weakness due to tumor bleeding/thrombosis. Given their rarity, these lesions are often overlooked in the differential diagnosis of epidural masses. The purpose of this article is to report the case of an epidural SAL and to conduct a literature review on the topic. METHODS A case report and review of the literature using the PubMed/Medline databases. All case reports and case series were reviewed up to June 2015. RESULTS A 65-year old female presented with neurogenic claudication and magnetic resonance imaging (MRI) revealed lumbar spinal stenosis. Following decompressive surgery, she experienced symptom resolution, but three months postoperatively she presented to the emergency department with acute paraparesis. A thoracic MRI revealed a lesion located between T8 and T10 causing severe spinal cord compression. Following emergent laminectomy and en bloc resection, the patient regained function and the lesion was diagnosed as SAL. Our literature review revealed 178 reported cases, with a female and thoracic predominance. The majority of patients underwent surgical treatment, achieving a gross total resection in most cases. Similarly, complete symptom resolution was the most common outcome. CONCLUSION Spinal angiolipomas are uncommon spinal tumors. However, they may be treated as any other space-occupying lesion, and surgical resection allows for complete symptom recovery in most patients.
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Affiliation(s)
- Mario Benvenutti-Regato
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Monterrey, México
- Neurology and Neurosurgery Institute, Centro Médico Hospital Zambrano Hellion, TecSalud, Monterrey, México
| | - Rafael De la Garza-Ramos
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Monterrey, México
- Neurology and Neurosurgery Institute, Centro Médico Hospital Zambrano Hellion, TecSalud, Monterrey, México
| | - Enrique Caro-Osorio
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Monterrey, México
- Neurology and Neurosurgery Institute, Centro Médico Hospital Zambrano Hellion, TecSalud, Monterrey, México
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Eap C, Bannwarth M, Jazeron JF, Kleber JC, Theret É, Duntze J, Litre CF. Spontaneous epidural hematoma due to cervico-thoracic angiolipoma. Neurochirurgie 2015; 61:398-400. [DOI: 10.1016/j.neuchi.2015.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 08/28/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
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16
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Sim K, Tsui A, Paldor I, Kaye AH, Gaillard F. Four cases of spinal epidural angiolipoma. J Clin Neurosci 2015; 25:134-9. [PMID: 26778809 DOI: 10.1016/j.jocn.2015.08.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/01/2015] [Accepted: 08/14/2015] [Indexed: 12/14/2022]
Abstract
Spinal angiolipomas are uncommon benign tumours composed of mature fatty tissue and abnormal vascular elements, most commonly found within the posterior spinal epidural space. Most tumours are located within the mid-thoracic spine; in contrast thoracolumbar junction and purely lumbar angiolipomas are rare. We report a case series of four spinal angiolipomas, including a thoracolumbar junction and a purely lumbar tumour.
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Affiliation(s)
- Kenneth Sim
- Department of Radiology, The Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia.
| | - Alpha Tsui
- Department of Pathology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Iddo Paldor
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Andrew H Kaye
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Frank Gaillard
- Department of Radiology, The Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia
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Abstract
Angiolipomas of the spine are rare benign tumors commonly presenting with compressive myelopathy. The present report describes a case of spinal angiolipoma with thoracic mediastinal extension in a 50-year-old woman. She presented with a long-standing history of mid-back pain with progressive lower extremities weakness. An MRI showed a heterogeneously enhancing mass located in the posterior epidural space of the thoracic spine with mediastinal extension. Histopathological examination demonstrated features consistent with spinal angiolipoma. This report emphasizes the diagnosis and therapeutic management options of infiltrating spinal angiolipomas.
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Affiliation(s)
- Mustafa M Nadi
- Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada. E-mail:
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18
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da Costa MDS, Paz DDA, Rodrigues TP, Gandolfi ACDC, Lamis FC, Stavale JN, Suriano IC, Cetl LDMN, Cavalheiro S. Hemorrhagic onset of spinal angiolipoma. J Neurosurg Spine 2014; 21:913-5. [PMID: 25303620 DOI: 10.3171/2014.9.spine131162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spinal angiolipomas are rare benign tumors that generally induce slow progressive cord compression. Here, the authors describe a case of sudden-onset palsy of the lower extremities caused by hemorrhagic spinal angiolipoma. An emergent laminectomy was performed to achieve total lesion removal. Follow-up examinations indicated neurological improvement and the absence of recurrence.
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19
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Ramdasi RV, Avinasha KM, Mahore A, Kawale J. Spinal angiolipoma manifesting with apoplexy. BMJ Case Rep 2014; 2014:bcr-2014-204379. [PMID: 24842366 DOI: 10.1136/bcr-2014-204379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a 58-year-old man presenting with acute paraplegia. MRI showed a haematoma within a well-defined epidural lesion at C7-D1. Intraoperatively, organised epidural haematoma surrounded by tumour tissue was found. The final histopathology report was angiolipoma. The patient had dramatic recovery. Angiolipomas should be considered in the differential diagnosis of acute paraplegia when imaging shows well-circumscribed haematoma.
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Affiliation(s)
| | - K M Avinasha
- Department of Neurosurgery, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Amit Mahore
- Department of Neurosurgery, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Juhi Kawale
- Department of Medicine, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
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20
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Bovier EG, Gardino E, Chemes LN, Nogueira F, Romero VD. Acute paraplegia by spinal angiolipoma. Case report and literature review. COLUNA/COLUMNA 2014. [DOI: 10.1590/s1808-18512014130200403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spinal angiolipoma is an uncommon form of benign tumor. There are 142 reported cases and only one of acute paraplegia. We describe a case of a 39 year old male with acute spinal paraplegia angiolipoma in T4-T5 with surgical resolution three weeks after the onset of the neurological syndrome. Postoperative neurologic recovery was complete. The angiolipoma consists of mature fat cells and abnormal blood vessels. There are 2 types: non-infiltrating and infiltrating. Its clinical course is slow and progressive, it can be accelerated by vascular phenomena, intratumoral abscess, and pregnancy. There is just one report of spontaneous intratumoral hemorrhage and acute paraplegia, coinciding with our case. There is no consensus as to treatment, and release and complete resection are suggested, as it is a disease with good prognosis. Angiolipoma spinal epidural is a rare form of benign tumor, and the treatment of this pathology continues to be release and resection of the tumor, with a favorable prognosis, despite the delay in surgery, as in the case reported. Intratumoral bleeding should be considered a cause of acute spinal compression syndrome, as ocurred in our patient.
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21
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Thoracolumbar spinal angiolipoma demonstrating high signal on STIR imaging: a case report and review of the literature. Spine J 2013; 13:e1-5. [PMID: 24071036 DOI: 10.1016/j.spinee.2013.06.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 02/05/2013] [Accepted: 06/14/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Angiolipomas are rare benign tumors, accounting for 0.14% to 1.2% of all tumors of the spinal axis with vascular and fatty histological features. Spinal angiolipoma (SAL) is most commonly found in the thoracic region and has high signal on contrast enhanced fat-saturated T1-weighted imaging. Although the international literature is extensive, there are few cases reported in United States. OBJECTIVE To present a case of SAL located in the thoracolumbar region without high signal on contrast enhanced fat-saturated T1-weighted imaging and to review previously reported cases. STUDY DESIGN/METHODS Case report and review the literature. RESULTS Magnetic resonance imaging obtained in a 68-year-old man with a long history of lumbago showed a heterogeneous mass (T10-L1) hyperintense on T1-weighted imaging but not enhancing on suppression fat sequences, suggesting epidural hematoma. Surgical excision of the lesion was performed, and SAL was diagnosed and confirmed by pathology. The patient became asymptomatic. CONCLUSIONS The predominance of either vascular or fatty components inside the tumor might alter the expected results on magnetic resonance imaging with suppression fat sequences.
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22
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Hu S, Hu CH, Hu XY, Wang XM, Dai H, Fang XM, Cui L. MRI features of spinal epidural angiolipomas. Korean J Radiol 2013; 14:810-7. [PMID: 24043978 PMCID: PMC3772264 DOI: 10.3348/kjr.2013.14.5.810] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 06/11/2013] [Indexed: 11/18/2022] Open
Abstract
Objective To describe the MRI findings in ten patients of spinal epidural angiolipoma for differentiated diagnosis presurgery. Materials and Methods Ten surgically proved cases of spinal epidural angiolipomas were retrospectively reviewed, and the lesion was classified according to the MR findings. Results Ten tumors were located in the superior (n = 4), middle (n = 2), or inferior (n = 4) thoracic level. The mass, with the spindle shape, was located in the posterior epidural space and extended parallel to the long axis of the spine. All lesions contained a fat and vascular element. The vascular content, correlating with the presence of hypointense regions on T1-weighted imaging (T1WI) and hyperintense signals on T2-weighted imaging, had marked enhancement. However, there were no flow void signs on MR images. All tumors were divided into two types based on the MR features. In type 1 (n = 3), the mass was predominantly composed of lipomatous tissue (> 50%) and contained only a few small angiomatous regions, which had a trabeculated or mottled appear. In type 2 (n = 7), the mass, however, was predominantly composed of vascular components (> 50%), which presented as large foci in the center of the mass. Conclusion Most spinal epidural angiolipomas exhibit hyperintensity on T1WI while the hypointense region on the noncontrast T1WI indicates to be vascular, which manifests an obvious enhancement with gadolinium administration.
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Affiliation(s)
- Su Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Jiangsu 215006, China
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23
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Chotai S, Hur JS, Moon HJ, Kwon TH, Park YK, Kim JH. Spinal angiolipoma--case report. Neurol Med Chir (Tokyo) 2013; 51:539-42. [PMID: 21785253 DOI: 10.2176/nmc.51.539] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 69-year-old male presented with a rare spinal angiolipoma manifesting as history of back pain, and numbness in both lower limbs, which progressed over a period of 5 years. Total T10-T12 laminectomy was performed and the tumor was removed en bloc. The symptoms gradually improved postoperatively. Spinal angiolipoma is an uncommon benign extradural tumor of spine, which accounts for 0.14-1.2% of all spinal tumors and is a rare cause of spinal cord compression. Recognition of this entity is crucial as a benign and curable cause of paraplegia and back pain.
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Affiliation(s)
- Silky Chotai
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, ROK
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24
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Meng J, Du Y, Yang HF, Hu FB, Huang YY, Li B, Zee CS. Thoracic epidural angiolipoma: A case report and review of the literature. World J Radiol 2013; 5:187-192. [PMID: 23671756 PMCID: PMC3647212 DOI: 10.4329/wjr.v5.i4.187] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 12/18/2012] [Accepted: 01/21/2013] [Indexed: 02/06/2023] Open
Abstract
Angiolipoma of the spine is a benign neoplasm consisting of both mature fatty tissue and abnormal vascular elements, and usually presents with a slow progressive clinical course. Our patient presented with bilateral lower extremity weakness and chest-back numbness. Physical examination revealed adipose elements superficial hypesthesia below the T5 level and analgesia below the T6 level. Magnetic resonance imaging (MRI) scan showed an avidly and heterogeneously enhancing mass which was located in the posterior epidural space. Compression of the thoracic cord by the fusiform mass was seen between T3-T4. During the operation, a flesh pink vascular mass (4.7 cm × 1.0 cm × 1.0 cm) with obscure margin and strong but pliable texture was found in the posterior epidural space extending from T3 to T4. There was no infiltration of the dura or the adjacent bony spine. Histopathological study of the surgical specimen showed a typical angiolipoma. We review the previously documented cases of spinal extradural angiolipomas performed with MRI.
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25
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Ghanta RK, Koti K, Dandamudi S. Spinal epidural angiolipoma: A rare cause of spinal cord compression. J Neurosci Rural Pract 2012. [PMID: 23188989 PMCID: PMC3505328 DOI: 10.4103/0976-3147.102617] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Spinal epidural angiolipomas are rare, benign tumors composed of mature lipocytes admixed with abnormal blood vessels. Only 128 cases of spinal epidural angiolipomas have been reported in literature till now. Spinal angiolipomas are predominantly located in the mid-thoracic region. We report a case of dorsal epidural angiolipoma in a 56-year-old male who presented with paraparesis and was diagnosed to have D4-5 epidural angiolipoma. Total surgical excision of the epidural angiolipoma was done and his paraparesis gradually improved.
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Affiliation(s)
- Rajesh K Ghanta
- Department of Neurosurgery, Suraksha Hospital, Vijayawada, India
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Treatment of spinal epidural compression due to hematological malignancies: a single institution's retrospective experience. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22:548-55. [PMID: 23143094 DOI: 10.1007/s00586-012-2562-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 09/05/2012] [Accepted: 10/28/2012] [Indexed: 12/31/2022]
Abstract
PURPOSE To analyze the neurological and mechanical outcomes in 44 consecutive patients treated for a hematological malignancy with epidural localization to assess the place of surgery in the treatment of this pathology. METHODS Clinical records, CT and MRI scans of 44 patients with epidural localizations of multiple myeloma or lymphoma treated between 1990 and 2005 were analyzed retrospectively. Neurological status, epiduritis and osteolysis volumes, vertebral collapse, and spinal canal compromise were assessed. The neurological outcome was graded according to Frankel and the mechanical outcome was evaluated on the rate of vertebral collapse. RESULTS Surgery was performed in 11 patients (25 %) for neurological (n = 9) or mechanical (n = 2) reasons. In five cases, a concomitant biopsy was performed because the etiology of the epiduritis was unknown. Fifteen patients (34.1 %) presented with a neurological deficit secondary to an acute vertebral collapse (n = 4), an epiduritis (n = 7), or both (n = 4). Whatever the treatment (surgical or not), a complete recovery (Frankel E) occurred in 14/15 (93.3 %) after a mean delay of 12 weeks (range 2-24 weeks). During the follow-up, seven collapses occurred. We estimated that a threshold of 30 % of osteolysis was associated with a significant risk of vertebral collapse (P = 0.005). CONCLUSIONS Hematological malignancies with epidural localization must be treated first medically, even in patients with neurological symptoms. Surgery should be considered only in the cases of acute vertebral collapse, medical treatment failure, or to prevent acute collapse in patients with vertebral osteolysis of more than 30 %.
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27
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Affiliation(s)
- Ali Akhaddar
- Department of Neurosurgery, Mohammed V Military Teaching Hospital, Morocco.
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28
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Tsutsumi S, Nonaka Y, Abe Y, Yasumoto Y, Ito M. Spinal angiolipoma in a pregnant woman presenting with acute epidural hemorrhage. J Clin Neurosci 2011; 18:849-51. [DOI: 10.1016/j.jocn.2010.09.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 09/22/2010] [Indexed: 01/15/2023]
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Sankaran V, Carey M, Shad A. Traumatic bleeding of spinal angiolipoma presenting with subacute paraparesis--a case report and histopathological aspects. Br J Neurosurg 2010; 24:714-5. [PMID: 20874452 DOI: 10.3109/02688697.2010.520760] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Spinal angiolipoma is a rare benign tumour. It usually presents as a slowly progressive compressive lesion. Bleeding in this tumour is extremely rare and is spontaneous and acute. This is the first reported case of post-traumatic bleeding from a spinal angiolipoma, who developed subacute progressive paraparesis. The pathological definition of this rare entity is not well established. Histologically it is distinct from cutaneous angiolipoma.
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Affiliation(s)
- Vijay Sankaran
- Department of Neurosurgery, University Hospital Coventry and Warwickshire, Coventry, UK.
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31
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Akhaddar A, Oukabli M, En-Nouali H, Boucetta M. Acute postpartum paraplegia caused by spinal extradural capillary hemangioma. Int J Gynaecol Obstet 2010; 108:75-6. [PMID: 19782976 DOI: 10.1016/j.ijgo.2009.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 07/28/2009] [Accepted: 08/24/2009] [Indexed: 02/04/2023]
Affiliation(s)
- Ali Akhaddar
- Department of Neurosurgery, Mohammed V Military Teaching Hospital, University of King Mohammed V-Souissi, Rabat, Morocco.
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