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Ruella M, Caffaratti G, Saenz A, Villamil F, Mormandi R, Cervio A. Intradural extramedullary tumors. Retrospective cohort study assessing prognostic factors for functional outcome in adult patients. NEUROCIRUGIA (ENGLISH EDITION) 2023; 34:256-267. [PMID: 37661156 DOI: 10.1016/j.neucie.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/30/2022] [Indexed: 09/05/2023]
Abstract
OBJECTIVE The purpose of this study is to analyze a series of patients with intradural extramedullary tumors (IDEM) and assess factors that may modify or determine the final long term outcome and management. MATERIALS AND METHODS Single Center, retrospective study of a series of surgical patients with IDEM lesions from our Institution operated between 2010 and 2021. Patients with less than 6 months of follow up were excluded. Several preoperative demographics, clinical, imaging and surgical features, as well as histopathology, recurrence and adjuvancy were assessed. Patients' final clinical outcome was categorized using the McCormick scale. RESULTS A total of 203 patients with a mean follow-up of 30.50 months (range 6-130) were included. 57.64% of the analyzed population was female and the mean age was 50.51 years. The most frequent location of the tumors was dorsal (34.98%) followed by the lumbar region (32.02%). Total resection was achieved in 84.24% of cases, and the most frequent histopathology was Schwannoma (36.45%), followed by Meningioma (30.05%). Pain was the most usual initial symptom (63.05%). In our analysis, functional outcome after surgery was associated with statistical significance with preoperative McCormick grade, tumor type, EOR and postoperative complications such as hematoma and sphincter involvement. CONCLUSION The management of these lesions depends on many factors. It is worthy of mention that clinical presentation, EOR, histopathology and postoperative complications have shown significant prognostic value for the final outcome. Early treatment with the intention of achieving GTR when possible, using carefully tailored approaches, should be considered before the onset of significant symptoms.
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Affiliation(s)
- Mauro Ruella
- Department of Neurosurgery, Fleni, Montañeses 2325, CP1428 Buenos Aires, Argentina.
| | - Guido Caffaratti
- Department of Neurosurgery, Fleni, Montañeses 2325, CP1428 Buenos Aires, Argentina
| | - Amparo Saenz
- Department of Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
| | - Facundo Villamil
- Department of Neurosurgery, Fleni, Montañeses 2325, CP1428 Buenos Aires, Argentina
| | - Rubén Mormandi
- Department of Neurosurgery, Fleni, Montañeses 2325, CP1428 Buenos Aires, Argentina
| | - Andrés Cervio
- Department of Neurosurgery, Fleni, Montañeses 2325, CP1428 Buenos Aires, Argentina
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Intradural extramedullary tumors. Retrospective cohort study assessing prognostic factors for functional outcome in adult patients. Neurocirugia (Astur) 2023. [DOI: 10.1016/j.neucir.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Amadasu E, Panther E, Lucke-Wold B. Characterization and Treatment of Spinal Tumors. INTENSIVE CARE RESEARCH 2022; 2:76-95. [PMID: 36741203 PMCID: PMC9893847 DOI: 10.1007/s44231-022-00014-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/03/2022] [Indexed: 02/07/2023]
Abstract
The prevalence of spinal tumors is rare in comparison to brain tumors which encompass most central nervous system tumors. Tumors of the spine can be divided into primary and metastatic tumors with the latter being the most common presentation. Primary tumors are subdivided based on their location on the spinal column and in the spinal cord into intramedullary, intradural extramedullary, and primary bone tumors. Back pain is a common presentation in spine cancer patients; however, other radicular pain may be present. Magnetic resonance imaging (MRI) is the imaging modality of choice for intradural extramedullary and intramedullary tumors. Plain radiographs are used in the initial diagnosis of primary bone tumors while Computed tomography (CT) and MRI may often be necessary for further characterization. Complete surgical resection is the treatment of choice for spinal tumors and may be curative for well circumscribed lesions. However, intralesional resection along with adjuvant radiation and chemotherapy can be indicated for patients that would experience increased morbidity from damage to nearby neurological structures caused by resection with wide margins. Even with the current treatment options, the prognosis for aggressive spinal cancer remains poor. Advances in novel treatments including molecular targeting, immunotherapy and stem cell therapy provide the potential for greater control of malignant and metastatic tumors of the spine.
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Affiliation(s)
- Efosa Amadasu
- School of Medicine, University of South Florida, Tampa, USA
| | - Eric Panther
- Department of Neurosurgery, University of Florida, Gainesville, USA
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Hanna SS, Jewell R, Anker CJ, DeWitt JC, Tranmer B, Thomas AA. Clinical Reasoning: A 67-Year-Old Woman With Abdominal Pain, Constipation, and Urinary Retention. Neurology 2022; 99:117-122. [PMID: 35523586 DOI: 10.1212/wnl.0000000000200748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/04/2022] [Indexed: 11/15/2022] Open
Abstract
Meningeal melanocytomas are extremely rare, pigmented tumors of the CNS. They generally carry a favorable prognosis, although recurrence and transformation into the more aggressive malignant melanoma have been reported. We present a case of a patient who reported constipation and abdominal pain around the umbilicus, which progressed into cord compression with lower extremity weakness and gait instability. Spinal MRI revealed a tumor at the level of T11, and she underwent gross total resection of the mass. Pathology demonstrated a meningeal melanocytoma with intermediate features. She received postoperative radiation therapy and had stable disease for 3 years, at which time she developed new weakness and drop metastases. This case represents a rare presentation of a rare disease, in which a spinal cord tumor presented with constipation and abdominal distress. Intradural extramedullary tumors of the thoracic spine are most commonly nerve sheath tumors or meningiomas, but rare entities such as melanocytomas can present in this location; even more rarely, these tumors can have an aggressive course with delayed recurrence.
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Affiliation(s)
- Sebastian S Hanna
- From the University of Vermont Larner College of Medicine (S.S.H., R.J., C.J.A., J.C.D., B.T., A.A.T.), Burlington; Department of Surgery, Division of Neurosurgery (R.J., B.T.); Department of Radiology, Division of Radiation Oncology (C.J.A.); Department of Pathology and Laboratory Medicine (J.C.D.); and Department of Neurological Sciences (A.A.T.).
| | - Ryan Jewell
- From the University of Vermont Larner College of Medicine (S.S.H., R.J., C.J.A., J.C.D., B.T., A.A.T.), Burlington; Department of Surgery, Division of Neurosurgery (R.J., B.T.); Department of Radiology, Division of Radiation Oncology (C.J.A.); Department of Pathology and Laboratory Medicine (J.C.D.); and Department of Neurological Sciences (A.A.T.)
| | - Christopher J Anker
- From the University of Vermont Larner College of Medicine (S.S.H., R.J., C.J.A., J.C.D., B.T., A.A.T.), Burlington; Department of Surgery, Division of Neurosurgery (R.J., B.T.); Department of Radiology, Division of Radiation Oncology (C.J.A.); Department of Pathology and Laboratory Medicine (J.C.D.); and Department of Neurological Sciences (A.A.T.)
| | - John C DeWitt
- From the University of Vermont Larner College of Medicine (S.S.H., R.J., C.J.A., J.C.D., B.T., A.A.T.), Burlington; Department of Surgery, Division of Neurosurgery (R.J., B.T.); Department of Radiology, Division of Radiation Oncology (C.J.A.); Department of Pathology and Laboratory Medicine (J.C.D.); and Department of Neurological Sciences (A.A.T.)
| | - Bruce Tranmer
- From the University of Vermont Larner College of Medicine (S.S.H., R.J., C.J.A., J.C.D., B.T., A.A.T.), Burlington; Department of Surgery, Division of Neurosurgery (R.J., B.T.); Department of Radiology, Division of Radiation Oncology (C.J.A.); Department of Pathology and Laboratory Medicine (J.C.D.); and Department of Neurological Sciences (A.A.T.)
| | - Alissa A Thomas
- From the University of Vermont Larner College of Medicine (S.S.H., R.J., C.J.A., J.C.D., B.T., A.A.T.), Burlington; Department of Surgery, Division of Neurosurgery (R.J., B.T.); Department of Radiology, Division of Radiation Oncology (C.J.A.); Department of Pathology and Laboratory Medicine (J.C.D.); and Department of Neurological Sciences (A.A.T.)
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Ursini T, Rodari P, Badona Monteiro G, Barresi V, Cicciò C, Moscolo F, Tamarozzi F. Large multicystic spinal lesion in a young African migrant: a problem of differential diagnosis. BMJ Case Rep 2021; 14:14/7/e242690. [PMID: 34321263 PMCID: PMC8319961 DOI: 10.1136/bcr-2021-242690] [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: 11/09/2022] Open
Abstract
We describe a rare case of large, fully cystic spinal schwannoma in a young adult from The Gambia. The initial clinical suspicion was spinal cystic echinococcosis. He came to our attention reporting progressive walking impairment and neurological symptoms in the lower limbs. An expansive lesion extending from L2 to S1 was shown by imaging (ie, CT scan and MRI). Differential diagnoses included aneurysmal bone cyst and spinal tuberculosis and abscess; the initial suggested diagnosis of spinal cystic echinococcosis was discarded based on contrast enhancement results. The final diagnosis of cystic schwannoma was obtained by histopathology of the excised mass. Cystic spinal lesions are rare and their differential diagnosis is challenging. Awareness of autochthonous and tropical infectious diseases is important, especially in countries experiencing consistent migration flow; however, it must be kept in mind that migrants may also present with ‘non-tropical’ pathologies.
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Affiliation(s)
- Tamara Ursini
- Department of Infectious and Tropical Diseases and Microbiology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Paola Rodari
- Department of Infectious and Tropical Diseases and Microbiology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Geraldo Badona Monteiro
- Department of Infectious and Tropical Diseases and Microbiology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Valeria Barresi
- Department of Diagnostics and Public Health, University of Verona, Verona, Veneto, Italy
| | - Carmelo Cicciò
- Department of Diagnostic Imaging and Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Fabio Moscolo
- Institute of Neurosurgery, University of Verona and City Hospital, Verona, Italy
| | - Francesca Tamarozzi
- Department of Infectious and Tropical Diseases and Microbiology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
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Sudhakar T, Désir LL, Ellis JA. Tarlov Cyst Rupture and Intradural Hemorrhage Mimicking Intraspinal Carcinomatosis. Cureus 2021; 13:e15423. [PMID: 34249569 PMCID: PMC8253477 DOI: 10.7759/cureus.15423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 11/05/2022] Open
Abstract
Lumbosacral Tarlov cysts (TCs) have rarely been seen to rupture. Here, we report an unusual presentation of a ruptured TC with intraspinal hemorrhage mimicking carcinomatosis. Pathological diagnosis was obtained using percutaneous biopsy. A conservative approach was utilized and an excellent outcome was achieved. Thus, in cases such as this, a ruptured hemorrhagic TC should be on the differential diagnosis to drive appropriate clinical management decisions.
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Affiliation(s)
- Tejaswi Sudhakar
- Neurosurgery, Lenox Hill Hospital Northwell Health, New York, USA
| | - Likowsky L Désir
- Medicine, City University of New York School of Medicine, New York, USA.,Neurosurgery, Lenox Hill Hospital Northwell Health, New York, USA
| | - Jason A Ellis
- Neurosurgery, Lenox Hill Hospital Northwell Health, New York, USA
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Ampie L, Snyder MH, Dominguez JF, Buchholz A, Yen CP, Shaffrey ME, Syed HR, Shaffrey CI, Smith JS. Clinical characteristics and long-term outcomes for patients who undergo cytoreductive surgery for thoracic meningiomas: a retrospective analysis. Neurosurg Focus 2021; 50:E18. [PMID: 33932925 DOI: 10.3171/2021.2.focus20977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Primary spinal meningiomas represent a rare indolent neoplasm usually situated in the intradural-extramedullary compartment. They have a predilection for afflicting the thoracic spine and most frequently present with sensory and/or motor symptoms. Resection is the first-line treatment for symptomatic tumors, whereas other clinical factors will determine the need for adjuvant therapy. In this study, the authors aimed to elucidate clinical presentation, functional outcomes, and long-term outcomes in this population in order to better equip clinicians with the tools to counsel their patients. METHODS This is a retrospective analysis of patients treated at the authors' institution between 1998 and 2018. All patients with thoracic meningiomas who underwent resection and completed at least one follow-up appointment were included. Multiple preoperative clinical variables, hospitalization details, and long-term outcomes were collected for the cohort. RESULTS Forty-six patients who underwent resection for thoracic meningiomas were included. The average age of the cohort was 59 years, and the median follow-up was 53 months. Persistent sensory and motor symptoms were present in 29 patients (63%). Fifteen lesions were ventrally positioned. There were 43 WHO grade I tumors, 2 WHO grade II tumors, and 1 WHO grade III tumor; the grade III tumor was the only case of recurrence. The median length of hospitalization was 4 days. Seventeen patients (37%) were discharged to rehabilitation facilities. Thirty patients (65.2%) experienced resolution or improvement of symptoms, and there were no deaths within 30 days of surgery. Only 1 patient developed painful kyphosis and was managed medically. Ventral tumor position, new postoperative deficits, and length of stay did not correlate with disposition to a facility. Age, ventral position, blood loss, and increasing WHO grade did not correlate with length of stay. CONCLUSIONS Outcomes are overall favorable for patients who undergo resection of thoracic meningiomas. Symptomatic patients often experience improvement, and patients generally do not require significant future operations. Tumors located ventrally, while anatomically challenging, do not necessarily herald a significantly worse prognosis or limit the extent of resection.
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Affiliation(s)
- Leonel Ampie
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.,2Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - M Harrison Snyder
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Jose F Dominguez
- 3Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, New York; and
| | - Avery Buchholz
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Chun-Po Yen
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Mark E Shaffrey
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Hasan R Syed
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | | | - Justin S Smith
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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Shields LBE, Harpring JE, Highfield HA, Zhang YP, Shields CB. Intradural, extramedullary hemangioblastoma at the level of the conus medullaris: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2145. [PMID: 35855219 PMCID: PMC9245781 DOI: 10.3171/case2145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hemangioblastomas are rare, slow-growing, and highly vascularized tumors that typically occur in the cerebellum and spinal cord. The cervical and thoracic regions are the most common spinal sites, and the tumors are usually intramedullary. OBSERVATIONS The authors report the case of a man whose chest computed tomography performed for managing coronavirus disease 2019 incidentally revealed an enhancing area in the spinal canal at T12–L1. The patient reported low back pain as well as leg numbness and tingling. Magnetic resonance imaging of the lumbar region with and without gadolinium contrast demonstrated an intradural, extramedullary lesion with displacement of the conus medullaris. The differential diagnosis included a schwannoma and myxopapillary ependymoma. Bilateral T12–L1 laminectomies were performed with resection of the mass. The general pathologist rendered the frozen section diagnosis of a spindle cell neoplasm, suggesting the differential diagnosis of schwannoma or myxopapillary ependymoma. Immunohistochemistry was positive for inhibin, GFAP, reticulin, CD31, SOX-10, S100, and EMA. A World Health Organization grade 1 hemangioblastoma was confirmed. LESSONS Spinal surgeons should be cognizant of the presenting symptoms and differential diagnosis of hemangioblastomas at the level of the conus medullaris, especially when the tumor is diagnosed incidentally. Additional investigations should be performed to determine whether von Hippel-Lindau syndrome is associated with the hemangioblastoma, as this combination portends a different clinical presentation, multiple tumor locations, and tumor recurrence following resection.
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Affiliation(s)
| | | | | | | | - Christopher B. Shields
- Norton Neuroscience Institute and
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
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Toll BJ, Samdani AF, Pahys JM, Franco A, Yezdani SG, Hwang SW. Single-Staged Management of Pediatric Neuropathic Scoliosis with Intradural-Extramedullary Schwannoma and Improvement in Intraoperative Neuromonitoring: A Case Report. JBJS Case Connect 2021; 10:e0352. [PMID: 32649096 DOI: 10.2106/jbjs.cc.19.00352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 16-year-old girl with lumbar prominence presented to our outpatient clinic complaining of sporadic back pain without paresthesia. Radiographic investigation revealed a 68° left thoracolumbar curve with the apex at L1. Preoperative magnetic resonance imaging identified a mass at T10-11, subsequently confirmed by pathology as a schwannoma. She was treated surgically with resection and posterior spinal fusion in a single-staged procedure under neuromonitoring guidance. Intraoperative improvement in motor evoked potentials after resection informed the decision to perform simultaneous deformity correction. CONCLUSION We discuss the unusual coincidence of a schwannoma with scoliosis and our management algorithm based on operative changes in neuromonitoring.
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Affiliation(s)
- Brandon J Toll
- 1Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania 2Division of Intraoperative Neuromonitoring, SpecialtyCare, Brentwood, Tennessee
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Functional Outcomes and Temporal Profile of Recovery in Patients with Intradural Extramedullary Spinal Cord Tumors with Poor Nurick Grade. World Neurosurg 2020; 146:e691-e700. [PMID: 33171318 DOI: 10.1016/j.wneu.2020.10.168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with spinal intradural extramedullary (IDEM) tumors usually have a good functional outcome after tumor excision. However, the literature is sparse on the functional outcome in patients with poor Nurick grade (NG 4 and 5). METHODS A retrospective review of 81 patients with IDEM tumors presenting with a poor NG was performed to determine postoperative functional outcome and the temporal pattern of recovery. The following risk factors were analyzed: preoperative NG, duration of symptoms, tumor location, peritumoral edema, presence of syrinx, and tumor type. RESULTS Neurologic function started recovering soon after surgery, with >80% of the patients improving by ≥1 grade at the end of 1 week after surgery. Of the 66 patients available for follow-up of >6 months after surgery, 63 (95.5%) improved to NG 0-2 and 51 (77.2%) became asymptomatic (NG 0 or 1). Three patients had a poor functional outcome on follow-up of >31 months; 2 had improved from NG 5 to NG 4, whereas 1 patient continued to be in NG 4. Factors associated with a poor outcome were an upper thoracic location (P = 0.025) and presence of a syrinx (P = 0.004). None of the patients had bladder dysfunction at follow-up of >6 months. CONCLUSIONS After excision of spinal IDEM tumors, in patients who present with a poor neurologic function (NG 4 and 5), good functional outcome (NG 0-2) can be expected in >95% of patients. No recovery can be anticipated beyond 1 year after surgery.
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Saway BF, Fayed I, Dowlati E, Derakhshandeh R, Sandhu FA. Initial Report of an Intradural Extramedullary Metastasis of a Pancreatic Neuroendocrine Tumor to the Cervical Spine: A Case Report and Review of the Literature. World Neurosurg 2020; 139:355-360. [PMID: 32344144 DOI: 10.1016/j.wneu.2020.04.120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pancreatic neuroendocrine tumors (pNETs) are known to frequently metastasize to the liver and lymphatics; however, metastasis to the spine is exceedingly rare. We report the first case of an intradural, extramedullary pNET metastasis to the upper cervical spine. CASE DESCRIPTION A 75-year-old Hispanic male patient with history of stage IV pNET with metastasis to the liver and lymph nodes and new-onset lymphadenopathy seen on CT of the chest was found on positron emission tomography scan to have a lesion in the cervical spine. The patient was neurologically intact on physical examination, yet given the patient's medical history, magnetic resonance imaging of the cervical spine was performed, revealing a right-sided intradural, extramedullary mass at the C1-C2 level with associated mass effect on the spinal cord, likely representing a schwannoma. Due to the tumor size, mass effect, and the need for definitive tissue diagnosis, a partial C1-C2 laminectomy with intradural resection of the tumor was performed. The histology was consistent with the patient's known pNET. CONCLUSIONS As treatment for pNETs has evolved, there has been a surge in unique presentations of systemic well-differentiated pNETs being reported. It is vital that patients diagnosed with pNET be monitored for metastases, and when discovered, treated promptly.
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Affiliation(s)
- Brian F Saway
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Islam Fayed
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Ehsan Dowlati
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Faheem A Sandhu
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
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12
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Romano N, Castaldi A. What's around the spinal cord? Imaging features of extramedullary diseases. Clin Imaging 2020; 60:109-122. [DOI: 10.1016/j.clinimag.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/31/2019] [Accepted: 12/04/2019] [Indexed: 01/31/2023]
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13
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Yamaguchi S, Menezes AH, Shimizu K, Woodroffe RW, Helland LC, Hitchon PW, Howard MA. Differences and characteristics of symptoms by tumor location, size, and degree of spinal cord compression: a retrospective study on 53 surgically treated, symptomatic spinal meningiomas. J Neurosurg Spine 2020; 32:931-940. [PMID: 32005026 DOI: 10.3171/2019.12.spine191237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/02/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The differences in symptoms of spinal meningiomas have rarely been discussed from the perspective of tumor characteristics. The main purpose of this paper was to define the differences, if any, in symptoms in patients with spinal meningiomas with respect to tumor size, location, and degree of spinal cord compression. The authors also sought the threshold of spinal cord compression that causes motor weakness. METHODS The authors conducted a retrospective study of 53 cases of spinal meningiomas that were surgically treated from 2013 to 2018. Symptoms related to the tumor were classified as motor weakness, sensory disturbance, pain, and bowel/bladder dysfunction. Based on MR images, tumor location was classified by spinal level and by its attachment to the dura mater. Tumor dimensions were also measured. Occupation ratios of the tumors to the spinal canal and degree of spinal cord flattening were sought from the axial MR images that showed the highest degree of spinal cord compression. RESULTS Motor weakness and sensory disturbance were significantly more common in thoracic spine meningiomas than in cervical spine meningiomas (p < 0.001 and p = 0.013, respectively), while pain was more common in meningiomas at the craniovertebral junction (p < 0.001). The attachment, height, width, depth, and volume of the tumor showed no significant difference irrespective of the presence or absence of each symptom. In cases of motor weakness and sensory disturbance, occupation ratios and spinal cord flattening ratios were significantly larger. However, these ratios were significantly smaller in the presence of pain. Multivariate logistic regression analysis revealed that occupation ratio independently contributed to motor weakness (OR 1.14, p = 0.035) and pain (OR 0.925, p = 0.034). Receiver operating characteristic curve analysis suggested that occupation ratio with a value of 63.678% is the threshold for the tumor to cause motor weakness. CONCLUSIONS The study showed the difference in clinical presentation of spinal meningiomas by spinal level, occupation ratio, and spinal cord flattening ratio. An occupation ratio of approximately 64% could be utilized as the threshold value of tumor growth to cause motor weakness. Tumor growth in the cervical spine might cause pain symptoms before causing motor weakness. The relationship between the tumor and its symptomatology should be discussed with respect to tumor size relative to the surrounding spinal canal.
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Affiliation(s)
- Satoshi Yamaguchi
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Arnold H Menezes
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Kiyoharu Shimizu
- 2Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Royce W Woodroffe
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Logan C Helland
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Patrick W Hitchon
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Matthew A Howard
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
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Sahu PK, Shankar Ganesh G. Physiotherapeutic management of a patient with spinal Schwannoma: A case report. J Bodyw Mov Ther 2020; 24:56-62. [PMID: 31987563 DOI: 10.1016/j.jbmt.2019.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Tumors are generally considered as red flags to manual therapy. The purpose of this report is to describe the clinical course of a patient diagnosed with spinal Schwannoma at L2-L3 level, who was referred to physiotherapy (PT) for the treatment of low back pain radiating to the left lower limb. CASE DESCRIPTION A 30-year old man previously diagnosed with L2-L3 Schwannoma was referred for physiotherapy for the treatment of radiating pain. The patient had not responded favorably to symptomatic management. As the patient's history and physical examination were consistent with a mechanical dysfunction, it was decided to manage the patient along similar lines. The patient was treated with McKenzie extension and central postero-anterior mobilization over T4-T6 vertebrae. This intervention was followed up with strengthening and aerobic exercises. RESULTS The outcomes were measured by the numerical rating scale (NRS), Oswestry Disability Index (ODI) and the Global rate of Change (GRC) scale. The patient responded well to McKenzie extension exercises and Thoracic mobilization. The NRS (7 at rest; 10 on activity) at the time of referral reduced to (2 on activity) at the time of discharge. The outcomes were maintained after 7 months. CONCLUSION This case suggests that there is a need to undertake a detailed musculoskeletal examination and mobilization may be safely performed in patients diagnosed with spinal schwannomas. An individualized tailored approach may be beneficial in these patients.
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Affiliation(s)
- Pradeep Kumar Sahu
- Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - G Shankar Ganesh
- Composite Regional Centre for Skill Development, Rehabilitation and Empowerment of Persons with Disabilities, Lucknow, Uttar Pradesh, India.
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Chang KW, Noh SH, Park JY, Cho YE, Chin DK. Retrospective Study on Accuracy of Intraoperative Frozen Section Biopsy in Spinal Tumors. World Neurosurg 2019; 129:e152-e157. [PMID: 31108252 DOI: 10.1016/j.wneu.2019.05.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Histologic types and grades are critical in the diagnosis and treatment of spinal tumors. Intraoperative frozen section is a fast and easy method in confirming pathologic diagnosis during the operation. This study was undertaken to reveal the accuracy of intraoperative frozen section biopsy in order to make proper treatment plans. METHODS This retrospective study concerned patients who underwent spinal tumor surgeries from 1 January, 2012 to 31 December, 2016. Frozen section biopsy and permanent biopsy were compared, and cases that had differences were counted. RESULTS Thirty-seven cases out of 324 patients had discrepancies (11.4%). In discrepant cases 11 cases were ependymoma (29.7%) and 6 cases were schwannoma (16.2%). Among 34 patients who were finally diagnosed with an ependymoma, 11 cases had discrepancies, which was the highest mismatch rate among tumor final pathologic types. By frozen biopsy, astrocytoma (n = 5) and ependymoma (n = 5) turned out to be the most discrepant pathologic types and 16 frozen section biopsy cases were "null." Frozen biopsy astrocytoma (n = 5) mostly turned out to be ependymoma in 4 cases. CONCLUSIONS Pathologic findings from frozen biopsy for spinal cord tumors could not be corresponded to final diagnosis, especially when the results of frozen biopsy were ependymoma or astrocytoma. Therefore careful decision making for treatment plans is required.
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Affiliation(s)
- Kyung Won Chang
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hyun Noh
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Yoon Park
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Eun Cho
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Kyu Chin
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea.
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Kalová K, Boberová K, Přichystalová R, Nováček J, Jarošová I, Zikmund T, Kaiser J, Kyselicová K, Šebest L, Baldovič M, Frtús A, Sikora M, Allentoft ME. Serious chronic disease of the cervical spine and trauma in a young female from the middle ages (Czech Republic). INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2019; 24:185-196. [PMID: 30497062 DOI: 10.1016/j.ijpp.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 06/09/2023]
Abstract
The skeletal remains of the young female (20-24 years) from Grave JP/106, discovered in the Southern Suburb of the Břeclav - Pohansko Stronghold (Early Middle Ages, 9th century-beginning of the 10th century, present day Czech Republic) display several noteworthy pathologies. The first is deformation of the mandible, which was most probably caused by a fracture of the ramus in combination with a subcondylar fracture. The spine of this young woman also exhibits a probable traumatic injury of the cervical spine in combination with a slowly growing structure situated inside the spinal canal, which caused deformation centered upon C7. The cervical and thoracic spine together with internal surfaces of several ribs exhibit infectious changes of advanced stage, in all likelihood of tuberculous origin, but osteomyelitis cannot be excluded. Histological analysis of the new bone formation in the ribs confirmed infectious origin, as does Micro CT of C5 and C6. Analyses conducted by two different departments with different methods (PCR amplification of 123 bp long section from IS6110 and Next Generation shotgun sequencing) failed to identify DNA of Mycobacterium tuberculosis from the first rib.
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Affiliation(s)
- Kateřina Kalová
- Department of Archaeology and Museology, Faculty of Arts, Masaryk University, Kounicova 67a, 602 00, Brno, Czech Republic.
| | - Kateřina Boberová
- Department of Archaeology and Museology, Faculty of Arts, Masaryk University, Kounicova 67a, 602 00, Brno, Czech Republic; Department of Experimental Biology, Faculty of Science, Masaryk University, Kamenice 753/5, 625 00, Brno, Czech Republic.
| | - Renáta Přichystalová
- Department of Archaeology and Museology, Faculty of Arts, Masaryk University, Kounicova 67a, 602 00, Brno, Czech Republic.
| | - Jan Nováček
- Thuringia State Service for Cultural Heritage and Archaeology, Weimar, Germany.
| | | | - Tomáš Zikmund
- CEITEC - Central European Institute of Technology, University of Technology, Purkyňova 656/123, 612 00, Brno, Czech Republic.
| | - Jozef Kaiser
- CEITEC - Central European Institute of Technology, University of Technology, Purkyňova 656/123, 612 00, Brno, Czech Republic.
| | - Klaudia Kyselicová
- Department of Physiology, Faculty of Medicine, Comenius University, Sasinkova 2, 81372, Bratislava, Slovakia.
| | - Lukáš Šebest
- Department of Medical Genetics, Oncological Institute of Saint Elizabeth, Heydukova 10, 812 50, Bratislava, Slovakia.
| | - Marián Baldovič
- Department of Molecular Biology, Faculty of Science, Comenius University, Ilkovičova 6, 842 15, Bratislava, Slovakia.
| | - Adam Frtús
- Department of Molecular Biology, Faculty of Science, Comenius University, Ilkovičova 6, 842 15, Bratislava, Slovakia.
| | - Martin Sikora
- Centre for GeoGenetics, Natural History Museum, Øster Voldgade 5-7, 1350, Copenhagen, Denmark.
| | - Morten E Allentoft
- Centre for GeoGenetics, Natural History Museum, Øster Voldgade 5-7, 1350, Copenhagen, Denmark.
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Meningioma in cervical spinal cord segment 6 of a dog – a case report. ACTA VET BRNO 2018. [DOI: 10.2754/avb201887030225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Meningiomas in dogs occur more commonly in the brain than in the cranial spinal cord. Intramedullary spinal cord tumours in dogs are described infrequently and present a diagnostic and therapeutic challenge. A nine-year-old Beagle dog was referred because of tetraparesis of a 20-day duration. The neurological signs were suggestive of a selective lesion involving the cervical spinal cord. Sagittal T2-weighted magnetic resonance imaging of the cervical vertebral column revealed a ventral, well-circumscribed mass within the vertebral canal at the level of cervical segment 6 (C6). A primary neoplasia was considered as probable differential diagnosis. The mass was removed by cervical laminectomy, durotomy and gentle dissections. On the basis of histological and immunohistochemical findings, a diagnosis of transitional meningioma (grade I) was made. Treatment of the meningioma with surgery resulted in a complete recovery, the dog was able to walk 21 days after surgery and had normal walk two months after presentation. Clinicopathologic and treatment data of cranial intraspinal meningiomas have been reported sporadically, but a segment 6 location was not thoroughly described before.
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Mussetto I, Matos J, Romano N, Cancelli C, Schettini D, Gandolfo N. A giant spinal schwannoma mimicking a renal mass: A case report. Radiol Case Rep 2018; 13:805-809. [PMID: 29988964 PMCID: PMC6034138 DOI: 10.1016/j.radcr.2018.05.003] [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] [Received: 11/19/2017] [Revised: 05/01/2018] [Accepted: 05/05/2018] [Indexed: 12/01/2022] Open
Abstract
Spinal schwannomas arise from the cells covering the nerves within the spinal canal. In most cases, they remain confined within the intradural extramedullary space, but occasionally they extend into the extradural space resembling abdominal masses. We present a case of very large spinal schwannoma mimicking a renal mass at ultrasound exam. Using contrast-enhanced computed tomography and magnetic resonance imaging we were able to detect and characterize the lesion and consequently assign a preoperative diagnosis later confirmed by the histopathology report. In this paper, we review computed tomography and magnetic resonance imaging features of spinal schwannomas and attempt a summary of possible differential diagnoses.
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Affiliation(s)
- Ilaria Mussetto
- Department of Health Sciences DISSAL, University of Genoa, Via Antonio Pastore 1, 16132 Genova, Italy
| | - João Matos
- Department of Health Sciences DISSAL, University of Genoa, Via Antonio Pastore 1, 16132 Genova, Italy
| | - Nicola Romano
- Department of Health Sciences DISSAL, University of Genoa, Via Antonio Pastore 1, 16132 Genova, Italy
| | - Claudio Cancelli
- Department of Radiology, Villa Scassi Hospital, Corso Scassi 1, 16121 Genova, Italy
| | - Daria Schettini
- Department of Radiology, Villa Scassi Hospital, Corso Scassi 1, 16121 Genova, Italy
| | - Nicoletta Gandolfo
- Department of Radiology, Villa Scassi Hospital, Corso Scassi 1, 16121 Genova, Italy
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Xu Y, Zhong W, Chen M, Zhao J, Wang M. ALK-rearranged lung cancer with intradural extramedullary spinal cord metastases responding to ceritinib treatment: A case report. Thorac Cancer 2018; 9:1078-1081. [PMID: 29862659 PMCID: PMC6068429 DOI: 10.1111/1759-7714.12778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 01/03/2023] Open
Abstract
Intradural extramedullary spinal cord metastases in lung cancer are rarely reported, but are a disastrous event because of severe clinical symptoms and poor prognosis. Herein, we report a case of a lung cancer patient with ALK rearrangement who experienced brain, leptomeningeal, and intradural extramedullary spinal cord metastases after developing resistance to crizotinib. After ceritinib therapy, his clinical symptoms improved and magnetic resonance imaging revealed that the intradural extramedullary lesions had reduced.
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Affiliation(s)
- Yan Xu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wei Zhong
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Minjiang Chen
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Zhao
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mengzhao Wang
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Excision of a centrally based ventral intradural extramedullary tumor of the cervical spine through a direct posterior approach. Spinal Cord Ser Cases 2017; 3:17092. [PMID: 29423297 DOI: 10.1038/s41394-017-0017-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 11/09/2022] Open
Abstract
Introduction Intradural extramedullary (IDEM) tumors of the cervical spine are removed through an assortment of surgical approaches including: dorsolateral, ventrolateral, and anterior or transoral. Historically, midline ventral IDEM tumors are ostensibly thought to be unfavorable candidates for removal through a direct posterior approach. A case report of a patient with a ventrally based centrally located meningioma in the upper cervical spine (C2/C3) that was removed with direct posterior approach is described. Case presentation A 51-year-old male presented with cervicalgia and radiating scapular pain following a remote motor vehicle collision. A ventrally located meningioma in relation to the C2 body was noted on MRI. Management of this patient included obtaining adequate exposure through a posterior approach, complete tumor excision, and maintenance of cervical spine stability. Cervical stability was maintained following total unilateral facetectomy and application of instrumentation from C1-C3. Discussion Subsequent to tumor removal, the patient had complete resolution of his cervicalgia, headaches, and scapular pain by his two month follow-up appointment. Although adhesions can make total resection difficult, a posterior approach can grant adequate access to midline ventral meningiomas. Cervical spine stability, tumor location, infection risk, and surgeon familiarity with the approach should all be weighed in decision-making.
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Barbagallo GMV, Maione M, Raudino G, Certo F. Thoracic Intradural-Extramedullary Epidermoid Tumor: The Relevance for Resection of Classic Subarachnoid Space Microsurgical Anatomy in Modern Spinal Surgery. Technical Note and Review of the Literature. World Neurosurg 2017; 108:54-61. [PMID: 28843754 DOI: 10.1016/j.wneu.2017.08.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 08/10/2017] [Accepted: 08/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Intradural epidermoid tumors of the spinal cord are commonly associated with spinal cord dysraphism or invasive procedures. We report the particular relationships between spinal subarachnoid compartments and thoracic intradural-extramedullary epidermoid tumor, highlighting the relevant anatomic changes that may influence microsurgery. METHODS A 40-year-old woman from compressive myelopathy owing to a thoracic epidermoid tumor extending from T3 to T4 and not associated with spina bifida, trauma, previous surgery, or lumbar spinal puncture underwent microsurgical excision. Accurate tumor membrane dissection, respecting spinal arachnoidal compartments, was performed. Reposition of a laminoplasty plateau helped in restoring thoracic spine anatomic integrity. RESULTS Safe gross total tumor resection was achieved. Complete neurologic recovery as well as absence of recurrent tumor was documented at 4-year follow-up. A literature review revealed only 2 other cases of "isolated" thoracic spine epidermoid tumor. However, description of the relationship between tumor membranes and spinal subarachnoid compartments was not available in either case. CONCLUSIONS A thorough knowledge of spinal subarachnoid space anatomy is helpful to distinguish between tumor membranes and arachnoidal planes and to achieve a safe and complete resection to avoid recurrences.
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Affiliation(s)
- Giuseppe M V Barbagallo
- Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy.
| | - Massimiliano Maione
- Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy
| | - Giuseppe Raudino
- Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy
| | - Francesco Certo
- Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy
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22
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Xu Y, Zhong W, Zhao J, Chen M, Li L, Wang M. [Clinical Features of Intradural Extramedullary Spinal Cord Metastases
in Primary Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 19:539-44. [PMID: 27561805 PMCID: PMC5972978 DOI: 10.3779/j.issn.1009-3419.2016.08.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
背景与目的 肺癌硬膜下脊髓外转移罕见, 可导致严重的神经损害, 本研究旨在阐明其临床特征。 方法 2013年5月-2016年5月, 北京协和医院8例确诊硬膜下脊髓外转移肺癌患者纳入该研究, 系统回顾分析临床资料。 结果 7例非小细胞肺癌及1例小细胞肺癌合并硬膜下脊髓外转移。马尾综合征是最常见的临床表现。行腰椎穿刺的5例(100%)患者脑脊液找到肿瘤细胞。脊髓增强核磁(magnetic resonance imaging, MRI)发现, 3例软脊膜弥漫线样增强, 4例硬膜下脊髓外多发结节, 1例具有上述两种表现。4例接受靶向治疗和/或放疗患者神经系统症状改善或稳定。中位生存时间是5.8个月。 结论 硬膜下脊髓外转移需依靠神经系统症状及增强MRI影像学检查诊断。靶向治疗和/或放疗可能有效。
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Affiliation(s)
- Yan Xu
- Department of Respiratory Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Wei Zhong
- Department of Respiratory Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Jing Zhao
- Department of Respiratory Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Minjiang Chen
- Department of Respiratory Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Longyun Li
- Department of Respiratory Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Mengzhao Wang
- Department of Respiratory Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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Abstract
Spinal schwannomas are benign intradural extramedullary tumors arising from spinal nerve root sheath. They are usually solid or heterogeneously solid. Totally cystic schwannomas are rare entities. Herein, we report a 60-year-old male presenting with backache radiating along the chest wall and weakness of both lower limbs. He had spastic paraparesis. Magnetic resonance imaging revealed a cystic mass in the thoracic region. At operation, the cystic mass was seen to be attached to D4 dorsal rootlets. It was excised in toto and histopathology confirmed it to be a schwannoma. The relevant literature is reviewed.
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Affiliation(s)
- Sushil Kumar
- Department of Neurosurgery, St Stephen's Hospital, Tis Hazari, Delhi, India
| | - Raghavendra Gupta
- Department of Neurosurgery, St Stephen's Hospital, Tis Hazari, Delhi, India
| | - Amit Handa
- Department of Neurosurgery, St Stephen's Hospital, Tis Hazari, Delhi, India
| | - Rohan Sinha
- Department of Neurosurgery, St Stephen's Hospital, Tis Hazari, Delhi, India
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Gong T, Liu Y, Wang G, Yang L, Chen W, Gao F, Chen X. Spinal perimedullary vein enlargement sign: an added value for the differentiation between intradural-extramedullary and intramedullary tumors on magnetic resonance imaging. Neuroradiology 2016; 58:1117-1124. [PMID: 27596484 DOI: 10.1007/s00234-016-1744-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 08/24/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The purpose of this study was to determine the added value of the perimedullary spinal vein enlargement sign on magnetic resonance imaging (MRI) in distinguishing intradural-extramedullary tumors (IDEMTs) from intramedullary spinal tumors (IMTs). METHODS Two hundred and eight consecutive spinal intradural tumors with histopathologic confirmation (21 IMTs, 187 IDEMTs) were enrolled. Two readers blinded to the final pathological diagnosis and clinical data independently assessed the venous enlargement sign to determine the agreement between them and jointly distinguished IDEMTs from IMTs according to the common MRI findings. Sensitivity, specificity, and accuracy for the diagnosis of IDEMTs were calculated for the common MRI findings, vein enlargement sign, and a combination of both. RESULTS Intraobserver agreement and interobserver agreement for both readers was excellent. The sensitivity, specificity, and accuracy of common MRI findings for differentiating IDEMTs from IMTs were 83.4, 95.2, and 89.3 %, respectively. Thirty-one IDEMTs were mistakenly diagnosed as IMTs, in which seven were cases with vein enlargement signs. By applying the vein enlargement sign to the common MRI findings, the specificity remained at 95.2 %, while the sensitivity improved to 89.3 % and the accuracy increased to 92.3 %. CONCLUSION The spinal perimedullary vein enlargement sign is useful in assessing intradural tumors and to differentiate IDEMTs from IMTs.
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Affiliation(s)
- Tao Gong
- Department of Shandong Medical Imaging Research Institute, Shandong University, Jinan, 250000, People's Republic of China
| | - Yubo Liu
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Guangbin Wang
- Department of Shandong Medical Imaging Research Institute, Shandong University, Jinan, 250000, People's Republic of China.
| | - Li Yang
- Department of Radiology, Zhongshan Hospital, Shanghai, People's Republic of China
| | - Weibo Chen
- Philips Healthcare, Shanghai, People's Republic of China
| | - Fei Gao
- Department of Shandong Medical Imaging Research Institute, Shandong University, Jinan, 250000, People's Republic of China
| | - Xin Chen
- Department of Shandong Medical Imaging Research Institute, Shandong University, Jinan, 250000, People's Republic of China
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Chung CY, Koffie RM, Dewitt JC, Aronson JP. Thoracic exophytic ependymoma masquerading as a benign extra-axial tumor. J Clin Neurosci 2016; 33:221-225. [PMID: 27578528 DOI: 10.1016/j.jocn.2016.03.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 03/29/2016] [Indexed: 11/29/2022]
Abstract
Spinal tumors are conventionally differentiated based on location in relation to the spinal cord. Benign spinal tumors such as schwannomas and meningiomas are typically extra-axial (intradural extramedullary) lesions, whereas more aggressive primary spinal tumors such as ependymomas are typically intramedullary masses. Rarely, ependymomas can have both intramedullary and extramedullary components (typically referred to as exophytic ependymomas). We report a case of a spinal exophytic ependymoma that radiographically masqueraded as a benign intradural extramedullary lesion causing cord compression and neurologic deficit in a 47-year-old man. The diagnosis of exophytic ependymoma was made intra-operatively, with resultant gross total resection of the extramedullary portion and subtotal resection of the intramedullary portion. Histopathological examination confirmed ependymoma with World Health Organization grade II/IV. Pre-operative suspicion of an exophytic ependymoma influences operative planning and clinical management. We review the literature and discuss clinical management strategies for these interesting spinal tumors.
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Affiliation(s)
- Charlotte Y Chung
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Robert M Koffie
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - John C Dewitt
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua P Aronson
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Tola S, De Angelis M, Bistazzoni S, Chiaramonte C, Esposito V, Paolini S. Hemilaminectomy for spinal meningioma: A case series of 20 patients with a focus on ventral- and ventrolateral lesions. Clin Neurol Neurosurg 2016; 148:35-41. [DOI: 10.1016/j.clineuro.2016.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/14/2016] [Accepted: 06/19/2016] [Indexed: 12/16/2022]
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C8-T1 Radiculopathy Due to an Intradural Extramedullary Metastasis of a Pancreatic Neuroendocrine Tumor: Case Report and Review of the Literature. Pancreas 2016; 45:772-9. [PMID: 27077714 DOI: 10.1097/mpa.0000000000000515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Pancreatic neuroendocrine tumors (pNETs) are usually well-to-moderately differentiated neuroendocrine tumors (NETs) that most often metastasize to the liver and lymph nodes with other locations being uncommon. We present a case of intradural pNET metastasis and conduct a review of the literature. Forty-five cases, including the case presently reported, of spinal cord compression due to well-differentiated NETs were found: carcinoid (80%), pNET (13.3%), and NETs of unknown primary (6.7%). Seventy-eight percent of cases consisted of extradural compressions from vertebral bone metastases, whereas there were only 5 cases of intradural extramedullary spinal cord compression. Most cases were managed with surgery and/or radiotherapy with a good clinical outcome in the majority. We report the first case of a pNET intradural extramedullary metastasis and conduct the largest review to date of an infrequent complication of well-differentiated NETs such as malignant spinal cord compression. Aggressive local treatment is warranted in most cases because it usually achieves neurologic improvement and symptomatic relief in patients who may still have a long life expectancy.
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Abstract
Intramedullary, intradural/extramedullary, and extradural spine tumors comprise a wide range of neoplasms with an even wider range of clinical symptoms and prognostic features. Magnetic resonance imaging (MRI), commonly used to evaluate the spine in patients presenting with pain, can further characterize lesions that may be encountered on other imaging studies, such as bone scintigraphy or computed tomography (CT). The advantage of the MRI is its multiplane capabilities, superior contrast agent resolution, and flexible protocols that play an important role in assessing tumor location, extent in directing biopsy, in planning proper therapy, and in evaluating therapeutic results. A multimodality approach can be used to fully characterize the lesion and the combination of information obtained from the different modalities usually narrows the diagnostic possibilities significantly. The diagnosis of spinal tumors is based on patient age, topographic features of the tumor, and lesion pattern, as seen at CT and MRI. The shift to high-end imaging incorporating diffusion-weighted imaging, diffusion tensor imaging, magnetic resonance spectroscopy, whole-body short tau inversion recovery, positron emission tomography, intraoperative and high-field MRI as part of the mainstream clinical imaging protocol has provided neurologists, neuro-oncologists, and neurosurgeons a window of opportunity to assess the biologic behavior of spine neoplasms. This chapter reviews neuroimaging of spine tumors, primary and secondary, discussing routine and newer modalities that can reduce the significant morbidity associated with these neoplasms.
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MRI aspect of intradural extramedullary lipoma. Joint Bone Spine 2016; 83:97. [DOI: 10.1016/j.jbspin.2015.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 11/22/2022]
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Nanda A, Kukreja S, Ambekar S, Bollam P, Sin AH. Surgical Strategies in the Management of Spinal Nerve Sheath Tumors. World Neurosurg 2015; 83:886-99. [DOI: 10.1016/j.wneu.2015.01.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 01/05/2015] [Accepted: 01/19/2015] [Indexed: 12/01/2022]
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Westwick HJ, Yuh SJ, Shamji MF. Complication avoidance in the resection of spinal meningiomas. World Neurosurg 2014; 83:627-34. [PMID: 25527885 DOI: 10.1016/j.wneu.2014.12.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/09/2014] [Accepted: 12/10/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Surgical resection is considered the treatment of choice for spinal meningiomas and can be safe and effective; however, neurologic and surgical complications occur. This article reviews the factors that may predict susceptibility to this postoperative decline and addresses therapeutic choices, adjunctive therapies, and technologic applications that may help avoid complications. METHODS A literature search was conducted for articles related to spinal meningiomas addressing surgical treatment, adjuvant treatment, and technologic applications related to management and minimizing of complications. RESULTS There were 16 surgical series identified, comprising 1090 patients with median mortality of 1% (range, 0%-4%), nonneurologic surgical morbidity of 4% (range, 0%-24%), and permanent neurologic deterioration of 6% (range, 0%-21%). Common complications were cerebrospinal fluid leaks and fistulas, venous thromboembolic disease, myocardial infarction, and neurologic deterioration with either transient or permanent neurologic deficits. Predictive risk factors of neurologic decline included pathoanatomic features of lesion calcification, anterior dural attachment, infiltrative tumor, and tumoral adherence to the spinal cord and patient-specific factors of preoperative neurologic and advanced age. CONCLUSIONS Alongside surgery, selection of more direct approaches and use of adjuvant radiotherapy in patients with higher grade lesions and recurrent disease may lead to improved outcomes. New technologies, including microsurgical technique, intraoperative electrophysiologic monitoring, intraoperative ultrasound, and ultrasonic aspiration, may improve the safety and limit the complications of resection.
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Affiliation(s)
- Harrison J Westwick
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada
| | - Sung-Joo Yuh
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Mohammed F Shamji
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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Hung HY, Chen TY, Li MH, Chen SY, Tsai ST. A purely midline ventral schwannoma mimicking a meningioma in the thoracic spine resected via costotransversectomy. Tzu Chi Med J 2014. [DOI: 10.1016/j.tcmj.2013.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Savardekar A, Singla N, Mohindra S, Ahuja CK, Gupta SK. Cystic spinal schwannomas: A short series of six cases. Can we predict them preoperatively? Surg Neurol Int 2014; 5:S349-53. [PMID: 25289159 PMCID: PMC4173214 DOI: 10.4103/2152-7806.139666] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 04/04/2014] [Indexed: 11/25/2022] Open
Abstract
Background: Spinal schwannomas are benign tumors arising from the spinal nerve root sheaths and are the commonest intradural extramedullary spinal tumors. Though cystic changes in schwannomas are well described, predominantly cystic schwannomas are uncommon lesions and form a different spectrum of conditions as compared with the commonly seen intradural extramedullary solid lesions. Case Description: We present a case series of six patients with spinal intradural extramedullary cystic schwannomas. Two patients had uniloculated cystic schwannomas, two patients had multi-loculated cystic lesions with thick walls and intralesional septations, and two patients had giant cystic schwannomas, one of which had an extradural extension. We report two cases in which preoperative radiological dilemma was encountered and discuss the differential diagnoses of this uncommon entity. Conclusion: Cystic spinal schwannomas may be confused with other cystic lesions in the spine, differentiating them preoperatively is important and in this regard, contrast-enhanced magnetic resonance imaging plays a vital role. Frozen section histopathology should be used to identify them at surgery. It is important to detect these lesions at surgery, as total excision is possible and almost always results in good long-term neurological outcome.
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Affiliation(s)
- Amey Savardekar
- Department of Neurosurgery, Post Graduate Institute of Medical education and Research, Chandigarh, India
| | - Navneet Singla
- Department of Neurosurgery, Post Graduate Institute of Medical education and Research, Chandigarh, India
| | - Sandeep Mohindra
- Department of Neurosurgery, Post Graduate Institute of Medical education and Research, Chandigarh, India
| | - Chirag K Ahuja
- Department of Radio-diagnosis, Post Graduate Institute of Medical education and Research, Chandigarh, India
| | - Sunil K Gupta
- Department of Neurosurgery, Post Graduate Institute of Medical education and Research, Chandigarh, India
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Menashe SJ, Iyer RS. Pediatric Spinal Neoplasia: A Practical Imaging Overview of Intramedullary, Intradural, and Osseous Tumors. Curr Probl Diagn Radiol 2013; 42:249-65. [DOI: 10.1067/j.cpradiol.2013.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
A schwannoma is a benign tumor arising from a schwann cell and occurs mainly in the nerve sheath in the intradural extramedullary region. Schwannomas have been well described as occurring in the lumbar spine, but total cystic degeneration of schwannomas is rarely reported. The authors describe the clinical and radiographic evaluations and treatment of a rare case of an intraextradural totally cystic schwannoma on the lumbar spine.Two patients reported a history of 6 to 12 months of pain accompanied by weakness in the lower extremities. On examination, 1 patient had bilateral lower-extremity muscle strength graded at 4/5, and magnetic resonance imaging revealed a cystic schwannoma (1.5 × 2.0 cm in the sagittal dimension) at L2-L3. The other patient had a right lower-extremity muscle strength graded at 3/5, and magnetic resonance imaging revealed a cystic schwannoma (2.0 × 3.0 cm in the sagittal dimension) at L4-L5. The patients underwent operative treatment, and the tumors were completely removed, as were the filum terminale adhered to the tumor. Pedicle screws were used to maintain stability of the lumbar spine. Gross examination of the tumors showed yellowish-white soft contents. Histologic examination confirmed that they were benign totally cystic schwannomas. Postoperatively, the patients' neurologic symptoms completely resolved.Cystic schwannomas can be diagnosed using preoperative magnetic resonance imaging. The filum terminale cut off the tumor walls did not cause the clinical symptoms in the 2 patients.
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Affiliation(s)
- Desheng Wu
- Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Kim EJ, Wang KC, Lee JY, Phi JH, Park SH, Cheon JE, Jang YE, Kim SK. Congenital solitary infantile myofibromatosis involving the spinal cord. J Neurosurg Pediatr 2013; 11:82-6. [PMID: 23082913 DOI: 10.3171/2012.9.peds12245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Infantile myofibromatosis, a rare mesenchymal disorder that develops in early childhood, is classified by the number of lesions that occur: solitary or multicentric. Involvement of the CNS is unusual in either type. Infantile myofibromatosis in the spine is exceptional, and most published cases represent a secondary invasion. Here, the authors report on an 8-month-old girl presenting with weakness below the ankle and an intraspinal mass extending from T-6 to the conus. The patient underwent only partial surgical removal of the lesion, and the pathology was confirmed as infantile myofibromatosis. After the operation, weakness in the lower extremities gradually improved; however, she could not walk at the time of the final follow-up. On follow-up MRI performed 19 months after the operation, the residual lesion remained unchanged with decreased enhancement.
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Affiliation(s)
- Eun Ji Kim
- Divisions of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Iacoangeli M, Gladi M, Di Rienzo A, Dobran M, Alvaro L, Nocchi N, Maria LG, Somma D, Colasanti R, Scerrati M. Minimally invasive surgery for benign intradural extramedullary spinal meningiomas: experience of a single institution in a cohort of elderly patients and review of the literature. Clin Interv Aging 2012; 7:557-64. [PMID: 23271902 PMCID: PMC3526880 DOI: 10.2147/cia.s38923] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Meningiomas of the spine are the most common benign intradural extramedullary lesions and account for 25%–46% of all spinal cord tumors in adults. The goal of treatment is complete surgical resection while preserving spinal stability. Usually, these lesions occur in the thoracic region and in middle-aged women. Clinical presentation is usually nonspecific and the symptoms could precede the diagnosis by several months to years, especially in older people, in whom associated age-related diseases can mask the tumor for a long time. We report a series of 30 patients, aged 70 years or more, harboring intradural extramedullary spinal meningiomas. No subjects had major contraindications to surgery. A minimally invasive approach ( hemilaminectomy and preservation of the outer dural layer) was used to remove the tumor, while preserving spinal stability and improving the watertight dural closure. We retrospectively compared the outcomes in these patients with those in a control group subjected to laminectomy or laminotomy with different dural management. In our experience, the minimally invasive approach allows the same chances of complete tumor removal, while providing a better postoperative course than in a control group.
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Affiliation(s)
- Maurizio Iacoangeli
- Department of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, Italy.
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O'Grady J, Kaliaperumal C, O'Sullivan M. Recurrent 'universal tumour' of the spinal cord. BMJ Case Rep 2012; 2012:bcr.12.2011.5284. [PMID: 22675149 DOI: 10.1136/bcr.12.2011.5284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lipoma is popularly known as the 'universal tumour' because of its ubiquitous presence anywhere in the body. This is the first documented case of recurrent thoracic spinal cord intramedullary lipoma in a 44-year-old man, with a background of spinal dysraphism, which recurred 15 years after initial surgery. He was followed up every 2 years and currently presented with an 8-month history of progressive weakness in his lower limbs. An MRI of the spine confirmed recurrence of lipoma. He underwent redo laminectomy and partial resection and spinal cord decompression with duroplasty. Lipoma, although a low-grade tumour, can cause significant neurological deficits because of its location. Surgical exploration and removal of lipoma is recommended. However, to preserve the functionality of the spinal cord, one may resort to partial resection and aim for spinal cord decompression. The literature on spinal cord lipoma is reviewed and the aetiopathogenesis of this rare occurrence is described.
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Affiliation(s)
- John O'Grady
- Department of Neurosurgery, Cork University Hospital, Cork, Ireland
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Meningioma of the conus medullaris mimicking neurofibroma--possibly radiation induced. Spine J 2011; 11:e11-5. [PMID: 21193353 DOI: 10.1016/j.spinee.2010.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 10/07/2010] [Accepted: 12/05/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Radiation-induced meningiomas (RIMs) of the brain are the most common RIMs. However, there has been no report in the literature of an RIM of the spine. Conus medullaris is a favorite site for ependymomas, whereas it is an extremely rare location for meningiomas. Dumbbell-shaped configuration is typical for nerve sheath tumors; however, it is very rarely seen in meningiomas. PURPOSE To describe imaging findings of a possibly RIM at the level of the conus medullaris mimicking a neurofibroma. STUDY DESIGN A 60-year-old male with 6-year history of irradiated urinary bladder cancer presented with paraparesis. METHODS Radiography, computed tomography, and magnetic resonance imaging of the thoracolumbar spine were undertaken. RESULTS Radiography showed widening of intervertebral foramina at T12-L1 level. Computed tomography and magnetic resonance imaging disclosed a lobulated intradural mass at the level of the conus medullaris causing widening and scalloping of adjacent bony structures, with dumbbell-shaped configuration. Surgical biopsy of the mass was consistent with fibroblastic meningioma. CONCLUSIONS The reported tumor might have developed secondary to irradiation for urinary bladder cancer because meningiomas are the most common radiation-induced central nervous system tumors. Although location at the level of the conus medullaris is atypical for meningioma, and dumbbell-shaped configuration is rather characteristic for neurogenic tumors, they should not exclude a diagnosis of meningioma.
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Espaces rachidiens intracanalaires : de l’anatomie radiologique au diagnostic étiologique. ACTA ACUST UNITED AC 2010; 91:950-68. [DOI: 10.1016/s0221-0363(10)70142-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
Spinal tumors can be intramedullary, intradural (within the meninges), or extradural (between the meninges and the bones), or they may extend secondary to the spine from other locations. Vertebral hemangioma represents the most common benign tumor of the spine. Metastases, lymphoma, and multiple myeloma are the most frequent malignant spinal tumors. Primary osseous tumors of the spine, in contrast, are rare conditions but may demonstrate typical imaging findings. For the differential diagnosis, the patient's age, the topographic localization of the mass, and morphologic features of the lesion as depicted by computed tomography and magnetic resonance imaging play important roles.
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Affiliation(s)
- F J Ahlhelm
- Klinik für Diagnostische and Interventionelle Neuroradiologie, Radiologische Kliniken, Universitätsklinkum des Saarlandes, 66421, Homburg, Saar.
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Intradural Extramedullary Arachnoid Cyst Presenting as Arteriovenous Malformation in the Thoracic Spinal Cord. Radiol Case Rep 2009; 4:263. [PMID: 27307803 PMCID: PMC4898001 DOI: 10.2484/rcr.v4i2.263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report the case of a 57-year-old man who was admitted on the basis of worsening paraplegia and incontinence. This patient had developed similar neurologic symptoms 15 previously but fully recovered after conservative medical therapy with corticosteroids. At that point, he was diagnosed with a thoracic spinal arteriovenous malformation (AVM); yet, no focal spinal lesion was identified. During this second presentation, the patient was initially worked up at an outside institution, where MR imaging revealed serpiginous flow voids along with anterior displacement or atrophy of the cord at the T5-T6 level. Edema of the mid and lower thoracic cord was also noted. While under our care, spinal arteriography and CT angiography failed to conclusively detect an underlying AVM. The patient underwent a second MR study, which showed no major interval change in the pathology. Subsequently, CT myelography of the thoracic spine demonstrated a large intradural extramedullary arachnoid cyst (or arachnoid adhesions resulting in the formation of an entrapped cystic collection). The flow voids that were seen on MR imaging were attributed to venous congestion and dilation arising from chronic compression by the cyst. Cord edema was also found to be secondary to increased interstitial pressure in the setting of this cord compression superiorly. Since surgery was not indicated for this patient at the time of diagnosis, no surgical or pathohistologic assessment was obtained to further characterize the nature of this cystic collection.
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