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Retroz-Marques C, Correia AFA, Marques A, Gomes P. Epidural analgesia and tattoos: a modified technique to minimise risks and improve safety. BMJ Case Rep 2023; 16:e254058. [PMID: 38142054 DOI: 10.1136/bcr-2022-254058] [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] [Indexed: 12/25/2023] Open
Abstract
A healthy young woman with a sizeable lumbar tattoo was admitted to the delivery room in active labour at full-term gestation. She was experiencing strong, painful contractions and anxiety, concerned about the possible risks of receiving an epidural through a tattoo. Although there is little published evidence to suggest complications of performing an epidural through a tattoo, some studies report 'tissue coring phenomenon'. The anaesthesiology team informed the patient of the risks inherent in a traditional epidural and the potential long-term risks of receiving an epidural through the tattoo. Upon signing the informed consent form, the modified epidural technique was performed, and its administration proceeded without complications. A healthy boy was born 3.5 hours later in a vacuum-assisted delivery. This article describes the modified epidural technique designed to minimise tissue coring, and the results of 18 months of uneventful patient follow-up.
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Affiliation(s)
| | | | - Acilio Marques
- Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Piedade Gomes
- Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
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Khan MSI, Ahmed N, Barua KK, Chaurasia B, Vats A, Goel A. Pathogenesis, management strategies, and outcome of non-communicating extradural spinal arachnoid cyst (NEAC): a systematic review. Br J Neurosurg 2023; 37:213-219. [PMID: 35766304 DOI: 10.1080/02688697.2022.2090505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Non-communicating extradural spinal arachnoid cysts (NEACs) are extremely rare aetiology of symptomatic spinal cord compression. The aim of this study was to address their pathogenesis, optimum management strategy and outcome through systematic review of existing published studies. MATERIALS AND METHOD We have found 13 eligible publications by searching through PubMed, ScienceDirect, and Google Scholar databases, published from inception to December 2020. We have analysed the data of 21 patients extracted from those 13 publications by IBM SPSS version 23. RESULTS According to our analysis congenital predisposition, trauma, and previous surgery history are the aetiology of NEAC. Clinical presentation of cyst depends upon the location and extent of compression or involvement of the neurovascular structures. Paraparesis with variable degree of sensory disturbance was seen among patients. Based on neuroimaging findings, NEACs are most commonly found at dorsal and dorsolumbar region. Magnetic resonance imaging (MRI) is the diagnostic modalities of choice and CT myelography can demonstrate the communication with the subarachnoid space. Recurrence rate of cyst after surgery is very low as only one out of twenty patients showed recurrence. If dural defect is not accurately addressed, the recurrence rate increased significantly. CONCLUSIONS Our study has highlighted aetiology, treatment strategies, and neurological outcome of NEAC. These findings may help neurosurgeons to manage this rare surgical entity for favourable outcome.
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Affiliation(s)
- Mohammad Shahidul Islam Khan
- Department of Orthopaedic Surgery, Spine Surgery Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Nazmin Ahmed
- Department of Neurosurgery, Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh
| | - Kanak Kanti Barua
- Department of Neurosurgery,, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Atul Vats
- James Cook University Hospital, Middlesborough, UK
| | - Atul Goel
- Department of Neurosurgery, King Edward Memorial Hospital and Seth G. S. Medical College, Mumbai, India
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Elnoamany H, Salim M. Idiopathic lumbar epidermoid: review of literature and case report. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-023-00188-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Abstract
Background
Spinal epidermoid tumors are rare, comprising of less than 1% of tumors involving the spine. These tumors arise from pathological displacement of epidermal cells into the spinal canal. Therefore, these tumors can be congenital, when there is improper closure of the neural tube; or acquired, in patients who have had prior lumbar punctures, trauma, or surgery. Spinal epidermoids are typically found in the lumbosacral region but can be found in other locations as well.
Case presentation
We report an original case of a 50 year old. He presented with 1 year with back pain and bilateral sciatica. The patient was neurological intact with no sphincter incompetence. The magnetic resonance image of the lumbosacral spine showed a 12 × 3 cm well-circumscribed intradural mass at the L3–S1 level. The patient was operated on with posterior lumbar laminectomy for tumor removal. Postoperation, the patient had improved pain and numbness. The motor power was intact as preoperative.
Conclusions
MRI with DWI is especially useful to confirm the diagnosis with the lesions appearing hyperintense. The most conventional approach to resection involved laminectomies and intradural tumor resection. GTR provided better outcomes in most cases even when the tumor was adherent to the nearby spinal cord or nerve roots.
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Patel V, Desai S, Thakkar V, Chaudhari S. Upper cervical spinal bronchogenic cyst: A rare lesion at an exceptional location. Indian J Radiol Imaging 2020; 30:513-516. [PMID: 33737784 PMCID: PMC7954160 DOI: 10.4103/ijri.ijri_262_19] [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: 06/18/2019] [Revised: 08/11/2020] [Accepted: 09/21/2020] [Indexed: 11/23/2022] Open
Abstract
An intraspinal bronchogenic cyst is a rare but important cause of compressive cord myelopathy, commonly seen in the cervicothoracic spine. We report a case of a 30-year-old female, presented with complaints of neck pain and progressive weakness of the extremities. The magnetic resonance imaging of the cervical spine revealed an intradural extramedullary, well-defined, multiloculated, cystic lesion in the upper cervical canal extending from the C2 to C5 vertebral levels. To our knowledge, only 11 cases of spinal bronchogenic cysts have been reported in the literature so far. We discuss the rare location of this unusual lesion, possible embryological reasons, and the overall surgical outcome.
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Affiliation(s)
- Viral Patel
- Department of Radio-Diagnosis, Pramukh Swami Medical College and Shree Krishna Hospital, Karamsad, Gujarat, India
| | - Shreya Desai
- Department of Radio-Diagnosis, Pramukh Swami Medical College and Shree Krishna Hospital, Karamsad, Gujarat, India
| | - Vishal Thakkar
- Department of Radio-Diagnosis, Pramukh Swami Medical College and Shree Krishna Hospital, Karamsad, Gujarat, India
| | - Sanjay Chaudhari
- Department of Pathology, Pramukh Swami Medical College and Shree Krishna Hospital, Karamsad, Gujarat, India
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Graupman P, Nussbaum ES, Mishra H. Delayed Onset of an Intradural Epidermoid Tumor in the Lumbar Region Seven Years After Spinal Anesthesia for Childbirth: A Case Report. Cureus 2020; 12:e10517. [PMID: 33094058 PMCID: PMC7571779 DOI: 10.7759/cureus.10517] [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] [Indexed: 11/09/2022] Open
Abstract
Epidural or spinal anesthesia is commonly administered in births in the US, and the potential risks for epidermoid tumors are not well-characterized. We present the case of a 29-year-old female patient who developed an intradural epidermoid tumor in the lumbar spine, discovered seven years after spinal anesthesia for childbirth. MRI revealed a 4 cm tumor filling the entire spinal canal. Pathology confirmed the mass to be an epidermoid. Complete surgical resection of the intradural lesion was accomplished with full symptomatic relief. This case supports the relationship between delayed development of epidermoid tumors and spinal puncture in adult populations.
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Affiliation(s)
| | - Eric S Nussbaum
- Neurosurgery, United Hospital, National Brain Aneurysm and Tumor Center, Minnesota Neurovascular and Skull Base Surgery, Minneapolis, USA
| | - Hemant Mishra
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Minneapolis, USA
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Sîrbu OM, Chirteş AV, Mitricã M, Sîrbu CA. Spinal Intramedullary Epidermoid Cyst: Case Report and Updated Literature Review. World Neurosurg 2020; 139:39-50. [DOI: 10.1016/j.wneu.2020.03.207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 11/17/2022]
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Kanamoto H, Norimoto M, Eguchi Y, Oikawa Y, Orita S, Inage K, Abe K, Inoue M, Kinoshita H, Umimura T, Matsumoto K, Masuda Y, Furuya T, Koda M, Aoki Y, Watanabe A, Takahashi K, Ohtori S. Evaluating Spinal Canal Lesions Using Apparent Diffusion Coefficient Maps with Diffusion-Weighted Imaging. Asian Spine J 2020; 14:312-319. [PMID: 32050309 PMCID: PMC7280930 DOI: 10.31616/asj.2019.0266] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/06/2019] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Observational study. PURPOSE To evaluate healthy volunteers and patients with spinal canal lesions using apparent diffusion coefficient (ADC) maps with diffusion-weighted imaging. OVERVIEW OF LITERATURE Decompression surgery for lumbar spinal stenosis (LSS) is selected on the basis of subjective assessment and cross-sectional magnetic resonance imaging (MRI). However, there is no objective standard for this procedure. METHODS We performed 3T MRI in 10 healthy volunteers and 13 patients with LSS. The ADC values in the spinal canal were evaluated at 46 vertebrae (L4/5 and L5/S1 for each participant), and the reduced and conventional fields of view were compared. RESULTS The ADC values were 2.72±0.12 at L4/5 in healthy volunteers, 2.76±0.19 at L5/S1 in healthy volunteers, 1.77±0.58 at L4/5 in patients with LSS, and 2.35±0.29 at L5/S1 in patients with LSS. The ADC value at L4/5 in patients with LSS was significantly lower than that at L5/S1 in patients with LSS and that at L4/5 and L5/S1 in healthy volunteers (p <0.05). With an ADC cutoff value of 2.46 to identify LSS, this approach provided an area under the curve of 0.81, sensitivity of 0.92, and specificity of 0.76 (p <0.05). CONCLUSIONS Preoperative examination using ADC maps permits visualization and quantification of spinal canal lesions, thus proving the utility of ADC maps in the selection of decompression surgery for LSS.
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Affiliation(s)
- Hirohito Kanamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaki Norimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Shimoshizu National Hospital, Yotsukaido, Japan
| | - Yasuhiro Oikawa
- Division of Orthopaedic Surgery, Chiba Children's Hospital, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koki Abe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hideyuki Kinoshita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomotaka Umimura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koji Matsumoto
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yoshitada Masuda
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Intraspinal Inclusion Tumor After Myelomeningocele Repair: A Long-Term Single-Center Experience. World Neurosurg 2019; 122:e1338-e1344. [DOI: 10.1016/j.wneu.2018.11.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 01/30/2023]
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Beechar VB, Zinn PO, Heck KA, Fuller GN, Han I, Patel AJ, Ropper AE. Spinal Epidermoid Tumors: Case Report and Review of the Literature. Neurospine 2018; 15:117-122. [PMID: 29991240 PMCID: PMC6104727 DOI: 10.14245/ns.1836014.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/23/2018] [Indexed: 11/19/2022] Open
Abstract
Spinal epidermoid tumors are rare, benign tumors that are either acquired from trauma, surgery, or lumbar puncture or arise as congenital lesions, particularly spinal dysraphisms. We report a case of a massive spinal epidermoid tumor and review the literature with a focus on the surgical outcomes. A 71-year-old female patient presented after a fall with subsequent symptoms of severe back and hip pain, as well as loss of motor strength in the left leg. Her magnetic resonance imaging demonstrated a T2/short tau inversion recovery hyperintense mass extending from the level of the T10–11 disc caudally through S2. A biopsy was recommended to determine whether the tumor was radio- or chemo-sensitive. The patient underwent a L4 laminectomy and a pearly-white tumor was encountered, with a subsequent biopsy confirming it to be an epidermoid tumor. The following conclusions can be drawn from a review of the literature. Spinal epidermoid tumors are more common in women and tend to present in younger patients (median age of 23). The majority of patients had acquired lesions (46%). In terms of surgical outcomes for adherent tumors, gross total resection was found to provide optimal outcomes, with 90% of patients improving clinically after surgery.
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Affiliation(s)
- Vivek B Beechar
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Pascal O Zinn
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Kent A Heck
- Department of Pathology, Baylor College of Medicine, Houston, TX, USA
| | - Gregory N Fuller
- Department of Pathology, MD Anderson Cancer Center, Houston, TX, USA
| | - Inbo Han
- Department of Neurosurgery, CHA University, CHA Bundang Medical Center, Seongnam, Korea
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Alexander E Ropper
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
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Funao H, Isogai N, Daimon K, Mima Y, Sugiura H, Koyanagi T, Nakamura M, Matsumoto M, Ishii K. A rare case of intradural and extramedullary epidermoid cyst after repetitive epidural anesthesia: case report and review of the literature. World J Surg Oncol 2017; 15:131. [PMID: 28716031 PMCID: PMC5513138 DOI: 10.1186/s12957-017-1186-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 06/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background Spinal epidermoid cysts are benign tumors, which are rarely seen as an intradural extramedullary spinal cord tumor in the conus medullaris region. Acquired spinal epidermoid cysts are mostly caused by iatrogenic procedures, such as lumbar puncture, and the majority of acquired spinal epidermoid cysts have been reported below the L1 level, because lumbar puncture is usually performed around the iliac crest. Here, we report an extremely rare case of an epidermoid cyst that occurred as an intradural and extramedullary spinal cord tumor attached to the conus medullaris after repetitive epidural anesthesia. Case presentation A 67-year-old female presented with a low back pain and left sciatica. Although the patient had experienced occasional mild low back pain for several years, her low back pain markedly worsened 2 months before her visit, as well as newly developed left sciatica resulting in intermittent claudication. She had a history of several abdominal surgeries. All abdominal procedures were performed under general anesthesia with epidural anesthesia in her thoracolumbar spine. Magnetic resonance imaging of her lumbar spine demonstrated an intradural extramedullary spinal cord tumor at the T12–L1 level. Because her symptoms deteriorated, the tumor excision was performed using microscopy. Histological examination of the specimens demonstrated that the cyst walls lined with stratified squamous keratinizing epithelium surrounded by the outer layer of collagenous tissue with the absence of skin adnexa. A diagnosis of epidermoid cysts was confirmed. Her MRI showed complete resection of the tumor, and there was no recurrence at 2-year follow-up. Conclusions In this case report, epidermoid cells might be contaminated into the spinal canal during repetitive epidural anesthesia. The patient was successfully treated by complete resection, and there was no recurrence at 2-year follow-up with a good clinical outcome. However, long-term follow-up is required for a potential risk of tumor recurrence.
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Affiliation(s)
- Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare Mita Hospital, Minato, Japan. .,Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Minato, Japan. .,Department of Orthopaedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan.
| | - Norihiro Isogai
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare Mita Hospital, Minato, Japan.,Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Minato, Japan
| | - Kenshi Daimon
- Department of Orthopaedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan
| | - Yuichiro Mima
- Department of Orthopaedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan
| | - Hitoshi Sugiura
- Department of Pathology, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan
| | - Takahiro Koyanagi
- Department of Orthopaedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare Mita Hospital, Minato, Japan.,Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Minato, Japan.,Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Japan
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Ma X, Li W, Niu C, Liang F, Guo L, Shakir TM, Zhang M. Intraspinal bronchogenic cyst: Series of case reports and literature review. J Spinal Cord Med 2017; 40:141-146. [PMID: 28317447 PMCID: PMC5430469 DOI: 10.1080/10790268.2017.1279816] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Spinal bronchogenic cysts (SBCs) are rare congenital lesions. The clinical and imaging characteristics and treatment of SBCs are not well known. We studied three cases of SBCs retrospectively, which were registered in our department and analyzed eight case reports which were all published in English, focusing on providing a deeper knowledge of SBCs. METHODS Three patients with SBCs registered in our department were retrospectively reviewed. Eight reported SBCs cases published from 1992 to 2015 were enrolled in our study. Imaging diagnosis was confirmed by computed tomography (CT), MRI, and computed tomography angiography (CTA). All of our patients and reviewed cases had undergone surgical resection and the final diagnosis was made by pathological examination. RESULTS Five lesions were located at the cervical spinal canal. Most patients presented with pain in the limbs and back, which might be related to compression of the spinal cord and the reduced blood supply of the anterior spinal artery. The signal intensity on MRI was correlated with cystic fluid traits to a large extent. Seven lesions were partially removed because of the adhesions to the nearby spinal cord. All reported cases had no recurrence in the later follow-up. CONCLUSIONS SBCs can occur anywhere in the spinal canal, but they are more likely to present at the cervical canal and might be present along with some developmental malformations of the spine. We emphasize the role of CT and MRI findings in the disease diagnosis. It is recommended that the lesion should be removed as completely as possible.
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Affiliation(s)
| | | | | | | | | | | | - Ming Zhang
- Correspondence to: Ming Zhang, 277#, Yan Ta Xi Lu, Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, Shan'Xi, China, 710061.
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