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Ganga A, Kim EJ, Lee JY, Leary OP, Sastry RA, Fridley JS, Chang KE, Niu T, Sullivan PZ, Somasundar PS, Gokaslan ZL. Disparities in Primary Spinal Osseous Malignant Bone Tumor Survival by Medicaid Status: A National Population-Based Risk Analysis. World Neurosurg 2024; 181:e192-e202. [PMID: 37777175 DOI: 10.1016/j.wneu.2023.09.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND The impact of Medicaid status on survival outcomes of patients with spinal primary malignant bone tumors (sPMBT) has not been investigated. METHODS Using the SEER-Medicaid database, adults diagnosed between 2006 and 2013 with sPMBT including chordoma, osteosarcoma, chondrosarcoma, Ewing sarcoma, or malignant giant cell tumor (GCT) were studied. Five-year survival analysis was performed using the Kaplan-Meier method. Adjusted survival analysis was performed using Cox proportional-hazards regression controlling for age, sex, marital status, cancer stage, poverty level, vertebral versus sacral location, geography, rurality, tumor diameter, tumor grade, tumor histology, and therapy. RESULTS A total of 572 patients with sPMBT (Medicaid: 59, non-Medicaid: 513) were identified. Medicaid patients were more likely to be younger (P < 0.001), Black (P < 0.001), live in high poverty neighborhoods (P = 0.006), have distant metastases at diagnosis (P < 0.001), and less likely to receive surgery (P = 0.006). The 5-year survival rate was 65.7% (chondrosarcoma: 70.0%, chordoma: 91.5%, Ewing sarcoma: 44.6%, GCT: 90.0%, osteosarcoma: 34.2%). Medicaid patients had significantly worse 5-year survival than non-Medicaid patients (52.0% vs. 67.2%, P = 0.02). Minority individuals on Medicaid were associated with an increased risk of cancer-specific mortality compared with White non-Medicaid patients (adjusted hazard ratio [aHR] = 2.51, [95% CI 1.18-5.35], P = 0.017). Among Medicaid patients, those who received surgery had significantly better survival than those who did not (64.5% vs. 30.6%, P = 0.001). For all patients, not receiving surgery (aHR = 1.90 [1.23-2.95], P = 0.004) and tumor diameter >50 mm (aHR=1.89 [1.10-3.25], P = 0.023) were associated with an increased risk of mortality. CONCLUSIONS Medicaid patients may be less likely to receive surgery and suffer from poorer survival. These disparities may be especially prominent among minorities.
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Affiliation(s)
- Arjun Ganga
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Eric J Kim
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - James Y Lee
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Owen P Leary
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rahul A Sastry
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jared S Fridley
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ki-Eun Chang
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tianyi Niu
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Patricia Zadnik Sullivan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ponnandai S Somasundar
- Department of Surgical Oncology, Roger Williams Medical Center, Providence, Rhode Island, USA; Department of Surgery, Boston University, Boston, Massachusetts, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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Leng A, Yang M, Sun H, Dai Z, Zhu Z, Wan W, Xiao J. Surgical Strategy for Recurrent Giant Cell Tumor in the Thoracolumbar Spine. Orthop Surg 2024; 16:78-85. [PMID: 38014475 PMCID: PMC10782228 DOI: 10.1111/os.13911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE Recurrent giant cell tumor (RGCT) of the spine represents a clinical challenge for surgeons, and the treatment strategy remains controversial. This study aims to describe the long-term follow-up outcomes and compare the efficacy of en bloc spondylectomy versus piecemeal spondylectomy in treating RGCT of the thoracolumbar spine. METHODS A total of 32 patients with RGCT of the thoracolumbar spine treated from June 2012 to June 2019 were retrospectively reviewed. A total of 15 patients received total en bloc spondylectomy (TES) with wide or marginal margin while 17 patients received total piecemeal spondylectomy (TPS) with intralesional margin. Postoperative Eastern Cooperative Oncology Group Performance Score (ECOG-PS), Frankel classification and recurrence-free survival (RFS) were evaluated after surgery. Survival curves were estimated by the Kaplan-Meier method and differences were analyzed with the log-rank test. Multivariate analysis was performed with Cox regression to identify the independent prognostic factors affecting RFS. RESULTS During a median follow-up of 41.9 ± 17.5 months, all patients with compromised neurologic functions exhibit significant improvement, with the mean ECOG-PS decreasing from 1.5 ± 1.3 to 0.13 ± 0.3 (p < 0.05). Among the 17 patients treated with TPS, eight patients developed local recurrence after a median time of 15.9 ± 6.4 months and four patients died from progressive disease. On the other hand, local recurrence were well managed with TES, since only one out of 15 patients experienced local relapse and all patients are alive with satisfied function at the latest follow-up. The median RFS for patients receiving TES and TPS are 75.0 months (95% CI: 67.5-82.5 m) and 38.3 months (95% CI: 27.3-49.3 m) respectively (p = 0.008). Multivariate analysis shows that the Ki67 index (p = 0.016), resection mode (p = 0.022), and denosumab (p = 0.039) are independent risk factors affecting RFS. CONCLUSIONS TES with wide/marginal margin should be offered to patients with RGCT whenever feasible, given its long-term benefits in local control and symptom alleviation. Additionally, patients with lower Ki67 index and application of denosumab tend to have a better prognosis.
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Affiliation(s)
- Ao Leng
- Department of Orthopedic OncologyThe Second Affiliated Hospital of Naval Medical UniversityShanghaiChina
- Department of OrthopedicsGeneral Hospital of Northern Theater Command of Chinese People's Liberation ArmyShenyangChina
| | - Minglei Yang
- Department of Orthopedic OncologyThe Second Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Haitao Sun
- Department of Orthopedic OncologyThe Second Affiliated Hospital of Naval Medical UniversityShanghaiChina
- Department of OrthopedicsNaval Hospital of Eastern Theater Command of Chinese People's Liberation ArmyZhoushanChina
| | - Zeyu Dai
- Department of Orthopedic OncologyThe Second Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Zhi Zhu
- Department of PathologyThe Second Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Wei Wan
- Department of Orthopedic OncologyThe Second Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Jianru Xiao
- Department of Orthopedic OncologyThe Second Affiliated Hospital of Naval Medical UniversityShanghaiChina
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Bedoya MA, Krokhmal AA, Kourmouzi VC, Kwatra NS, Drubach LA, Fehnel KP, Proctor MR, Voss SD. Use of intraoperative bone scintigraphy for resection of spinal osteoid osteoma. Pediatr Radiol 2023; 53:2424-2433. [PMID: 37740781 DOI: 10.1007/s00247-023-05773-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND The location and proximity to the spinal cord in spinal osteoid osteoma can increase the likelihood of an incomplete resection. Intraoperative bone scintigraphy (IOBS) can be used to verify location and complete surgical resection. OBJECTIVE To review our experience using IOBS for resection of intraspinal osteoid osteoma. METHODS IRB approved, retrospective review of IOBS-guided resection over 10 years. Patients underwent injection of 200 uCi/kg (1-20 mCi) 99mTc-MDP 3-4 h prior surgery. Portable single-headed gamma camera equipped with a pinhole collimator (3- or 4-mm aperture) was used. Images were obtained pre-operatively, at the start of the procedure, and intraoperatively. Operative notes were reviewed. Evaluation of recurrence and clinical follow-up was performed. RESULTS Twenty IOBS-guided resections were performed in 18 patients (median age 13.5 years, 6-22 years, 12 males). Size ranged 5-16 mm, with 38.9% (7/18) cervical, 22.2% (4/18) thoracic, 22.2% (4/18) lumbar, and 16.7% (3/18) sacral. In all cases, IOBS was able to localize the lesion. After suspected total excision, IOBS altered the surgical plan in 75% of cases (15/20), showing residual activity prompting further resection. Median length of follow-up was 6 months (range 1-156 months) with 90% (18/20) showing complete resection without recurrence. Two patients had osteoid osteoma recurrence at 7 and 10 months following the original resection, requiring re-intervention. CONCLUSIONS IOBS is a useful tool for real-time localization and assessment of spinal osteoid osteoma resection. In all cases, IOBS was able to localize the lesion and changed surgical planning in 75% of cases. Ninety percent of patients achieved complete resection and remain recurrence free.
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Affiliation(s)
- M Alejandra Bedoya
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Aleksandra A Krokhmal
- Department of Radiology, Mount Auburn Hospital, 330 Mt Auburn St, Cambridge, MA, USA
| | - Vasiliki C Kourmouzi
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Neha S Kwatra
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Laura A Drubach
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Katie P Fehnel
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, , USA
| | - Mark R Proctor
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, , USA
| | - Stephan D Voss
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
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Joshi G, Bhatta OP, Chand H, Mudbhari B, Dangol N, Bhetwal P. A solitary osteochondroma of the sixth cervical spine: A case report. Int J Surg Case Rep 2023; 110:108729. [PMID: 37657384 PMCID: PMC10509925 DOI: 10.1016/j.ijscr.2023.108729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Osteochondromas, the most common benign tumors of the appendicular skeleton, are uncommonly found in the spine. Although the cervical spine is the most frequent location of spinal osteochondromas, the lower cervical spine is less commonly affected. CASE PRESENTATION We present the case of a 16-year-old female adolescent who presented with a hard palpable mass over the nape of the neck more toward the right side associated with non-radiating pain for 3 years. Radiography and computed tomography (CT) revealed an expansile bone lesion arising from the sixth cervical spinous process (C6). En-bloc resection of the tumor was performed, which alleviated her symptoms. A histopathological examination revealed the presence of an osteochondroma without any features suggestive of malignancy. CLINICAL DISCUSSION Osteochondroma is a common benign bone tumor, mainly found in the appendicular skeleton, with rare occurrences in the spine. It can be solitary or associated with multiple hereditary exostoses (MHE). The cervical spine is the most affected area, and its symptoms vary depending on its location. Diagnosis involves imaging, and surgical excision is recommended for symptomatic cases to prevent neurological compromise, and recurrence, and to confirm the diagnosis by histopathology. CONCLUSION Diagnosing rare conditions such as cervical osteochondroma requires a high level of clinical suspicion and the assistance of imaging techniques in patients exhibiting relevant symptoms. Optimal outcomes were achieved using en bloc resection.
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Affiliation(s)
- Gyanendra Joshi
- Department of Orthopedics, Seti Provincial Hospital, Kailali, Nepal
| | | | - Hemant Chand
- Department of Emergency Medicine, Nova Hospital, Kailali, Nepal
| | | | - Neha Dangol
- Department of Emergency Medicine, Nova Hospital, Kailali, Nepal
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Truong VT, Al-Shakfa F, Roberge D, Masucci GL, Tran TPY, Dib R, Yuh SJ, Wang Z. Assessing the Performance of Prognostic Scores in Patients with Spinal Metastases from Lung Cancer Undergoing Non-surgical Treatment. Asian Spine J 2023; 17:739-749. [PMID: 37408290 PMCID: PMC10460656 DOI: 10.31616/asj.2022.0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/06/2023] [Accepted: 02/13/2023] [Indexed: 07/07/2023] Open
Abstract
STUDY DESIGN Retrospective study. PURPOSE The purpose of this study was to see how well the Tomita score, revised Tokuhashi score, modified Bauer score, Van der Linden score, classic Skeletal Oncology Research Group (SORG) algorithm, SORG nomogram, and New England Spinal Metastasis Score (NESMS) predicted 3-month, 6-month, and 1-year survival of non-surgical lung cancer spinal metastases. OVERVIEW OF LITERATURE There has been no study assessing the performance of prognostic scores for non-surgical lung cancer spinal metastases. METHODS Data analysis was carried out to identify the variables that had a significant impact on survival. For all patients with spinal metastasis from lung cancer who received non-surgical treatment, the Tomita score, revised Tokuhashi score, modified Bauer score, Van der Linden score, classic SORG algorithm, SORG nomogram, and NESMS were calculated. The performance of the scoring systems was assessed by using receiver operating characteristic (ROC) curves at 3 months, 6 months, and 12 months. The predictive accuracy of the scoring systems was quantified using the area under the ROC curve (AUC). RESULTS A total of 127 patients are included in the present study. The median survival of the population study was 5.3 months (95% confidence interval [CI], 3.7-9.6 months). Low hemoglobin was associated with shorter survival (hazard ratio [HR], 1.49; 95% CI, 1.00-2.23; p =0.049), while targeted therapy after spinal metastasis was associated with longer survival (HR, 0.34; 95% CI, 0.21-0.51; p <0.001). In the multivariate analysis, targeted therapy was independently associated with longer survival (HR, 0.3; 95% CI, 0.17-0.5; p <0.001). The AUC of the time-dependent ROC curves for the above prognostic scores revealed all of them performed poorly (AUC <0.7). CONCLUSIONS The seven scoring systems investigated are ineffective at predicting survival in patients with spinal metastasis from lung cancer who are treated non-surgically.
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Affiliation(s)
- Van Tri Truong
- Division of Orthopaedics, Centre Hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, QC,
Canada
- Department of Neurosurgery, Vinmec Central Park International Hospital, Vinmec Healthcare System, Ho Chi Minh City,
Vietnam
| | - Fidaa Al-Shakfa
- Division of Orthopaedics, Centre Hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, QC,
Canada
| | - David Roberge
- Division of Radiation Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, QC,
Canada
| | - Giuseppina Laura Masucci
- Division of Radiation Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, QC,
Canada
| | - Thi Phuoc Yen Tran
- Research Center, Centre Hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, QC,
Canada
- Department of Internal Medicine, Vinmec Central Park International Hospital, Vinmec Healthcare System, Ho Chi Minh City,
Vietnam
| | - Rama Dib
- Division of Orthopaedics, Centre Hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, QC,
Canada
| | - Sung-Joo Yuh
- Division of Neurosurgery, Centre Hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, QC,
Canada
| | - Zhi Wang
- Division of Orthopaedics, Centre Hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, QC,
Canada
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Huang YC, Tsuang FY, Lee CW, Lin YH. Efficacy of preoperative embolization for metastatic spinal tumor surgery using angiographic vascularity assessment. Eur Radiol 2023; 33:2638-2646. [PMID: 36449062 DOI: 10.1007/s00330-022-09276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/22/2022] [Accepted: 10/27/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVES Preoperative embolization (PE) for metastatic spinal tumors is a method of minimizing intraoperative blood loss during aggressive surgery. This study specified angiographic standards and investigated the influence of these and other factors on blood loss in patients with spinal metastases and various pathologies. METHODS The cohort comprised 126 consecutive patients receiving PE from 2015 to 2021. Their clinical, surgical, and angiographic characteristics were reviewed. Standard angiographic grading was used for vascularity assessment. Degree of embolization was divided into complete (≥ 90%), near complete (67 to < 90%), and partial (< 67%). Logistic regression analysis was used to investigate factors predictive of massive blood loss (> 2500 mL). A proportional odds model was used to assess factors predictive of the degree of embolization. RESULTS Mean intraoperative blood loss was 1676 mL. Among the patients, 62 had hypervascular tumors and 64 had nonhypervascular tumors, according to the angiographic classification. Intraoperative blood loss differed significantly with embolization degree, both overall (p < 0.001) and in the hypervascular and nonhypervascular groups (p = 0.01 and 0.03). Angiographic hypervascularity, spinal metastasis invasiveness index, and embolization degree were significant predictors of massive blood loss in univariate analysis, but only embolization degree was significant in multivariate analysis. Only the presence of the radiculomedullary artery at the target level was significant in both the univariate and multivariate analyses for embolization degree. CONCLUSIONS In addition to pathological classification, angiographic vascularity assessment is valuable. Although complete embolization is a reasonable goal, it is challenging to achieve in cases of visible radiculomedullary artery. KEY POINTS • Angiography has a supplementary role in vascularity assessment for spinal metastatic surgery. • Better embolization degree is associated with less intraoperative blood loss in both angiographic hypervascular and nonhypervascular groups. • Presence of radiculomedullary artery in the target level causes worse embolization outcome.
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Affiliation(s)
- Yu-Cheng Huang
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10055, Taiwan
- Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Fon-Yih Tsuang
- Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Wei Lee
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10055, Taiwan
| | - Yen-Heng Lin
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10055, Taiwan.
- Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan.
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Sun W, Wang J, Wang J, Fan J, Zhou Y, Wang Y, Han R. Esketamine combined with pregabalin on acute postoperative pain in patients undergoing resection of spinal neoplasms: study protocol for a randomized controlled trial. Trials 2023; 24:144. [PMID: 36841794 PMCID: PMC9960454 DOI: 10.1186/s13063-023-07178-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 02/17/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Perioperative pain management is one of the most challenging issues for patients with spinal neoplasms. Inadequate postoperative analgesia usually leads to severe postsurgical pain, which could cause patients to suffer from many other related complications. Meanwhile, there is no appropriate analgesic strategy for patients with spinal neoplasms. METHODS/DESIGN This is a protocol for a randomized double-blind controlled trial to evaluate the effect of esketamine combined with pregabalin on postsurgical pain in spinal surgery. Patients aged 18 to 65 years scheduled for spinal neoplasm resection will be randomly allocated into the combined and control groups in a 1:1 ratio. In the combined group, esketamine will be given during the during the surgery procedure until 48-h postoperative period, and pregabalin will be taken from 2 h before the surgery to 2 weeks postoperatively. The control group will receive normal saline and placebo capsules at the same time points. Both groups received a background analgesic regimen by using patient-controlled intravenous analgesia (containing 100 μg sufentanil and 16 mg ondansetron) until 2 days after surgery. To ensure the accuracy and reliability of this trial, all the researchers and patients will be blinded until the completion of this study. The primary outcome will be the proportion of patients with acute moderate-to-severe postsurgical pain (visual analog scale, VAS ≥ 40, range: 0-100, with 0, no pain; 100, the worst pain) during the 48-h postoperative period. The secondary outcomes will include the maximal VAS scores (when the patients felt the most intense pain over the last 24 h before being interviewed) at 0-2 h, 2-24 h, 24-48 h, and 48-72 h after leaving the operating room and 24 h before discharge; the incidence of acute moderate-to-severe postsurgical pain at each other time point; chronic postsurgical pain assessment; neuropathic pain assessment; and the incidence of drug-related adverse events and other postoperative complications, such as postoperative delirium and postoperative nausea and vomiting (PONV). DISCUSSION The aim of this study was to evaluate the effect of esketamine combined with pregabalin on acute postsurgical pain in patients undergoing resection of spinal neoplasms. The safety of this perioperative pain management strategy will also be examined. TRIAL REGISTRATION ClinicalTrials.gov NCT05096468. Registered on October 27, 2021.
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Affiliation(s)
- Wanchen Sun
- grid.24696.3f0000 0004 0369 153XDepartment of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, People’s Republic of China 100070
| | - Juan Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, People’s Republic of China 100070
| | - Jing Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, People’s Republic of China 100070
| | - Jingyi Fan
- grid.24696.3f0000 0004 0369 153XDepartment of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, People’s Republic of China 100070
| | - Yang Zhou
- grid.24696.3f0000 0004 0369 153XDepartment of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, People’s Republic of China 100070
| | - Yunzhen Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, People’s Republic of China 100070
| | - Ruquan Han
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, People's Republic of China, 100070.
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Truong VT, Al-Shakfa F, Newman N, Roberge D, Masucci GL, Tran TPY, Boubez G, Shedid D, Yuh SJ, Wang Z. Spinal Metastasis in Multiple Primary Malignancies Involving Lung Cancer: Clinical Characteristics and Survival. World Neurosurg 2022; 167:e726-e731. [PMID: 36030008 DOI: 10.1016/j.wneu.2022.08.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The incidence of multiple primary malignancies (MPM) has increased in recent decades. Our aim was to evaluate incidence, clinical features, and survival in cases of spinal metastases from MPM in which one of the malignancies is lung cancer. METHODS We retrospectively reviewed an institutional database of lung cancer patients with spinal metastasis and extracted all cases of MPM. RESULTS Among 275 patients who had spinal metastasis with lung cancer as one of the diagnoses, 21 (7.6%) patients with MPM were identified. Mean patient age was 68.5 years (95% confidence interval [CI], 65.3-71.7). The most common cancers diagnosed in addition to lung cancer were breast cancer (5 patients, 24%), upper aerodigestive tract cancer (4 patients, 19%), and prostate cancer (4 patients, 19%). Eighteen (86%) patients walked independently, and 3 (14%) patients walked with help. Seventeen (80.9%) patients had a good Karnofsky performance scale score. The median survivals from the date of first cancer diagnosis, last cancer diagnosis, and spinal metastasis diagnosis were 109.8 months (95% CI, 23.5-196.1), 17.8 months (95% CI, 5.8-29.8), and 10.3 months (95% CI, 5.4-15.2), respectively. Actual rates of survival at 6 months, 12 months, and 24 months from the date of spinal metastasis diagnosis were 81%, 42.9%, and 23.8%, respectively. CONCLUSIONS The present study is the first series to our knowledge to show that survival of patients with spinal metastasis and MPM involving lung cancer is not clearly inferior to that of patients with spinal metastasis and lung cancer alone.
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Affiliation(s)
- Van Tri Truong
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada; Department of Neurosurgery, Vinmec Central Park International Hospital, Vinmec Healthcare System, Ho Chi Minh City, Vietnam.
| | - Fidaa Al-Shakfa
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Nicholas Newman
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - David Roberge
- Division of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Giuseppina Laura Masucci
- Division of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Thi Phuoc Yen Tran
- Department of Neurosurgery, Vinmec Central Park International Hospital, Vinmec Healthcare System, Ho Chi Minh City, Vietnam; Research Center, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Ghassan Boubez
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Daniel Shedid
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Sung-Joo Yuh
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
| | - Zhi Wang
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
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Moulin B, Servois V, Dbjay J, Dutertre G, Thery L, Bouleuc C, Marchal T, Laouisset C, Burnod A, Smadja J, Brisse H. CT-Guided Percutaneous Vertebroplasty of the Cervico-Thoracic Junction for the Management of Pathologic Fracture or Symptomatic Lytic Lesion in Cancer Patients. Cardiovasc Intervent Radiol 2021; 45:244-248. [PMID: 34853875 DOI: 10.1007/s00270-021-03018-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this retrospective observational study is to report author's experience in computed-tomography (CT)-guided percutaneous vertebroplasty (PV) of the cervicothoracic junction. METHODS The records of all consecutive patients treated by PV at levels C7, T1, T2, and T3 in a tertiary cancer center during year 2020 were extracted from the Institutional electronic archive. Following data were collected: demographics, indication for PV, procedure features, outcomes, and complications. Technical success was defined as when the trocar was placed into the vertebral body, allowing the injection of polymethyl-metacrylate (PMMA). RESULTS Eleven patients were identified who received PV on 14 levels. Mean procedure duration was 57 ± 22 min (range [31-142]). A "trans-pedicular approach at the targeted level" was used in 1 vertebra (7%), a "costotransverse approach, at the targeted level" was used in 1 vertebra (7%), a "transpedicular approach via the level below" was used in 3 vertebrae (22%), and a "costotransverse approach via the level below" was used in 9 vertebrae (64%). Meantime to deploy each trocar was 20 ± 5 min (range [12-32]). Technical success was achieved in 14/14 (100%) of vertebrae. Mean postoperative hospitalization duration was 1.9 ± 1.7 days (range [1-11]). According to CIRSE classification, no adverse event occurred. PMMA leakage occurred in two patients; both remained asymptomatic. CONCLUSION This study provides arguments in favor of safety and efficiency of CT-guided vertebroplasty of levels C7, T1, T2, and T3, for both trocar deployment and monitoring of the vertebral body filling during the PMMA injection.
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Affiliation(s)
- Benjamin Moulin
- Interventional Radiology Unit, Imaging Department, Institut Curie, 26 rue d'Ulm, 75005, Paris, France.
| | - Vincent Servois
- Interventional Radiology Unit, Imaging Department, Institut Curie, 26 rue d'Ulm, 75005, Paris, France
| | - Jonathan Dbjay
- Interventional Radiology Unit, Imaging Department, Institut Curie, 26 rue d'Ulm, 75005, Paris, France
| | - Guillaume Dutertre
- Department of Surgery, Institut Curie, 26 rue d'Ulm, 75005, Paris, France
| | - Laura Thery
- Palliative Care Unit, Institut Curie, 26 rue d'Ulm, 75005, Paris, France
| | - Carole Bouleuc
- Palliative Care Unit, Institut Curie, 26 rue d'Ulm, 75005, Paris, France
| | - Timothee Marchal
- Palliative Care Unit, Institut Curie, 26 rue d'Ulm, 75005, Paris, France
| | - Celine Laouisset
- Palliative Care Unit, Institut Curie, 26 rue d'Ulm, 75005, Paris, France
| | - Alexis Burnod
- Palliative Care Unit, Institut Curie, 26 rue d'Ulm, 75005, Paris, France
| | - Jeremy Smadja
- Interventional Radiology Unit, Imaging Department, Institut Curie, 26 rue d'Ulm, 75005, Paris, France
| | - Herve Brisse
- Interventional Radiology Unit, Imaging Department, Institut Curie, 26 rue d'Ulm, 75005, Paris, France
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Wang J, Qi Q, Ni S. Primary Intradural Hemangioendothelioma of Lumbar Spine. World Neurosurg 2022; 157:46-7. [PMID: 34601170 DOI: 10.1016/j.wneu.2021.09.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 11/20/2022]
Abstract
Hemangioendotheliomas are rare, intermediate-grade malignant tumors in the neuraxis, mainly involving the brain and meninges. Hemangioendotheliomas of the spine have been encountered more often in the vertebral body than the intradural space. Here, we present a rare case of a unique intradural hemangioendothelioma of the lumbar spine; only a few such cases exist in the literature.
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Wang Z, Yuh SJ, Renaud-Charest E, Tarabay B, Gennari A, Shedid D, Boubez G, Truong VT. Cervical Spine Reconstruction with Chest Tube Technique After Metastasis Resection: A Single-Center Experience. World Neurosurg 2021; 157:e49-e56. [PMID: 34583005 DOI: 10.1016/j.wneu.2021.09.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The silastic tube technique, in which a chest tube is placed into the vertebral body defect and impregnated with polymethyl methacrylate, showed good results in patients with lumbar and thoracic neoplastic diseases. There has been only 1 study about the effectiveness and safety of this technique in patients with cervical metastases. We aimed to report our experience in using this technique to reconstruct the spine after corpectomy for cervical metastasis. METHODS All patients with cervical spinal metastasis who underwent surgical treatment using a chest tube impregnated with polymethyl methacrylate in conjunction with anterior cervical plate stabilization were retrospectively recruited. Demographics, tumor histology, revised Tokuhashi score, preoperative and postoperative American Spinal Injury Association score, preoperative and postoperative ambulatory status, perioperative complications, and survival time were collected. RESULTS This study included 16 patients. The most common primary tumor site was the lung (6 patients; 37.5%). The mean (SD) survival time was 408 (401) days (range, 1-2797 days), and the median survival time was 72 days (95% confidence interval 28-116 days). Four patients (25%) died within 30 postoperative days. There was no surgical site infection or instrument failure after the surgery. Five patients (31.2%) lived >180 days, and 3 patients (18.8%) lived >360 days. One patient (6.2%) was still alive at the end of the study. CONCLUSIONS The silastic tube technique in conjunction with anterior cervical plate stabilization might be safe, effective, and cost-effective for patients with cervical spine metastasis.
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Affiliation(s)
- Zhi Wang
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Sung-Joo Yuh
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Emilie Renaud-Charest
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Bilal Tarabay
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Antoine Gennari
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Daniel Shedid
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Ghassan Boubez
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Van Tri Truong
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada.
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12
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Truong VT, Al-Shakfa F, Phan P, Newman N, Boubez G, Shedid D, Yuh SJ, Wang Z. Does the Region of the Spine Involved with Metastatic Tumor Affect Outcomes of Surgical Treatments? World Neurosurg 2021; 156:e139-e151. [PMID: 34530150 DOI: 10.1016/j.wneu.2021.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Spinal metastases occur primarily in the thoracic spine (50%-60%), less commonly in the lumbar (30%-35%), and, infrequently, in the cervical spine (10%-15%). There has been only 1 study with a limited population comparing the postoperative outcome among cervical, thoracic, and lumbar spine metastasis. The aim of this study is to identify whether the region of surgically treated spinal metastasis affects postoperative outcomes. METHODS A retrospective study of patients with spinal metastasis was performed. The collected data were as follows: age, gender, smoking history, tumor histology, revised Tokuhashi score, preoperative and postoperative American Spinal Injury Association score, region of spinal metastasis, ambulatory status, surgical approach, surgery time, blood loss, complications, length of hospital stay, postoperative pain relief, postoperative adjuvant therapy, and survival. Data were analyzed to identify the factors affecting the survival and postoperative functional outcome. RESULTS We studied 191 patients with spinal metastasis including 47 cervical spine metastases, 96 thoracic spine metastases, and 48 lumbar spine metastases, with a mean age of 60.91 ± 9.72 years. The overall median survival was 7 months (95% confidence interval, 2.9-20.63 months). Univariate analysis showed that region of the spine involved with metastasis did not significantly affect the survival and postoperative motor function improvement. Multivariate analysis showed that revised Tokuhashi score, postoperative radiotherapy, and postoperative chemotherapy were independent factors affecting survival. The rate of 30-day complications among patients with different regions of spine metastasis did not reach significance. CONCLUSIONS The postoperative outcomes of patients undergoing surgery for metastases are not affected by the region of the spine.
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Affiliation(s)
- Van Tri Truong
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada.
| | - Fidaa Al-Shakfa
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Philippe Phan
- Division of Orthopedics, Ottawa Hospital-Civic Campus, Ottawa, Ontario, Canada
| | - Nicholas Newman
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Ghassan Boubez
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Daniel Shedid
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Sung-Joo Yuh
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Zhi Wang
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
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13
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Facchini G, Parmeggiani A, Peta G, Martella C, Gasbarrini A, Evangelisti G, Miceli M, Rossi G. The role of percutaneous transarterial embolization in the management of spinal bone tumors: a literature review. Eur Spine J 2021; 30:2839-2851. [PMID: 34415449 DOI: 10.1007/s00586-021-06963-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Spinal bone tumors include a heterogeneous broad of primary or metastatic lesions that may present as incidental findings or manifest with painful symptoms and pathological fractures. Optimal management of spine bone lesions is often difficult and treatment algorithms are usually solidly based on surgery. We aimed to evaluate the contribution of trans-arterial embolization in this field, with particular attention to the procedure efficacy, technical difficulties and complications. METHODS We present a literature review on the role of trans-arterial embolization in the management of spinal bone tumors, both primary and metastatic, evaluating its contribution as preoperative treatment, palliative procedure and standalone curative strategy. RESULTS Trans-arterial embolization provides an important contribution to reducing surgery hemorrhagic risks, offering a better visualization of the operating field, and possibly increasing tumor susceptibility to chemotherapy or radiation therapy. Nonetheless, it plays an important part in pain palliation, with the unquestionable advantage of being easily repeatable in case of necessity. Its curative role as a standalone therapy is still subject of debate, and at the present time, satisfactory results have been recorded only in the treatment of aneurysmal bone cysts. CONCLUSION Percutaneous trans-arterial embolization has established as a highly useful minimally invasive procedure in the management of spinal bone lesions, particularly as adjuvant preoperative therapy and palliative treatment.
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Affiliation(s)
- Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Anna Parmeggiani
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy. .,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - Giuliano Peta
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Claudia Martella
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gisberto Evangelisti
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Giuseppe Rossi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy
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14
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Moulin B, Brisse H, Dutertre G, Brenet O, Queinnec M, Cottu P, Zadegan F, Moreau S, Benchimol R, Cao K, Servois V. CT-guided vertebroplasty of first (C1) or second (C2) cervical vertebra using an electromagnetic navigation system and a transoral approach. Diagn Interv Imaging 2021; 102:571-575. [PMID: 33972193 DOI: 10.1016/j.diii.2021.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Benjamin Moulin
- Interventional Radiology Unit, Imaging Department, Institut Curie, 75005 Paris, France.
| | - Herve Brisse
- Interventional Radiology Unit, Imaging Department, Institut Curie, 75005 Paris, France
| | - Guillaume Dutertre
- Interventional Radiology Unit, Imaging Department, Institut Curie, 75005 Paris, France
| | - Olivier Brenet
- Anesthesiology and Pain Management Unit, Institut Curie, 75005 Paris, France
| | - Marie Queinnec
- Anesthesiology and Pain Management Unit, Institut Curie, 75005 Paris, France
| | - Paul Cottu
- Medical Oncology Unit, Institut Curie, 75005 Paris, France
| | - Frederic Zadegan
- Orthopedic Surgery Unit, Institut Mutualiste Montsouris, 75014 Paris, France
| | - Sebastien Moreau
- Orthopedic Surgery Unit, Institut Mutualiste Montsouris, 75014 Paris, France
| | - Raphael Benchimol
- Interventional Radiology Unit, Imaging Department, Institut Curie, 75005 Paris, France
| | - Kim Cao
- Radiation Therapy Unit, Institut Curie, 75005 Paris, France
| | - Vincent Servois
- Interventional Radiology Unit, Imaging Department, Institut Curie, 75005 Paris, France
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15
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Kim H, Pyo H, Park HC, Lim DH, Yu JI, Park W, Ahn YC, Choi DH, Oh D, Noh JM, Cho WK, Yoo GS, Jung SH, Kim ES, Lee SH, Park SJ, Lee CS. Clinical and dosimetric risk factors for vertebral compression fracture after single-fraction stereotactic body radiation therapy for spine metastases. J Bone Oncol 2021; 28:100368. [PMID: 34026479 PMCID: PMC8131921 DOI: 10.1016/j.jbo.2021.100368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 10/31/2022] Open
Abstract
Objectives This analysis was performed to evaluate the incidence of vertebral compression fracture (VCF) and determine the contributing factors for VCF in patients undergoing single-fraction stereotactic body radiotherapy (SBRT) for spinal bone metastases (SBM). Methods A retrospective review of medical records was conducted for patients undergoing SBRT for SBM at our institution between January 2010 and December 2018. Patients who had undergone neither pre-SBRT surgical excision nor post-SBRT prophylactic fixation were included. The effects of clinical and dosimetric parameters were analyzed with respect to VCF risk. The following dosimietric parameters of the planning target volume (PTV) were calculated: mean/minimum/maximum dose, radiation dose to 10-90% volume, and irradiated volume receiving more than 10-25 Gy (PTV_V10 - 25 Gy). Results Among 163 patients (179 vertebrae), 21 (12.8%) experienced VCF. The 1-year and 2-year VCF rates were 12.1% and 13.2%, respectively. Among dosimetric parameters, PTV_V15 Gy was the most significant for VCF prediction. In a univariate analysis, breast or prostate primary, no vertebral body collapse, and PTV_V15 Gy ≤42 cm3 were significantly associated with a lower incidence rate of VCF. In a multivariate analysis, PTV_V15 Gy was the only significant factor for VCF risk. The 1-year VCF rate was 3.8% in patients with PTV_V15 Gy ≤42 cm3, while it was 22.1% in those with PTV_V15 Gy > 42 cm3 (p < 0.01). Conclusions SBRT-related VCF was found in 12% of patients in our institution. The PTV_V15 Gy is a significant factor for VCF prediction.
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Affiliation(s)
- Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hongryull Pyo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Jung
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun-Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se-Jun Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chong-Suh Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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16
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Müther M, Lüthge S, Gerwing M, Stummer W, Schwake M. Management of Spinal Dumbbell Tumors via a Minimally Invasive Posterolateral Approach and Carbon Fiber-Reinforced Polyether Ether Ketone Instrumentation: Technical Note and Surgical Case Series. World Neurosurg 2021; 151:277-283.e1. [PMID: 33915306 DOI: 10.1016/j.wneu.2021.04.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Stand-alone minimally invasive approaches for the surgical management of spinal dumbbell tumors carry the risk of incomplete resections and impaired hemostasis. More-extensive approaches require subsequent instrumentation with metal artifacts impairing follow-up imaging. Here, we present a technical note on percutaneous instrumentation using carbon fiber-reinforced polyether ether ketone (CFR-PEEK) hardware combined with a minimally invasive posterolateral approach for tumor resection. METHODS We present a Technical Note and according case series of 7 patients with dumbbell tumors in the lumbar and thoracolumbar spine operated on between 2017 and 2020. CFR-PEEK pedicle screws and rods were inserted percutaneously. Afterwards, a dedicated self-standing retractor for posterolateral approaches was connected to the screws. Following a unilateral facetectomy, the tumor was resected in a microsurgical fashion. Clinical data are reported with respect to the Preferred Reporting Of CasE Series in Surgery (PROCESS) guidelines. RESULTS Four patients presented with de novo tumors. Three patients were treated for residual tumor mass after previous surgeries. Gross total resection was achieved in all 7 cases, as demonstrated by early postoperative magnetic resonance imaging. Histopathology demonstrated 5 World Health Organization grade I schwannomas, 1 grade II hemangiopericytoma, and 1 cavernous hemangioma. No postoperative complications were observed. CFR-PEEK hardware allowed unambiguous visualization of the resection cavity on follow-up imaging. CONCLUSIONS Resection of dumbbell tumors via a minimally invasive posterolateral approach and instrumentation with CFR-PEEK hardware allows maximal and safe resection. Due to lack of major metal artifacts, carbon fiber hardware improves the interpretation of follow-up imaging as well as planning of radiation if required for tumor recurrence.
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Affiliation(s)
- Michael Müther
- Department of Neurosurgery, University Hospital Münster, Münster, Germany.
| | - Swenja Lüthge
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Mirjam Gerwing
- Department of Radiology, University Hospital Münster, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
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Choi HY, Kim KH, Cho BK, Wang KC, Phi JH, Lee JY, Park SH, Kim SK. Clinicopathological Features of Primary Solitary Spinal Cord Tumors in Pediatric Patients : A 32-Year Single Institution Experience. J Korean Neurosurg Soc 2021; 64:592-607. [PMID: 33853299 PMCID: PMC8273779 DOI: 10.3340/jkns.2020.0243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/21/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Few studies exist on primary spinal cord tumors (PSCTs) in pediatric patients. The purpose of this study was to perform descriptive analysis and detailed survival analysis for PSCTs. METHODS Between 1985 and 2017, 126 pediatric patients (male : female, 56 : 70) with PSCTs underwent surgery in a single institution. We retrospectively analyzed data regarding demographics, tumor characteristics, outcomes, and survival statistics. Subgroup analysis was performed for the intramedullary (IM) tumors and extradural (ED) tumors separately. RESULTS The mean age of the participants was 6.4±5.04 years, and the mean follow-up time was 69.5±46.30 months. The most common compartment was the ED compartment (n=57, 45.2%), followed by the IM (n=43, 34.1%) and intradural extramedullary (IDEM; n=16, 12.7%) compartments. Approximately half of PSCTs were malignant (n=69, 54.8%). The most common pathologies were schwannomas (n=14) and neuroblastomas (n=14). Twenty-two patients (17.5%) died from the disease, with a mean disease duration of 15.8±15.85 months. Thirty-six patients (28.6%) suffered from progression, with a mean period of 22.6±30.81 months. The 10-year overall survival (OS) rates and progression-free survival (PFS) rates were 81% and 66%, respectively. Regarding IM tumors, the 10-year OS rates and PFS rates were 79% and 57%, respectively. In ED tumors, the 10-year OS rates and PFS rates were 80% and 81%, respectively. Pathology and the extent of resection showed beneficial effects on OS for total PSCTs, IM tumors, and ED tumors. PFS was affected by both the extent of removal and pathology in total PSCTs and ED tumors; however, pathology was a main determinant of PFS rather than the extent of removal in IM tumors. The degree of improvement in the modified McCormick scale showed a trend towards improvement in patients with IM tumors who achieved gross total removal (p=0.447). CONCLUSION Approximately half of PSCTs were malignant, and ED tumors were most common. The most common pathologies were schwannomas and neuroblastomas. Both the pathology and extent of resection had a decisive effect on OS. For IM tumors, pathology was a main determinant of PFS rather than the extent of removal. Radical excision of IM tumors could be a viable option for better survival without an increased risk of worse functional outcomes.
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Affiliation(s)
- Ho Yong Choi
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kyung Hyun Kim
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Kyu Cho
- Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam, Korea
| | - Kyu-Chang Wang
- Neuro-oncology Clinic, National Cancer Center, Goyang, Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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18
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Abstract
OBJECTIVE To evaluate the value of CT spectral curve in differentiating spinal tumor metastasis (STM) from spinal infections (SI). METHODS In the study, 29 STM and 18 SI patients proved pathologically and clinically were examined by dual energy spectral CT (DESCT). The monochromatic images and CT spectral curves were generated automatically by GSI Viewer software. The attenuation values at different energy levels (40-140 keV, every 10 keV), the attenuation values of the lesions on the conventional polychromatic CT images and the gradients of the curve were calculated and compared between STM and SI. RESULTS The median age of STM and SI (58 years vs. 64 years) were not significantly different (U=171, P=0.4). The attenuation values of STM at 40-100 keV were 281.79 (143.67, 446.19) HU, 199.68 (100.04, 321.49) HU, 151.54 (81.47, 243.49) HU, (122.64±27.72) HU, (99.90±23.88) HU, (85.82±21.61) HU, and (75.94±20.27) HU, respectively, which were significantly higher than SI: 185.29 (164.19, 277.03) HU, 138.44 (124.98, 238.56) HU, 105.46 (92.94, 169.53) HU, (93.77±15.55) HU, (79.15±12.84) HU, (68.99±11.75) HU, and (62.22±11.71) HU (all P < 0.05). The attenuation values at 110-140 keV and the attenuation value on the conventional CT images were not significantly different between STM and SI. The gradient of CT spectral curve of STM was 2.43±0.58, which was higher than the value of 1.50±0.40 for SI (P < 0.001). Using 1.72 and 248.80 HU as the threshold value for CT spectral curve slope and the attenuation value at 40 keV, could obtain the area under receiver operating characteristic (ROC) curve of 0.905 and 0.892, sensitivity of 88.0% and 80.0%, and specificity of 76.9% and 92.3%. CONCLUSION CT spectral curve provides valuable semi-quantitative information for the differential diagnosis of STM and SI, which can be used as a supplement to traditional CT imaging.
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Santos RHP, França CNL, Guimarães VD, Prigenzi CKC, Fontoura EAF, Botelho RV. Aggressive vertebral hemangiomas in asymptomatic patients: A review. Surg Neurol Int 2020; 11:453. [PMID: 33408938 PMCID: PMC7771498 DOI: 10.25259/sni_683_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/01/2020] [Indexed: 11/04/2022] Open
Abstract
Background Hemangioma is the most common benign tumor of the spine. Most patients are asymptomatic, but some lesions can become aggressive, leading to spinal compression. Here, we reviewed the natural history and treatment of aggressive hemangiomas in asymptomatic patients. Methods An electronic review of the literature was performed regarding the diagnosis/treatment modalities for asymptomatic aggressive hemangiomas of the spine utilizing the Medline (PubMed) and Google Scholar databases. Results We selected four articles describing the diagnosis/management of four cases of aggressive, asymptomatic hemangiomas in patients averaging 11.25 ± 2.36 years of age. Three of the four patients were females, and all were followed an average of 36.5 ± 25 months. Notably, two of four patients required emergency surgery. Conclusion There is a paucity of the literature regarding the diagnosis and optimal therapeutic management of aggressive hemangiomas in asymptomatic patients, half of whom may present with acute neurological deterioration warranting emergency surgery.
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Affiliation(s)
| | | | | | | | | | - Ricardo Vieira Botelho
- Department of Neurosurgery, Instituto de Assistência Médica ao Servidor Público do Estado de São Paulo, São Paulo, Brazil
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Oztek MA, Mayr NA, Mossa-Basha M, Nyflot M, Sponseller PA, Wu W, Hofstetter CP, Saigal R, Bowen SR, Hippe DS, Yuh WTC, Stewart RD, Lo SS. The Dancing Cord: Inherent Spinal Cord Motion and Its Effect on Cord Dose in Spine Stereotactic Body Radiation Therapy. Neurosurgery 2020; 87:1157-1166. [PMID: 32497210 PMCID: PMC8184298 DOI: 10.1093/neuros/nyaa202] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/19/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Spinal cord dose limits are critically important for the safe practice of spine stereotactic body radiotherapy (SBRT). However, the effect of inherent spinal cord motion on cord dose in SBRT is unknown. OBJECTIVE To assess the effects of cord motion on spinal cord dose in SBRT. METHODS Dynamic balanced fast field echo (BFFE) magnetic resonance imaging (MRI) was obtained in 21 spine metastasis patients treated with SBRT. Planning computed tomography (CT), conventional static T2-weighted MRI, BFFE MRI, and dose planning data were coregistered. Spinal cord from the dynamic BFFE images (corddyn) was compared with the T2-weighted MRI (cordstat) to analyze motion of corddyn beyond the cordstat (Dice coefficient, Jaccard index), and beyond cordstat with added planning organ at risk volume (PRV) margins. Cord dose was compared between cordstat, and corddyn (Wilcoxon signed-rank test). RESULTS Dice coefficient (0.70-0.95, median 0.87) and Jaccard index (0.54-0.90, median 0.77) demonstrated motion of corddyn beyond cordstat. In 62% of the patients (13/21), the dose to corddyn exceeded that of cordstat by 0.6% to 13.8% (median 4.3%). The corddyn spatially excursed outside the 1-mm PRV margin of cordstat in 9 patients (43%); among these dose to corddyn exceeded dose to cordstat >+ 1-mm PRV margin in 78% of the patients (7/9). Corddyn did not excurse outside the 1.5-mm or 2-mm PRV cord cordstat margin. CONCLUSION Spinal cord motion may contribute to increases in radiation dose to the cord from SBRT for spine metastasis. A PRV margin of at least 1.5 to 2 mm surrounding the cord should be strongly considered to account for inherent spinal cord motion.
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Affiliation(s)
- Murat Alp Oztek
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Nina A Mayr
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Matthew Nyflot
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington.,Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Patricia A Sponseller
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Wei Wu
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Christoph P Hofstetter
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Rajiv Saigal
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Stephen R Bowen
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington.,Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Daniel S Hippe
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - William T C Yuh
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Robert D Stewart
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
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De la Garza Ramos R, Echt M, Benton JA, Gelfand Y, Longo M, Yanamadala V, Yassari R. Accuracy of Freehand versus Navigated Thoracolumbar Pedicle Screw Placement in Patients with Metastatic Tumors of the Spine. J Korean Neurosurg Soc 2020; 63:777-783. [PMID: 33181866 PMCID: PMC7671770 DOI: 10.3340/jkns.2020.0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/25/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To compare the accuracy and breach rates of freehand (FH) versus navigated (NV) pedicle screws in the thoracic and lumbar spine in patients with metastatic spinal tumors.
Methods A retrospective review of adult patients who underwent pedicle screw fixation in the thoracic or lumbar spine for metastatic spinal tumors between 2012 and 2018 was conducted. Breaches were assessed based on the Gertzbein and Robbins classification and only screws placed >4 mm outside of the pedicle wall (lateral or medial) were considered breached.
Results A total of 62 patients received 547 pedicle screws (average 8 per patient) – 34 patients received 298 pedicle screws in the FH group and 28 patients received 249 screws in the NV group. There were 40/547 breaches, corresponding to a breach and accuracy rate of 7.3% and 92.7%, respectively. The breach rate was 9.7% in the FH group and 4.4% in the NV group (chi-squared test, p=0.017); this corresponded to an accuracy rate of 90.3% and 95.6%, respectively. Only one patient from the overall cohort (in the FH group) required revision surgery due to a medial breach abutting the spinal cord (1.6% of all patients; 2.9% of FH patients); no patient suffered organ, vessel, or neurological injury from screw breaches.
Conclusion Navigated pedicle screw placement in patients with metastatic spinal tumors has a significantly higher radiographic accuracy compared to the FH technique. However, the revision surgery was low and no patient suffered from clinically-relevant breach. Navigation also offers the advantage of real-time localization of spinal tumors and aids in targeting and resection of these lesions.
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Affiliation(s)
- Rafael De la Garza Ramos
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Murray Echt
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joshua A Benton
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yaroslav Gelfand
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Longo
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vijay Yanamadala
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Reza Yassari
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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Li Y, Xu J, Zheng W. [Comparison of the safety and outcomes between keyhole surgery and total laminectomy for resection of intradural extramedullary spinal cord tumors]. Zhonghua Yi Xue Za Zhi 2020; 100:3093-8. [PMID: 33105961 DOI: 10.3760/cma.j.cn112137-20200305-00605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To compare the safety and outcomes between keyhole surgery and total laminectomy for resection of intradural extramedullary spinal cord tumors. Methods: Retrospectively collected the clinical data of 102 patients with intradural extramedullary spinal cord tumors(≤3 cm) treated by surgery in Department of Orthopedics in Fujian Provincial Hospital from January 2014 to January 2017. Fifty cases underwent the keyhole surgery and the other 52 received total laminectomy. The operation time, volume of intraoperative bleeding, the leaving bed time, the length of postoperative hospital stay, drainage, postoperative complications, intraoperative neuroelectrophysiological monitoring (IONM), preoperative and postoperative visual analogue score (VAS), neck disability index (NDI), Oswestry disability index (ODI), McCormick spinal cord function grading were analyzed and compared between the two groups to evaluate the safety and clinical outcomes. The data of two groups were compared by t, χ(2) or rank sum test. Results: The keyhole group was followed up for (30±15) months and the total laminectomy group was followed up for (45±15) months. All the tumors were completely resected. All the incision healed well and no cerebrospinal fluid leakage occurred. There was no statistically significant differences in baseline data, operation time, the results of IONM, preoperative and 3 months, 6 months, 12 months postoperative VAS, NDI (cervical tumors), ODI (thoracic and lumbar tumors), McCormick spinal cord function grading, tumor recurrence between the two groups (all P>0.05). The keyhole group had less intraoperative bleeding than that in the total laminectomy group ((73±24) ml vs (136±26) ml, t=-12.610, P<0.05), earlier postoperative leaving bed time ((1.4±0.6) d vs (6.5±1.0) d, t=-31.822, P<0.05), and the postoperative hospital stay was shorter ((4.3±0.8) d vs (11.2±2.0) d, t=-22.319, P<0.05), and it was more advantageous in terms of drainage. The VAS, NDI and ODI in the keyhole group improved significantly compared with those in the total laminectomy group 2 weeks post operation (all P<0.05). Conclusion: Compared with the total laminectomy, keyhole surgery is suitable for the treatment of intradural extramedullary spinal cord tumors with small size and limited location, and it is equivalently safe with faster functional recovery.
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Cazzato RL, de Marini P, Auloge P, Autreausseau PA, Koch G, Dalili D, Rao P, Garnon J, Gangi A. Percutaneous vertebroplasty of the cervical spine performed via a posterior trans-pedicular approach. Eur Radiol 2021; 31:591-8. [PMID: 32851445 DOI: 10.1007/s00330-020-07198-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/14/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Percutaneous vertebroplasty (PV) of the cervical spine has been traditionally performed with a trans-oral or antero-lateral approach. The posterior trans-pedicular approach (PTPA) has been sporadically reported. Therefore, the aim of this study is to retrospectively assess the technical feasibility, safety, and clinical outcomes of cervical PV performed with a PTPA. METHODS All consecutive patients undergoing PV in cervical levels with PTPA (under general anesthesia and computed tomography [CT] guidance) from January 2008 to November 2019 were identified. The following data were collected: patients' demographics; indication for PV; vertebral level features; procedure-related variables; and clinical outcomes including complications and pain relief. RESULTS Thirty-two patients (18 females, 14 males; mean age 61.1 ± 13.2 years, range 36-88) were included accounting for 36 vertebrae. Three vertebrae (3/36, 8%) were referred due to an underlying traumatic fracture, the remaining (33/36, 92%) due to a painful lytic tumor. Technical success was 97% (35/36 levels). Mean time required to deploy the trocar was 23 ± 11 min (range 7-60). Extra-vertebral asymptomatic cement leakage was observed in 3/35 (9%) vertebral levels. One patient (1/32, 3%) developed an acute cardiogenic pulmonary edema requiring admission in the intensive care unit; another patient (1/32, 3%) developed localized infection to the skin entry site, which was managed conservatively. At 1-month follow-up, the mean pain in the study population was 1.0 ± 1.1 (range 0-4/10) vs 6.2 ± 1.4 (range 4-9/10) at baseline (p < 0.05). CONCLUSIONS Cervical PV performed via a CT-guided PTPA is technically feasible, safe, and results in effective pain relief. KEY POINTS • Percutaneous vertebroplasty (PV) is a well-established technique for the treatment of benign and malignant compression fractures. • Common PV approaches used for cervical vertebrae include the trans-oral, antero-lateral, lateral, and sporadically the posterior trans-pedicular approach. • Retrospective analysis of our 11-year experience with the posterior trans-pedicular approach used for cervical vertebrae proved that such approach was safe and effective.
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Thomas A, Hollstein T, Zwingenberger S, Schaser KD, Disch AC. [Intraoperative and late complications after spinal tumour resection and dorsoventral reconstruction]. Orthopade 2020; 49:157-68. [PMID: 31996948 DOI: 10.1007/s00132-020-03883-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Spinal tumors are a continuously growing pathology group among the spinal diseases. The often-difficult circumstances increase vulnerability to a wide range of intervention-related complications, which can occur at different times in the course of the disease and must be included in the consideration of the indication. OBJECTIVES The aim of the work is to present the wide spectrum of complications in the surgical treatment of spinal tumors, as well as their treatment and prophylaxis through optimal therapy management. MATERIALS AND METHODS The article summarizes the current literature. RESULTS The literature describes complication rates of 10-67% after metastatic surgery of the spinal column. The most common complications are infections and internal, especially pulmonary, complications. Other relevant complications include surgical positioning/surgical access/instrumentation/mechanical failure, and anesthesiological, neurological, vascular and oncological complications. The socio-economic costs for patients with complications compared to those for patients without complications are twice as high. A special risk situation exists with radical spinal tumor resections. Negative predictors are previous operations, previous irradiation and local recurrences. CONCLUSIONS An early, interdisciplinary concept can reduce complications significantly. Due to the planning intensity, surgical expertise and comprehensive structural requirements, treatment in an interdisciplinary tumour centre is necessary.
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Zhang J, Chen Y, Zhang Y, Zhang E, Yu HJ, Yuan H, Zhang Y, Su MY, Lang N. Diagnosis of spinal lesions using perfusion parameters measured by DCE-MRI and metabolism parameters measured by PET/CT. Eur Spine J 2020; 29:1061-70. [PMID: 31754820 DOI: 10.1007/s00586-019-06213-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/08/2019] [Accepted: 11/07/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the correlation of parameters measured by dynamic-contrast-enhanced MRI (DCE-MRI) and 18F-FDG PET/CT in spinal tumors, and their role in differential diagnosis. METHODS A total of 49 patients with pathologically confirmed spinal tumors, including 38 malignant, six benign and five borderline tumors, were analyzed. The MRI and PET/CT were done within 3 days, before biopsy. On MRI, the ROI was manually placed on area showing the strongest enhancement to measure pharmacokinetic parameters Ktrans and kep. On PET, the maximum standardized uptake value SUVmax was measured. The parameters in different histological groups were compared. ROC was performed to differentiate between the two largest subtypes, metastases and plasmacytomas. Spearman rank correlation was performed to compare DCE-MRI and PET/CT parameters. RESULTS The Ktrans, kep and SUVmax were not statistically different among malignant, benign and borderline groups (P = 0.95, 0.50, 0.11). There was no significant correlation between Ktrans and SUVmax (r = - 0.20, P = 0.18), or between kep and SUVmax (r = - 0.16, P = 0.28). The kep was significantly higher in plasmacytoma than in metastasis (0.78 ± 0.17 vs. 0.61 ± 0.18, P = 0.02); in contrast, the SUVmax was significantly lower in plasmacytoma than in metastasis (5.58 ± 2.16 vs. 9.37 ± 4.26, P = 0.03). In differential diagnosis, the AUC of kep and SUVmax was 0.79 and 0.78, respectively. CONCLUSIONS The vascular parameters measured by DCE-MRI and glucose metabolism measured by PET/CT from the most aggressive tumor area did not show a significant correlation. The results suggest they provide complementary information reflecting different aspects of the tumor, which may aid in diagnosis of spinal lesions. These slides can be retrieved under Electronic Supplementary Material.
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Li Z, Wei F, Liu Z, Liu X, Jiang L, Yu M, Xu N, Wu F, Dang L, Zhou H, Li Z. Risk Factors for Instrumentation Failure After Total En Bloc Spondylectomy of Thoracic and Lumbar Spine Tumors Using Titanium Mesh Cage for Anterior Reconstruction. World Neurosurg 2020; 135:e106-15. [PMID: 31756507 DOI: 10.1016/j.wneu.2019.11.057] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The present study investigated the risk factors for instrumentation failure (IF) after total en bloc spondylectomy (TES) of thoracic and lumbar spine tumors using a titanium mesh cage (TMC) for anterior reconstruction. METHODS The data from patients who had undergone TES for thoracic and lumbar spine tumors in our institution were retrospectively reviewed. Anterior reconstruction was performed using a TMC filled with morcelized allograft or morcelized autograft. Posterior reconstruction was performed using pedicle fixation. Survival analysis from TES to IF was conducted. The Kaplan-Meier method was used for univariate analysis. Factors of statistical significance were included in the multivariate analysis using Cox regression analysis. RESULTS A total of 30 patients (20 men and 10 women), with a mean age of 37.1 ± 14.3 years (range, 14-65 years) were included. The mean follow-up period was 41.8 ± 21.3 months (range, 13-120 months). Bone fusion was achieved in 23 patients (76.7%). IF occurred in 8 patients. The mean interval from TES to the first IF was 31.8 ± 15.1 months (range, 13-64 months). On univariable analysis, a body mass index >28 kg/m2, perioperative radiotherapy, and the TMC in an oblique position were associated with IF. On multivariable analysis, these 3 factors were entered into the Cox regression model and were also significant. CONCLUSIONS The use of TES can achieve durable oncological control. However, IF, a not uncommon late complication that leads to reoperation, should be a cause for concern. We found perioperative radiotherapy, a TMC in an oblique position, and a body mass index >28 kg/m2 were significant predictive factors for IF.
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Ropper AE, Huang KT, Ho AL, Wong JM, Nalbach SV, Chi JH. Intraoperative Cerebrospinal Fluid Leak in Extradural Spinal Tumor Surgery. Neurospine 2018; 15:338-347. [PMID: 30531655 PMCID: PMC6347353 DOI: 10.14245/ns.1836042.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/28/2018] [Indexed: 11/19/2022] Open
Abstract
Objective Patients with extradural spine tumors are at an increased risk for intraoperative cerebrospinal fluid (CSF) leaks and postoperative wound dehiscence due to radiotherapy and other comorbidities related to systemic cancer treatment. In this case series, we discuss our experience with the management of intraoperative durotomies and wound closure strategies for this complex surgical patient population. Methods We reviewed our recent single-center experience with spine surgery for primarily extradural tumors, with attention to intraoperative durotomy occurrence and postoperative wound-related complications.
Results A total of 105 patients underwent tumor resection and spinal reconstruction with instrumented fusion for a multitude of pathologies. Twelve of the 105 patients (11.4%) reviewed had intraoperative durotomies. Of these, 3 underwent reoperation for a delayed complication, including 1 epidural hematoma, 1 retained drain, and 1 wound infection. Of the 93 uncomplicated index operations, there were a total of 9 reoperations: 2 for epidural hematoma, 3 for wound infection, 2 for wound dehiscence, and 2 for recurrent primary disease. One patient was readmitted for a delayed spinal fluid leak. The average length of stay for patients with and without intraoperative durotomy was 7.3 and 5.9 days, respectively, with a nonsignificant trend for an increased length of stay in the durotomy cases (p=0.098).
Conclusion Surgery for extradural tumor resections can be complicated by CSF leaks due to the proximity of the tumor to the dura. When encountered, a variety of strategies may be employed to minimize subsequent morbidity.
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Affiliation(s)
- Alexander E Ropper
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin T Huang
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Allen L Ho
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Judith M Wong
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephen V Nalbach
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John H Chi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Masuda K, Ebata K, Yasuhara Y, Enomoto A, Saito T. Outcomes and Prognosis of Neurological Decompression and Stabilization for Spinal Metastasis: Is Assessment with the Spinal Instability Neoplastic Score Useful for Predicting Surgical Results? Asian Spine J 2018; 12:846-853. [PMID: 30213167 PMCID: PMC6147881 DOI: 10.31616/asj.2018.12.5.846] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 03/19/2018] [Indexed: 12/01/2022] Open
Abstract
Study Design Retrospective study. Purpose To evaluate the efficacy of the Spinal Instability Neoplastic Score (SINS) in predicting surgical outcomes and survival. Patients were categorized into two groups according to the SINS, and their surgical outcomes and survival following decompression and stabilization were assessed. Overview of Literature Palliative surgery in patients with a life expectancy ≥3 months may effectively improve their overall condition in the long term. Currently, the effectiveness of the SINS for predicting surgical results and survival remains controversial. Methods This study included 44 patients who underwent decompression and stabilization for spinal metastases at Yokosuka Kyosai Hospital between 2008 and 2017. The patients were divided into two groups: stable (SINS ≤12) and unstable (SINS ≥13). Changes in the Frankel score and Eastern Cooperative Oncology Group Performance Status (ECOG-PS) were compared between the two groups, and patient survival was evaluated according to the SINS, Tokuhashi score, and Katagiri score. Results The stable group (SINS range, 7–12) included 24 patients while the unstable group (SINS range, 13–16) included 20 patients. The Frankel score significantly improved from 2.8 to 3.6 in the stable group (p <0.001) and from 2.7 to 3.9 in the unstable group (p <0.001). The ECOG-PS significantly improved from 3.2 to 2.1 in the stable group (p <0.001) and from 3.0 to 1.8 in the unstable group (p <0.001). There was a statistically significant difference in median survival between the two groups. Conclusions All patients treated with palliative surgery showed favorable outcomes, as indicated by improved the Frankel score and ECOG-PS following surgery. However, median survival was significantly better in the stable group. The results of this study indicate that the SINS is appropriate for surgical decision making and may be used to predict survival.
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Affiliation(s)
- Kenji Masuda
- Department of Orthopaedic Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Ko Ebata
- Department of Orthopaedic Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Yoshimasa Yasuhara
- Department of Orthopaedic Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Akira Enomoto
- Department of Orthopaedic Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Tomoyuki Saito
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
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Mohajeri Moghaddam S, Bhatt AA. Location, length, and enhancement: systematic approach to differentiating intramedullary spinal cord lesions. Insights Imaging 2018; 9:511-526. [PMID: 29949034 PMCID: PMC6108975 DOI: 10.1007/s13244-018-0608-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/24/2018] [Accepted: 02/08/2018] [Indexed: 11/04/2022] Open
Abstract
Purpose Intramedullary spinal cord abnormalities are often challenging to diagnose. Spinal cord biopsy is a high-risk procedure with the potential to cause permanent neurological injury. Magnetic resonance imaging is the modality of choice for diagnosis and preoperative assessment of patients with spinal cord abnormalities. The radiologist’s ability to narrow the differential diagnosis of spinal cord abnormalities has the potential to save patients from invasive approaches for diagnosis and also guide appropriate management. Approach/methods This article will provide a systematic approach to the evaluation of intramedullary spinal cord lesions—with emphasis on location, length and segment distribution, and enhancement pattern—to help narrow the differential diagnosis. In doing so, we will review various spinal cord pathologies, including demyelinating and metabolic conditions, neoplasms, and vascular lesions. Summary/conclusion Although intramedullary spinal cord abnormalities can be a challenge for the radiologist, a systematic approach to the differential diagnosis with a focus on lesion location, cord length and segment involvement, as well as enhancement pattern, can greatly help narrow the differential diagnosis, if not synch the diagnosis. This strategy will potentially obviate the need for an invasive approach to diagnosis and help guide treatment. Teaching points • Imaging diagnosis of intramedullary spinal cord lesions could obviate cord biopsy. • Evaluation of cord lesions should focus on location, length, and enhancement pattern. • In demyelination, the degree of cross-sectional involvement is a distinguishing feature.
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Affiliation(s)
- Sarah Mohajeri Moghaddam
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 648, Rochester, NY, 14642, USA.
| | - Alok A Bhatt
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 648, Rochester, NY, 14642, USA
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Rkhami M, Kedous MA, Achoura S, Zehani A, Bahri K, Zammel I. Epidural angiolipoma: A rare cause of spinal cord compression. Int J Surg Case Rep 2018; 45:72-6. [PMID: 29573600 DOI: 10.1016/j.ijscr.2018.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 02/23/2018] [Accepted: 03/11/2018] [Indexed: 11/22/2022] Open
Abstract
Spinal epidural angiolipoma is a rare cause of progressive spinal cord compression. Magnetic resonance imaging is necessary for diagnosis. Total resection is the treatment of choice. Necessary precautions before and during surgery have to be taken (embolisation, transfusion). Prognosis after surgical management is excellent even at the stage of complete paraplegia.
Introduction Angiolipomas are benign, slow growing lesions, almost always located subcutaneously in the trunc or limbs. They are composed of mature lipocytes admixed with abnormal blood vessels. Spinal epidural angiolipoma are rare accounting for approximately 0.14–1.2% of all spinal axis tumors and 2–3% of epidural spinal tumors. Presentation of case We report the case of a 65 years-old-woman, presenting with complete paraplegia installed since 7 months. Magnetic resonance imaging (MRI) showed an epidural dorsal fatty mass. The patient recovered immediately after surgery. The pathological examination concluded to an angiolipoma. Discussion Angiolipoma patients most commonly have long-lasting pain and then develop progressive neurological symptoms secondary to spinal cord compression. The mean duration of symptom progression at diagnosis is 1 year. MRI is the most reliable examination for the diagnosis of spinal angiolipoma. Total resection is the treatment of choice. No adjuvant treatment is indicated. Since SAL are very haemorrhagic lesions, preoperative embolization is recommended. Conclusion We think that spinal cord compression caused by angiolipoma have very good functional prognosis, even if tardily diagnosed
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Gauthé M, Testart Dardel N, Ruiz Santiago F, Ohnona J, Nataf V, Montravers F, Talbot JN. Vertebral metastases from neuroendocrine tumours: How to avoid false positives on 68Ga-DOTA-TOC PET using CT pattern analysis? Eur Radiol 2018. [PMID: 29532242 DOI: 10.1007/s00330-017-5294-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To develop criteria to improve discrimination between vertebral metastases from neuroendocrine tumours (NETs) and benign bone lesions on PET combined with CT using DOTA-D-Phe1-Tyr3-octreotide labelled with gallium-68 (68Ga-DOTA-TOC). METHODS In 535 NET patients, 68Ga-DOTA-TOC PET/CT examinations were reviewed retrospectively for vertebral CT lesions and/or PET foci. For each vertebral PET abnormality, appearance on CT, biological volume (BV), standardized uptake value (SUVmax) and ratios to those of reference organs were determined. All vertebral abnormalities were characterized as a metastasis, a typical vertebral haemangioma (VH) or other benign lesion. RESULTS In 79 patients (14.8 %), we found 107 metastases, 34 VHs and 31 other benign lesions in the spine. The optimal cut-off values to differentiate metastases from benign lesions were BV ≥0.72 cm3, SUVmax ≥2, SUVmax ratio to a reference vertebra ≥2.1, to liver ≥0.28 and to spleen ≥0.14. They corresponded to lesion-based 68Ga-DOTA-TOC PET/CT sensitivity of 87 %, 98 %, 97 %, 99 % and 94 %, and specificity of 55 %, 100 %, 90 %, 97 %, 100 %, respectively. CONCLUSIONS The high sensitivity of 68Ga-DOTA-TOC-PET/CT in detecting NET vertebral metastases was confirmed; this study showed that specificity could be improved by combining CT features and quantifying 68Ga-DOTA-TOC uptake. KEY POINTS • Bone metastases in neuroendocrine tumours correlate with prognosis. • Benign bone lesions may mimic metastases on 68 Ga-DOTA-TOC PET/CT imaging. • The specific polka-dot CT pattern may be missing in some vertebral haemangiomas. • Lesion atypical for haemangiomas can be better characterized by quantifying 68 Ga-DOTA-TOC uptake.
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Affiliation(s)
- Mathieu Gauthé
- Médecine Nucléaire, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France. .,Université P&M Curie, Paris, France.
| | | | | | - Jessica Ohnona
- Médecine Nucléaire, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Université P&M Curie, Paris, France
| | - Valérie Nataf
- Médecine Nucléaire, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Université P&M Curie, Paris, France
| | - Françoise Montravers
- Médecine Nucléaire, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Université P&M Curie, Paris, France
| | - Jean-Noël Talbot
- Médecine Nucléaire, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Université P&M Curie, Paris, France
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Asakawa A, Ishibashi H, Kobayashi M, Hachimaru T, Arai H, Okubo K. Excision of thoracic vertebral chondrosarcoma after spinal decompression. Asian Cardiovasc Thorac Ann 2018; 26:311-313. [PMID: 29486576 DOI: 10.1177/0218492318763431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 44-year-old man presented with an abnormal chest shadow. Computed tomography-guided biopsy showed a chondral tumor of the thoracic vertebrae. Five years later, he developed a walking disorder, left leg numbness, and a vesicorectal disorder. Emergency orthopedic spinal decompression was performed. Eight months later, the residual tumor had become larger and was adjacent to the aorta. Prior to thoracotomy, an intraaortic stent was inserted. The 4th and 5th ribs were invaded by the tumor. The entire tumor and chest wall were excised with the aortic adventitia. The tumor was diagnosed as a low-grade chondrosarcoma of the thoracic vertebrae.
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Affiliation(s)
- Ayaka Asakawa
- 1 Department of Thoracic Surgery, 118084 Tokyo Medical and Dental University , Tokyo Japan
| | - Hironori Ishibashi
- 1 Department of Thoracic Surgery, 118084 Tokyo Medical and Dental University , Tokyo Japan
| | - Masashi Kobayashi
- 1 Department of Thoracic Surgery, 118084 Tokyo Medical and Dental University , Tokyo Japan
| | - Tsuyoshi Hachimaru
- 2 Department of Cardiovascular Surgery, 118084 Tokyo Medical and Dental University , Tokyo, Japan
| | - Hirokuni Arai
- 2 Department of Cardiovascular Surgery, 118084 Tokyo Medical and Dental University , Tokyo, Japan
| | - Kenichi Okubo
- 1 Department of Thoracic Surgery, 118084 Tokyo Medical and Dental University , Tokyo Japan
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Revuelta Barbero JM, Saab Mazzei A, Cotúa Quinteros C, de Reina L. Primary well differentiated neuroendocrine tumor of the filum terminale. Case report and literature review. Neurocirugia (Astur) 2018; 29:244-249. [PMID: 29295804 DOI: 10.1016/j.neucir.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/15/2017] [Accepted: 11/25/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To present a case of a well-differentiated primary intradural-extramedullary neuroendocrine tumor of the filum terminale and to conduct a literature review. CASE A 68-years old patient was assessed after presenting lower back pain and sciatica with ineffective pain relief. The patient presented an intradural-extramedullary lumbar lesion arising from the filum terminale, which was partially resected. The pathology diagnosis was a well-differentiated primary neuroendocrine tumor (carcinoid tumor). After a multidisciplinary evaluation, fractionated stereotactic radiotherapy was administered. No progression or metastatic spread was observed in successive assessments. DISCUSSION Neuroendocrine tumors are heterogeneous neoplasms derived predominantly from enterochromaffin cells, in which chemotherapy plays a very limited role. In contrast, radiotherapy has been described in partially resected lesions. CONCLUSION Well-differentiated primary neuroendocrine tumors with intradural-extramedullary lumbosacral location are an exceptional rarity. Isolated surgical resection, or associated with an adjuvant radiotherapy treatment in subtotal resections, could be considered an effective therapeutic strategy.
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Affiliation(s)
| | - Anwar Saab Mazzei
- Servicio de Neurocirugía, Hospital Puerta de Hierro Majadahonda, Madrid, España
| | | | - Laura de Reina
- Servicio de Neurocirugía, Hospital Puerta de Hierro Majadahonda, Madrid, España
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Zhang JJ, Zhou Y, Hu HY, Sun YJ, Wang YG, Gu YF, Wu CG, Shen Z, Yao Y. Safety and efficacy of multilevel vertebroplasty for painful osteolytic spinal metastases: a single-centre experience. Eur Radiol 2016; 27:3436-3442. [PMID: 27975147 DOI: 10.1007/s00330-016-4683-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/03/2016] [Accepted: 11/29/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To retrospectively assess the safety and efficacy of percutaneous vertebroplasty (PVP) for painful osteolytic spinal metastases when treating more than three vertebrae per session. METHODS A total of 153 patients with painful osteolytic spinal metastases underwent PVP. Group A patients (n = 93) underwent PVP at up to three vertebral levels per session. Group B patients (n = 60) underwent PVP at more than three levels in one session. Pain, quality of life (QoL), and mobility were assessed before and after PVP. Minor and major complications were systematically assessed. RESULTS Both groups experienced significant pain relief and QoL improvement after the intervention (p < 0.001). Mobility improvement was observed in both groups, despite worse mobility status before PVP in group B compared with group A. There was no significant difference between the two groups throughout the follow-up period in overall pain relief and improvement in QoL and mobility. There was also no significant difference between groups in minor and major complications. CONCLUSIONS Multilevel vertebroplasty is safe and effective for the treatment of multiple osteolytic spinal metastases. Multilevel PVP relieves pain and improves QoL and mobility. KEY POINTS • Percutaneous vertebroplasty is safe and effective for painful osteolytic spinal metastases. • Multilevel vertebroplasty does not cause more complications than single-level vertebroplasty. • Multiple spinal metastases patients may regain functional independence after multilevel vertebroplasty.
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Affiliation(s)
- Jian-Jun Zhang
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Yan Zhou
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Hai-Yan Hu
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Yuan-Jue Sun
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Yong-Gang Wang
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Yi-Feng Gu
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Chun-Gen Wu
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Zan Shen
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Yang Yao
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China.
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Abstract
Spine tumors comprise a small percentage of reasons for back pain and other symptoms originating in the spine. The majority of the tumors involving the spinal column are metastases of visceral organ cancers which are mostly seen in older patients. Primary musculoskeletal system sarcomas involving the spinal column are rare. Benign tumors and tumor-like lesions of the musculoskeletal system are mostly seen in young patients and often cause instability and canal compromise. Optimal diagnosis and treatment of spine tumors require a multidisciplinary approach and thorough knowledge of both spine surgery and musculoskeletal tumor surgery. Either primary or metastatic tumors involving the spine are demanding problems in terms of diagnosis and treatment. Spinal instability and neurological compromise are the main and critical problems in patients with tumors of the spinal column. In the past, only a few treatment options aiming short-term control were available for treatment of primary and metastatic spine tumors. Spine surgeons adapted their approach for spine tumors according to orthopaedic oncologic principles in the last 20 years. Advances in imaging, surgical techniques and implant technology resulted in better diagnosis and surgical treatment options, especially for primary tumors. Also, modern chemotherapy drugs and regimens with new radiotherapy and radiosurgery options caused moderate to long-term local and systemic control for even primary sarcomas involving the spinal column.
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Versteeg AL, van der Velden JM, Verkooijen HM, van Vulpen M, Oner FC, Fisher CG, Verlaan JJ. The Effect of Introducing the Spinal Instability Neoplastic Score in Routine Clinical Practice for Patients With Spinal Metastases. Oncologist 2015; 21:95-101. [PMID: 26668252 DOI: 10.1634/theoncologist.2015-0266] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/13/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Stable spinal metastases are effectively treated with radiotherapy, whereas unstable spinal metastases often need surgical fixation followed by radiotherapy for local control. The Spinal Instability Neoplastic Score (SINS) was developed as a tool to assess spinal neoplastic related instability with the goal of helping to guide referrals among oncology specialists. We compare the average degree of spinal instability between patients with spinal metastases referred for surgery or for radiotherapy and evaluate whether this difference changed after introduction of the SINS in clinical practice. METHODS All patients with spinal metastases treated with palliative surgery or radiotherapy in the period 2009-2013 were identified in two spine centers. For all patients, the SINS was scored on pretreatment imaging. The SINS before and after introduction of the SINS in 2011 were compared within the surgical and radiotherapy group. Furthermore, the overall SINS was compared between the two groups. RESULTS The overall SINS was significantly higher in the surgical group, with a mean SINS of 10.7 (median 11) versus 7.2 (median 8) for the radiotherapy group. The mean SINS decreased significantly for both groups after introduction of the SINS in clinical practice from 11.2 to 10.3 in the surgical group and from 8.4 to 7.2 in the radiotherapy group. CONCLUSION The SINS differed significantly between patients treated with surgery or radiotherapy. The introduction of SINS led to a decrease in SINS score for both groups, suggesting that using SINS in metastatic spinal disease increases awareness for instability and may subsequently result in earlier referrals for surgical intervention. IMPLICATIONS FOR PRACTICE Spinal metastases can present with varying degrees of mechanical instability. Because unstable spinal metastases may respond insufficiently to palliative radiotherapy and can lead to loss of ambulation, timely detection and appropriate referral are important. The Spinal Instability Neoplastic Score (SINS) may help physicians caring for patients with metastasized disease to identify spinal instability before the onset of neurological deficits. In this study, it was shown that the introduction of SINS in routine practice led to a decrease in spinal instability in radiotherapy and surgical cohorts. The use of SINS may increase awareness of instability and subsequently result in earlier referrals.
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Affiliation(s)
- Anne L Versteeg
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Helena M Verkooijen
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marco van Vulpen
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Cumhur Oner
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Charles G Fisher
- Division of Spine, Department of Orthopedics, University of British Columbia, and the Combined Neurosurgical and Orthopedic Spine Program at Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Bellato RT, Teixeira WGJ, Torelli AG, Cristante AF, Barros Filho TEPD, Camargo OPD. Late failure of posterior fixation without bone fusion for vertebral metastases. Acta Ortop Bras 2015; 23:303-6. [PMID: 27057142 PMCID: PMC4775506 DOI: 10.1590/1413-785220152306151402] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE : To verify the frequency of late radiological com-plications in spinal fixation surgeries performed without fu-sion in oncological patients METHODS : This is a retrospective analysis analysing failure in cases of non-fused vertebral fixation in an oncology reference hospital between 2009 and 2014. Failure was defined as implant loosening or bre-akage, as well as new angular or translation deformities RESULTS : One hundred and five cases were analyzed. The most common site of primary tumor was the breast and the most common place of metastasis was the thoracic spine. The average follow-up was 22.7 months. Nine cases (8%) of failure were reported, with an average time until failure of 9.5 months. The most common failure was implant loosening. No case required further surgery CONCLUSION : The occurrence of failure was not different than that reported for fused cases. The time interval until failure was higher than the median of survival of the majority (88%) of cases. Level of Evidence IV, Therapeutic Study.
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Kobayashi K, Imagama S, Tsunekawa S, Hosokawa K, Watanabe M, Ito Z, Ando K, Ishiguro N. Spinal metastasis from struma ovarii: case report and review of the literature. Asian Spine J 2015; 9:281-5. [PMID: 25901242 DOI: 10.4184/asj.2015.9.2.281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/24/2014] [Accepted: 04/25/2014] [Indexed: 11/22/2022] Open
Abstract
Struma ovarii is a rare tumor that is defined as an ovarian teratoma with a thyroid tissue component exceeding 50%. Most of these tumors are benign, with malignant struma ovarii occurring in <1% of patients. Here, we describe the case of a 49-year-old female patient with malignant struma ovarii who developed thoracic spine metastasis. She had undergone an oophorectomy and was diagnosed with struma ovarii 10 years previously. She had remained recurrence-free thereafter. At 49 years of age, she developed low back pain and was admitted to our hospital for evaluation of a spinal tumor at the Th7 level. An emergency bone biopsy led to a diagnosis of metastasis from malignant struma ovarii. External beam radiotherapy inhibited further tumor growth and there was no resulting muscle weakness. This is the first report of spinal metastasis occurring 10 years after resection of struma ovarii, indicating the need for long-term follow-up.
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Ortega-Porcayo LA, Cabrera-Aldana EE, Arriada-Mendicoa N, Gómez-Amador JL, Granados-García M, Barges-Coll J. Operative technique for en bloc resection of upper cervical chordomas: extended transoral transmandibular approach and multilevel reconstruction. Asian Spine J 2014; 8:820-6. [PMID: 25558326 DOI: 10.4184/asj.2014.8.6.820] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 04/25/2014] [Accepted: 04/25/2014] [Indexed: 01/22/2023] Open
Abstract
Anterior exposure for cervical chordomas remains challenging because of the anatomical complexities and the restoration of the dimensional balance of the atlanto-axial region. In this report, we describe and analyze the transmandibular transoral approach and multilevel spinal reconstruction for upper cervical chordomas. We report two cases of cervical chordomas (C2 and C2-C4) that were treated by marginal en bloc resection with a transmandibular approach and anterior-posterior multilevel spinal reconstruction/fixation. Both patients showed clinical improvement. Postoperative imaging was negative for any residual tumor and revealed adequate reconstruction and stabilization. Marginal resection requires more extensive exposure to allow the surgeon access to the entire pathology, as an inadequate tumor margin is the main factor that negatively affects the prognosis. Anterior and posterior reconstruction provides a rigid reconstruction that protects the medulla and decreases axial pain by properly stabilizing the cervical spine.
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Amendola L, Cappuccio M, De Iure F, Bandiera S, Gasbarrini A, Boriani S. En bloc resections for primary spinal tumors in 20 years of experience: effectiveness and safety. Spine J 2014; 14:2608-17. [PMID: 24561037 DOI: 10.1016/j.spinee.2014.02.030] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 01/28/2014] [Accepted: 02/18/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Many studies have demonstrated that en bloc surgical resection of primary spinal tumors with adequate margins results in improved local disease control and survival compared with intralesional excision. Nevertheless, the use of this procedure is under debate because most of the current evidence is provided by small and heterogeneous series of cases. PURPOSE To validate the application of en bloc resection for the treatment of aggressive benign and primary malignant spinal tumors. STUDY DESIGN This is a prospective cohort study. PATIENT SAMPLE From August 1990 to March 2010, 103 consecutive patients affected by primary spinal tumors were enrolled in the study. All patients were submitted to the same clinical and imaging workup. OUTCOME MEASURES Analysis of local recurrence (LR) and tumor-related mortality, reliability of preoperative surgical planning, and morbidity and mortality. In addition, the effects of possible predictors of these events were studied. METHODS The parameters for the effectiveness and safety of en bloc resections performed on primary spinal tumors were considered as primary end points of this study, and two research questions were formulated. The analysis of the procedure effectiveness considered the identification of possible predictors of LR and tumor-related mortality. Information about safety is collected so as to clarify the possibility to respect the preoperative planning and to identify possible predictors of morbidity and mortality. Data from clinical and imaging examination were collected in a database and were used to answer the proposed research questions. RESULTS All patients were followed for a minimum of 24 months or until death. At the final assessment, 69 patients resulted with no evidence of disease with a mean follow-up of 100 months. Among the 103 patients, tumor recurred in 22 cases with a mean follow-up period of 39 months after surgery. A Cox regression multivariate analysis shows that marginal and intralesional resections are independent predictors of LR (hazard ratio [HR] 9.45, 95% confidence interval [CI] 1.06-84.47 and HR 38.62, 95% CI 4.67-319.21, respectively, compared with wide resection) and tumor-related mortality (in particular, HR 17.10, 95% CI 3.80-77.04 for intralesional resection compared with the wide one). The same analysis demonstrates that en bloc resection performed in recurrent cases or patients previously submitted to open biopsy (nonintact cases) have a LR risk higher than intact cases (HR 3.45, 95% CI 1.38-8.63). The success rate of en bloc resections in achieving adequate margins is 82.4%, and Weinstein-Boriani-Biagini surgical staging can also predict the margins in a high percentage of cases (75.7%). Complications occurred in 41.7% of patients with a higher rate observed in the nonintact group and for surgery with a double-approach or multisegmental resections. The mortality rate related to surgery complications was 1.9%, whereas tumor-related mortality was 15.5%. CONCLUSIONS Statistical analysis of the long-term results referred to 103 patients affected by aggressive benign and malignant primary spine tumors indicates that an en bloc resection is associated with a high rate of complications. Nevertheless, it decreases the risk of LR and tumor-related mortality. En bloc resection is a highly demanding procedure but can be performed to an acceptable degree of safety.
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Affiliation(s)
- Luca Amendola
- Department of Orthopedics and Traumatology-Spine Surgery, Maggiore Hospital, "C. A. Pizzardi," Largo Nigrisoli 1, Bologna 40100, Italy.
| | - Michele Cappuccio
- Department of Orthopedics and Traumatology-Spine Surgery, Maggiore Hospital, "C. A. Pizzardi," Largo Nigrisoli 1, Bologna 40100, Italy
| | - Federico De Iure
- Department of Orthopedics and Traumatology-Spine Surgery, Maggiore Hospital, "C. A. Pizzardi," Largo Nigrisoli 1, Bologna 40100, Italy
| | - Stefano Bandiera
- Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Via Pupilli 1, Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Via Pupilli 1, Bologna, Italy
| | - Stefano Boriani
- Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Via Pupilli 1, Bologna, Italy
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Szövérfi Z, Lazary A, Bozsódi Á, Klemencsics I, Éltes PE, Varga PP. Primary Spinal Tumor Mortality Score (PSTMS): a novel scoring system for predicting poor survival. Spine J 2014; 14:2691-700. [PMID: 24650850 DOI: 10.1016/j.spinee.2014.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 01/04/2014] [Accepted: 03/08/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although the surgical and oncological therapies of primary spinal tumors (PSTs) have changed significantly over the last few decades, the prognosis of this rare disease is still poor. The decision-making process in the multidisciplinary management is handicapped by the lack of large-scale population-based prognostic studies. PURPOSE The objective of the present study was to investigate preoperative factors associated with PST mortality and to develop a predictive scoring system of poor survival. STUDY DESIGN This is a large-scale ambispective cohort study. PATIENT SAMPLE The study included 323 consecutive patients with PSTs, treated surgically over an 18-year period at a tertiary care spine referral center for a population of 10 million. OUTCOME MEASURE Survival was the outcome measure. METHODS Patients were randomly divided into a training cohort (n=273) and a validation cohort (n=50). In the training cohort, 12 preoperative factors were investigated using Cox proportional hazard models. Based on the mortality-related variables, a simple scoring system of mortality was created, and three groups of patients were identified. Kaplan-Meier and log-rank analyses were used to compare the survival in the three groups. The model performance was assessed by measuring the discriminative ability (c-index) of the model and by applying a pseudo-R(2) goodness-of-fit test (Nagelkerke R(2), RN(2)). Internal validation was performed using bootstrapping in the training cohort and assessing the discrimination and explained variation of the model in the validation cohort. RESULTS Patient age, spinal region, tumor grade, spinal pain, motor deficit, and myelopathy/cauda equina syndrome were significantly associated with poor survival in the multivariate analysis (p<.001, RN(2)=0.799). Based on these variables, we developed the Primary Spinal Tumor Mortality Score (PSTMS), where an eight-point scale was divided into three categories (low, medium, and high mortality). The three PSTMS categories were significantly associated with the overall survival (p<.001, RN(2)=0.811, c=0.82). The model performance remained similarly high in the validation cohort (RN(2)=0.831, c=0.81). CONCLUSIONS The present study identifies six predictive variables for mortality in PSTs. Using these six variables, an easy-to-use scoring system was developed that can be applied to the estimation of postoperative survival in all types of PST patients.
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Affiliation(s)
- Zsolt Szövérfi
- National Center for Spinal Disorders, Kiralyhagó St 1-3, Budapest 1126, Hungary
| | - Aron Lazary
- National Center for Spinal Disorders, Kiralyhagó St 1-3, Budapest 1126, Hungary
| | - Árpád Bozsódi
- National Center for Spinal Disorders, Kiralyhagó St 1-3, Budapest 1126, Hungary
| | - István Klemencsics
- National Center for Spinal Disorders, Kiralyhagó St 1-3, Budapest 1126, Hungary
| | - Péter E Éltes
- National Center for Spinal Disorders, Kiralyhagó St 1-3, Budapest 1126, Hungary
| | - Péter Pál Varga
- National Center for Spinal Disorders, Kiralyhagó St 1-3, Budapest 1126, Hungary.
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Kim W, Yoo H, Shin SH, Gwak HS, Lee SH. Extraneural Metastases of Glioblastoma without Simultaneous Central Nervous System Recurrence. Brain Tumor Res Treat 2014; 2:124-7. [PMID: 25408938 PMCID: PMC4231629 DOI: 10.14791/btrt.2014.2.2.124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 09/12/2014] [Accepted: 09/23/2014] [Indexed: 12/01/2022] Open
Abstract
Glioblastoma multiforme (GBM) is well known as the most common malignant primary brain tumor. It could easily spread into the adjacent or distant brain tissue by infiltration, direct extension and cerebro-spinal fluid dissemination. The extranueural metastatic spread of GBM is relatively rare but it could have more progressive disease course. We report a 39-year-old man who had multiple bone metastases and malignant pleural effusion of the GBM without primary site recurrence.
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Affiliation(s)
- Wonki Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Heon Yoo
- Neuro-Oncology Clinic, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sang Hoon Shin
- Neuro-Oncology Clinic, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Ho Shin Gwak
- Neuro-Oncology Clinic, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Seung Hoon Lee
- Neuro-Oncology Clinic, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Kim MS, Eun JP, Park JS. A dumbbell-shaped meningioma mimicking a schwannoma in the thoracic spine. J Korean Neurosurg Soc 2011; 50:264-7. [PMID: 22102962 DOI: 10.3340/jkns.2011.50.3.264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 06/27/2011] [Accepted: 08/30/2011] [Indexed: 11/27/2022] Open
Abstract
A 50-year-old man presented bilateral hypesthesia on and below the T6 dermatome and paresthesia. Magnetic resonance imaging (MRI) showed an intraspinal extradural tumor, which located from the 6th thoracic vertebral body to the upper margin of the 7th vertebral body, continuing dumbbell-like through the intervertebral foramen into the right middle thorax suggesting a neurogenic tumor (neurofibroma or neurilemmoma). With the patient in a prone position, we exposed and excised the tumor via a one stage posterior approach through a hemi-laminictomy of T6. Histologic examination showed a grade 1 meningothelial meningioma, according to the World Health Organization classification. Initially, we assumed the mass was a schwannoma because of its location and dumbbell shape. However, the tumor was actually a meningioma. Postoperatively, hypesthesia resolved completely and motor power of the leg gradually full recovered. A postoperative MRI revealed no evidence of residual tumor.
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Affiliation(s)
- Myeong-Soo Kim
- Department of Neurosurgery, Research Institute of Clinical Medicine, Institute for Medical Science, Chonbuk National University Medical School/Hospital, Jeonju, Korea
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