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Yamamoto Y, Shimauchi-Ohtaki H, Honda F, Shirakura T, Aramaki K, Shintoku R, Miyagishima T, Aihara M, Yokoo H, Yoshimoto Y. Thoracic Intra and Extramedullary Capillary Hemangioma with Subacute Clinical Course: A Case Report and Literature Review. NMC Case Rep J 2024; 11:85-91. [PMID: 38666032 PMCID: PMC11043801 DOI: 10.2176/jns-nmc.2023-0205] [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: 08/31/2023] [Accepted: 01/24/2024] [Indexed: 04/28/2024] Open
Abstract
Capillary hemangiomas are benign tumors comprising a lobulated proliferation of capillary vessels frequently located in the soft tissues of the neck and head. Spinal intradural capillary hemangiomas are rare, particularly intramedullary lesions. To our knowledge, only 31 cases of spinal intramedullary capillary hemangiomas have been reported. Here, we describe a rare case of a thoracic capillary hemangioma comprising extramedullary and intramedullary components. A 51-year-old male patient presented with bilateral lower extremity numbness and subsequent paraparesis, sensory disturbance, and bladder-bowel dysfunction with a subacute clinical course. Magnetic resonance imaging revealed a mass lesion with intramedullary and intradural extramedullary components at the Th9-10 vertebrae level and widespread spinal cord edema. Contrast-enhanced computed tomography revealed abnormal vessels on the dorsal spinal cord surface. Spinal angiography revealed a light-stained mass lesion fed by the radiculopial artery from the right Th11 intercostal artery. The tumor was resected en bloc, and the histological diagnosis was a capillary hemangioma. Postoperatively, the spinal cord edema diminished, and the patient was discharged from the convalescent rehabilitation ward. Although intramedullary capillary hemangioma is a rare spinal tumor and its preoperative diagnosis is difficult, it should be considered in the differential diagnosis of spinal intramedullary tumors.
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Affiliation(s)
- Yumeki Yamamoto
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroya Shimauchi-Ohtaki
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Fumiaki Honda
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takahiro Shirakura
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Keigo Aramaki
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Ryosuke Shintoku
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takaaki Miyagishima
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masanori Aihara
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hideaki Yokoo
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yuhei Yoshimoto
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Alhalabi OT, Heene S, Landré V, Neumann JO, Haux D, Zweckberger K, Unterberg AW, Younsi A. Association of early surgery and absence of ataxia with full recovery after spinal intramedullary ependymoma resection. J Neurosurg Spine 2024; 40:185-195. [PMID: 37922542 DOI: 10.3171/2023.8.spine23606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/22/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Spinal intramedullary ependymomas (IEs) represent a well-defined tumor entity usually warranting resection. Factors that determine full long-term neurological recovery after resection are seldomly reported on in larger clinical series. In this study, the authors aimed to highlight the neurological outcome of patients with IEs after resection, with a focus on full neurological recovery, and to explore possible risk factors for the absence of neurological amelioration to an optimal function after surgical treatment. METHODS A single-center retrospective analysis of all patients undergoing surgery for IEs between 2007 and 2021 was performed. Data collection included patient demographics, symptoms, clinical findings, histopathological diagnosis, surgical procedures, complications, and neurological outcome. Patients harboring a favorable outcome (modified McCormick Scale [mMS] grade of I) were compared with patients with a less favorable outcome (mMS grade ≥ II) at the final follow-up. RESULTS In total, 72 patients with a histologically diagnosed IE were included. IEs in those patients (41 males, 31 females; median age 51 [IQR 40-59] years) mostly occurred in the cervical (n = 40, 56%) or thoracic (n = 23, 32%) spine. Upon admission, motor deficits or gait deficits (mMS grade ≥ II) were present in 29 patients (40%), with a median mMS grade of II (IQR I-II). Gross-total resection was achieved in 60 patients (90%), and the rate of surgical complications was 7%. Histopathologically, 67 tumors (93%) were classified as WHO grade 2 ependymomas, 3 (4%) as WHO grade 1 subependymomas, and 2 (3%) as WHO grade 3 anaplastic ependymomas. After a mean follow-up of 863 ± 479 days, 37 patients (51%) had a fully preserved neurological function and 62 patients (86%) demonstrated an mMS grade of I or II. Comparison of favorable with unfavorable outcomes revealed an association of early surgery (within a year after symptom onset), the absence of ataxia or gait disorders, and a low mMS grade with full neurological recovery at the final follow-up. A subgroup of patients (n = 15, 21%) had nonresolving deterioration at the final follow-up, with no significant differences in relevant variables compared with the rest of the cohort. CONCLUSIONS The data presented solidify the role of early surgery in the management of spinal IEs, especially in patients with mild neurological deficits. Furthermore, the presence of gait disturbance or ataxia confers a higher risk of incomplete long-term recovery after spinal ependymoma resection. Because a distinct subgroup of patients had nonresolving deterioration, even when presenting with an uneventful history, further analyses into this subgroup of patients are required.
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Zavala-Romero L, Villanueva-Castro E, Datta-Banik R, Ortiz-Altamirano AG, Rodriguez-Esquivel MM, Cienfuegos-Meza J, Arriada-Mendicoa JN. Mature Teratoma at the Lumbar Spinal Cord: A Case Report and Literature Review. Cureus 2024; 16:e52307. [PMID: 38357074 PMCID: PMC10866183 DOI: 10.7759/cureus.52307] [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] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Mature spinal teratoma is a rare type of germ cell tumor that arises from any of the three germ cell layers (ectoderm, mesoderm, and endoderm) and consists of differentiated tissues and structures that reflect the cellular organization and morphology of normal adult tissues. It has the ability to grow independently and cause compressive symptoms when found in this rare location. In this article, we present the case of a 29-year-old male patient with the onset of neurological symptoms beginning with pelvic limb paresthesias and progressing to back pain. Magnetic resonance imaging (MRI) revealed a tumor at L1-L4, which was resected by laminotomy, and histopathology revealed a mature intradural teratoma. Fortunately, this histologic type had a good prognosis for our patient, who had a significant clinical improvement. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology with PubMed and Google Scholar to find similar case reports and to summarize the main features of this disease, which contributes to the understanding of its diagnostic presentation, treatment, and prognosis, improving clinical practice in the management of similar cases. The rarity of this condition, together with its wide clinical heterogeneity and prognosis, underscores the importance of a thorough evaluation of cases of intramedullary lesions, where the consideration of uncommon diseases in the differential diagnosis should be highlighted.
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Affiliation(s)
- Lilian Zavala-Romero
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Eliezer Villanueva-Castro
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Rudradeep Datta-Banik
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | | | - Jesús Cienfuegos-Meza
- Department of Neuropathology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
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4
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Dauleac C, Boulogne S, Cotton F, Mertens P. Spinal cord tractography and neuromonitoring-based surgical strategy for intramedullary ependymoma. Neurosurg Focus Video 2023; 9:V4. [PMID: 37854656 PMCID: PMC10580745 DOI: 10.3171/2023.7.focvid2368] [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] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/14/2023] [Indexed: 10/20/2023]
Abstract
Because the spinal cord contains a rich concentration of longitudinal and transversal fibers in a very small area, intramedullary surgery could result in a high likelihood of morbidity. In this video, the authors demonstrate the microsurgical technique and surgical skills used to perform excision of an intramedullary ependyma. The authors also present tools (electrophysiology and neuroimaging) that are useful for surgical decision-making and planning, and thus are used intraoperatively, that allow safer and more effective resection of an intramedullary tumor.
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Affiliation(s)
- Corentin Dauleac
- Service de Neurochirurgie Fonctionnelle, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon
- Université de Lyon, Université Claude Bernard Lyon I, Lyon
- Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, INSA Lyon, Université Claude Bernard Lyon I, Lyon
| | - Sébastien Boulogne
- Université de Lyon, Université Claude Bernard Lyon I, Lyon
- Service de Neurologie et électrophysiologie, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon; and
| | - François Cotton
- Université de Lyon, Université Claude Bernard Lyon I, Lyon
- Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, INSA Lyon, Université Claude Bernard Lyon I, Lyon
- Service de Radiologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, France
| | - Patrick Mertens
- Service de Neurochirurgie Fonctionnelle, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon
- Université de Lyon, Université Claude Bernard Lyon I, Lyon
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5
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Soloukey S, Verhoef L, Generowicz BS, De Zeeuw CI, Koekkoek SKE, Vincent AJPE, Dirven CMF, Harhangi BS, Kruizinga P. Case report: High-resolution, intra-operative µDoppler-imaging of spinal cord hemangioblastoma. Front Surg 2023; 10:1153605. [PMID: 37342792 PMCID: PMC10277559 DOI: 10.3389/fsurg.2023.1153605] [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: 01/29/2023] [Accepted: 05/19/2023] [Indexed: 06/23/2023] Open
Abstract
Surgical resection of spinal cord hemangioblastomas remains a challenging endeavor: the neurosurgeon's aim to reach total tumor resections directly endangers their aim to minimize post-operative neurological deficits. The currently available tools to guide the neurosurgeon's intra-operative decision-making consist mostly of pre-operative imaging techniques such as MRI or MRA, which cannot cater to intra-operative changes in field of view. For a while now, spinal cord surgeons have adopted ultrasound and its submodalities such as Doppler and CEUS as intra-operative techniques, given their many benefits such as real-time feedback, mobility and ease of use. However, for highly vascularized lesions such as hemangioblastomas, which contain up to capillary-level microvasculature, having access to higher-resolution intra-operative vascular imaging could potentially be highly beneficial. µDoppler-imaging is a new imaging modality especially fit for high-resolution hemodynamic imaging. Over the last decade, µDoppler-imaging has emerged as a high-resolution, contrast-free sonography-based technique which relies on High-Frame-Rate (HFR)-ultrasound and subsequent Doppler processing. In contrast to conventional millimeter-scale (Doppler) ultrasound, the µDoppler technique has a higher sensitivity to detect slow flow in the entire field-of-view which allows for unprecedented visualization of blood flow down to sub-millimeter resolution. In contrast to CEUS, µDoppler is able to image high-resolution details continuously, without being contrast bolus-dependent. Previously, our team has demonstrated the use of this technique in the context of functional brain mapping during awake brain tumor resections and surgical resections of cerebral arteriovenous malformations (AVM). However, the application of µDoppler-imaging in the context of the spinal cord has remained restricted to a handful of mostly pre-clinical animal studies. Here we describe the first application of µDoppler-imaging in the case of a patient with two thoracic spinal hemangioblastomas. We demonstrate how µDoppler is able to identify intra-operatively and with high-resolution, hemodynamic features of the lesion. In contrast to pre-operative MRA, µDoppler could identify intralesional vascular details, in real-time during the surgical procedure. Additionally, we show highly detailed post-resection images of physiological human spinal cord anatomy. Finally, we discuss the necessary future steps to push µDoppler to reach actual clinical maturity.
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Affiliation(s)
- Sadaf Soloukey
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands
- Department of Neurosurgery, Erasmus MC, Rotterdam, Netherlands
| | - Luuk Verhoef
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands
| | | | - Chris I. De Zeeuw
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands
- Royal Dutch Academy for Arts and Sciences, Netherlands Institute for Neuroscience, Amsterdam, Netherlands
| | | | | | | | - Biswadjiet S. Harhangi
- Department of Neurosurgery, Erasmus MC, Rotterdam, Netherlands
- Department of Neurosurgery, Park MC, Rotterdam, Netherlands
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6
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Nakanishi Y, Kunihiro N, Umaba R, Matsusaka Y, Inoue T, Sakamoto H. Limited dorsal myeloschisis associated with intramedullary infantile hemangioma in the conus medullaris: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22359. [PMID: 37096816 PMCID: PMC10550677 DOI: 10.3171/case22359] [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] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/28/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Limited dorsal myeloschisis (LDM) and intramedullary infantile hemangioma rarely coexist in the spinal cord. OBSERVATIONS The authors describe the case of a 3-month-old girl who, despite lacking neurological symptoms or signs, had a cigarette burn-like mark at the lumbosacral area and skin dimpling in the gluteal area. Magnetic resonance imaging showed a low-set conus due to a thickened filum and an abnormal subcutaneous stalk connected to the conus medullaris. In combination with the skin lesions, these findings strongly implied nonsaccular-type LDM. An intramedullary mass in the conus medullaris was also shown on magnetic resonance imaging and was homogenously enhanced with isointensity on T1- and T2-weighted images. We prophylactically untethered the spinal cord and partially removed the intramedullary mass, which had no clear borders, for a safe surgical dissection. Histologically, the intramedullary mass was an infantile hemangioma, and the subcutaneous stalk was a lesion associated with LDM. The patient remained neurologically intact after surgery, and then 2 years later, there was spontaneous regression of the residual tumor. LESSONS Although rare, nonsaccular type LDM may appear concurrently with intramedullary infantile hemangioma at the conus medullaris. The authors present a possible mechanism behind this concurrent presentation in the same area.
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Affiliation(s)
- Yoko Nakanishi
- Departments of Pediatric Neurosurgery, and
- Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan
| | | | | | | | - Takeshi Inoue
- Pathology, Osaka City General Hospital, Osaka, Japan; and
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7
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Hersh AM, Liu A, Rincon-Torroella J, Sair HI, Lubelski D, Bettegowda C, Shimony N, Larry Lo SF, Sciubba DM, Jallo GI. The Ribbon Sign as a Radiological Indicator of Intramedullary Spinal Cord Subependymomas. World Neurosurg 2023:S1878-8750(23)00452-7. [PMID: 37028485 DOI: 10.1016/j.wneu.2023.03.128] [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: 12/27/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE Intramedullary spinal cord (IMSC) subependymomas are rare World Health Organization grade 1 ependymal tumors. The potential presence of functional neural tissue within the tumor and poorly demarcated planes presents a risk to resection. Anticipating a subependymoma on preoperative imaging can inform surgical decision-making and improve patient counseling. Here, we present our experience recognizing IMSC subependymomas on preoperative magnetic resonance imaging (MRI) based on a distinctive characteristic termed the "ribbon sign." METHODS We retrospectively reviewed preoperative MRIs of patients presenting with IMSC tumors at a large tertiary academic institution between April 2005 and January 2022. The diagnosis was confirmed histologically. The "ribbon sign" was defined as a ribbon-like structure of T2 isointense spinal cord tissue interwoven between regions of T2 hyperintense tumor. The ribbon sign was confirmed by an expert neuroradiologist. RESULTS MRIs from 151 patients were reviewed, including ten patients with IMSC subependymomas. The ribbon sign was demonstrated on nine (90%) patients with histologically proven subependymomas. Other tumor types did not display the ribbon sign. CONCLUSION The ribbon sign is a potentially distinctive imaging feature of IMSC subependymomas and indicates the presence of spinal cord tissue between eccentrically located tumor. Recognition of the ribbon sign should prompt clinicians to consider a diagnosis of subependymoma, aiding the neurosurgeon in planning the surgical approach and adjusting the surgical outcome expectation. Consequently, the risks and benefits of gross- vs. sub-total resection for palliative debulking should be carefully considered and discussed with patients.
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Affiliation(s)
- Andrew M Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287
| | - Ann Liu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287
| | - Jordina Rincon-Torroella
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287
| | - Haris I Sair
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiologic Science, The Johns Hopkins Hospital, Baltimore, MD, USA 21287
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287
| | - Nir Shimony
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287; Department of surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN 38105, USA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA 38120
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA 11030
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287; Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA 11030
| | - George I Jallo
- Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA 33701.
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8
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Yaltırık CK, Yamaner EO, Suakar Ö, Gürkan S, Sav A, Türe U. Whorling Sclerosing Ependymoma of the Cervical Spinal Cord Presenting Tanycytic Histopathologic Features: A Rare Case Report. Int J Surg Pathol 2023; 31:239-246. [PMID: 35611479 DOI: 10.1177/10668969221099629] [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] [Indexed: 11/16/2022]
Abstract
Tanycytic ependymoma is a neuroectodermal tumor that arises from ependymoglial cells or tanycytes. It is highly uncommon. We reported a 34-year-old man who was diagnosed with intradural-intramedullary tanycytic ependymoma, located at the level of C4-5 who had a 9-months history of neck pain and left arm pain, and numbness on fingers. One month prior to presentation, his left arm numbness and paresthesia deteriorated. The lesion was removed totally by C4, C5 hemilaminoplasty. The histologic pattern of this lesion was consisted of fascicles forming nebula-like whorling structures. Because of these structures, tanycytic ependymoma should be taken into consideration in the differential diagnosis of a whorling-sclerosing variant of meningiomas.
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Affiliation(s)
- Cumhur Kaan Yaltırık
- Department of Neurosurgery, Ümraniye Training And Research Hospital, Istanbul, Turkey
| | - Emin Oğuzcan Yamaner
- Department of Neurosurgery, 64172Yeditepe University School of Medicine, Istanbul, Turkey
| | - Öznur Suakar
- Department of Medical Genetics, School of Medicine, Yeditepe University, Istanbul, Turkey
| | - Sezin Gürkan
- Department of Medical Genetics, School of Medicine, Yeditepe University, Istanbul, Turkey
| | - Aydın Sav
- Department of Pathology, 64172Yeditepe University School of Medicine, Istanbul, Turkey
| | - Uğur Türe
- Department of Neurosurgery, 64172Yeditepe University School of Medicine, Istanbul, Turkey
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9
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Chai RC, Yan H, An SY, Pang B, Chen HY, Mu QH, Zhang KN, Zhang YW, Liu YQ, Liu X, Zhao Z, Jiang T, Wang YZ, Jia WQ. Genomic profiling and prognostic factors of H3 K27M-mutant spinal cord diffuse glioma. Brain Pathol 2023:e13153. [PMID: 36751054 DOI: 10.1111/bpa.13153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
H3 K27-altered diffuse midline glioma is a highly lethal pediatric-type tumor without efficacious treatments. Recent findings have highlighted the heterogeneity among diffuse midline gliomas with different locations and ages. Compared to tumors located in the brain stem and thalamus, the molecular and clinicopathological features of H3 K27-altered spinal cord glioma are still largely elusive, thus hindering the accurate management of patients. Here we aimed to characterize the clinicopathological and molecular features of H3 K27M-mutant spinal cord glioma in 77 consecutive cases. We found that the H3 K27M-mutant spinal cord glioma, with a median age of 35 years old, had a significantly better prognosis than H3 K27M-mutant brain tumors. We noticed a molecular heterogeneity of H3 K27M-mutant spinal cord astrocytoma via targeted sequencing with 34 cases. TP53 mutation which occurred in 58.8% of cases is mutually exclusive with PPM1D (26%) and NF1 (44%) mutations. The TP53-mutant cases had a significantly higher number of copy number variants (CNV) and a marginally higher proportion of pediatric patients (age at diagnosis <18 years old, p = 0.056). Cox regression and Kaplan-Meier curve analysis showed that the higher number of CNV events (≥3), chromosome (Chr) 9p deletion, Chr 10p deletion, ATRX mutation, CDK6 amplification, and retinoblastoma protein (RB) pathway alteration are associated with worse survival. Cox regression analysis with clinicopathological features showed that glioblastoma histological type and a high Ki-67 index (>10%) are associated with a worse prognosis. Interestingly, the histological type, an independent prognostic factor in multivariate Cox regression, can also stratify molecular features of H3 K27M-mutant spinal cord glioma, including the RB pathway, KRAS/PI3K pathway, and chromosome arms CNV. In conclusion, although all H3 K27M-mutant spinal cord diffuse glioma were diagnosed as WHO Grade 4, the histological type, molecular features representing chromatin instability, and molecular alterations associated with accelerated cell proliferative activity should not be ignored in clinical management.
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Affiliation(s)
- Rui-Chao Chai
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Hao Yan
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Song-Yuan An
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bo Pang
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Hui-Yuan Chen
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Quan-Hua Mu
- Department of Chemical and Biological Engineering, The Hong Kong University of Science and Technology, Hong Kong, SAR, China
| | - Ke-Nan Zhang
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yao-Wu Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu-Qing Liu
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xing Liu
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zheng Zhao
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Tao Jiang
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong-Zhi Wang
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen-Qing Jia
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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10
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Kajikawa K, Nagoshi N, Tsuji O, Suzuki S, Ozaki M, Takahashi Y, Yagi M, Matsumoto M, Nakamura M, Watanabe K. Clinical and Imaging Characteristics of Non-Neoplastic Spinal Lesions: A Comparative Study with Intramedullary Tumors. Diagnostics (Basel) 2022; 12. [PMID: 36552976 DOI: 10.3390/diagnostics12122969] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/13/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
The features of non-neoplastic lesions are often similar to those of intramedullary tumors, and a differential diagnosis is challenging to obtain in some cases. A surgical biopsy, which is performed on highly invasive tumors, should be avoided in cases of non-neoplastic lesions. Therefore, an accurate diagnosis is important prior to treatment. We evaluated 43 patients suspected of having spinal cord tumors and, finally, were diagnosed with non-neoplastic intramedullary lesions via magnetic resonance imaging. The patients commonly presented with myelitis. The patients with non-neoplastic neurological diseases had a significantly shorter symptom duration than those with intramedullary astrocytomas. The proportion of patients with non-neoplastic neurological diseases who presented with lesions at the cervical spinal level and focal lesions on axial imaging but without a spinal cord enlargement was significantly higher than that of patients with intramedullary astrocytomas. The current study aimed to distinguish spinal cord tumors from non-neoplastic intramedullary lesions based on their distinct features.
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11
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Levin RS, Vasiliev SA, Aslanukov MN, Zuev AA, Oshchepkov SK. [Intraoperative ultrasound-assisted surgery of spinal tumors]. Zh Vopr Neirokhir Im N N Burdenko 2022; 86:56-65. [PMID: 35170277 DOI: 10.17116/neiro20228601156] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To improve technique of intraoperative ultrasound-assisted microsurgery of spinal tumors. MATERIAL AND METHODS There were 68 patients with 70 spinal tumors who underwent intraoperative ultrasound-assisted resection between 2007 and 2018. Age of patients varied from 21 to 80 (mean 48.5±14.3). Intradural tumors were diagnosed in 54 (79.4%) patients (of them intramedullary in 16 (23.5%) and extramedullary in 38 (55.9%) cases). Fourteen patients (20.6%) had extradural tumors. Intraoperative ultrasound was used to determine localization, margins and structure of tumors, interrelations with neural structures, zones of dura opening and myelotomy. We also assessed quality of resection and spinal decompression. RESULTS In surgery of spinal tumors, intraoperative ultrasound allows to localize the tumor with 95.3% sensitivity, determine the character of its growth, shape, size and internal structure. One can also differentiate the margins of neoplasm, control accuracy of approach, select the optimal zone for dura opening and myelotomy, objectively assess spinal cord and nerve roots decompression in real-time mode. Quality of intraoperative ultrasonography images is comparable to preoperative MRI, and even exceed resolution of MR scans in some cases. CONCLUSION In our study, intraoperative ultrasound has proven to be a method complementing preoperative CT and MRI. This approach provides additional data in real-time mode to form a complete picture of surgical area, increase accuracy of manipulations and reduce surgical trauma.
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Affiliation(s)
- R S Levin
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - S A Vasiliev
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - M N Aslanukov
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - A A Zuev
- Pirogov National Medical Surgical Center, Moscow, Russia
| | - S K Oshchepkov
- Petrovsky National Research Centre of Surgery, Moscow, Russia
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12
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Singh AK, Sheikh AI, Pandey TK, Chabbra DK. Congenital Mobile Atlantoaxial Dislocation with Cervicomedullary Astrocytoma in Pediatric Patient. Neurol India 2021; 69:194-197. [PMID: 33642301 DOI: 10.4103/0028-3886.310076] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Congenital mobile atlantoaxial dislocation with cervicomedullary astrocytoma has never been described. We present a case of a 7-year-old male child who presented to us with gradually progressive spastic quadriparesis following a fall from table. His lateral radiograph and magnetic resonance images showed mobile atlantoaxial dislocation with intramedullary heterogeneously enhancing cervicomedullary mass. The patient underwent suboccipital craniectomy with C1-4 laminectomy. Tumor was pinkish grey, tenacious with ill-defined plane and cyst at poles. C1-C2 fusion was done using C1 lateral mass and C2 pars screw and rod system with onlay bone graft. Histopathology revealed pilocytic astrocytoma. At the time of discharge, the patient showed improvement in spasticity. Postoperative lateral radiograph showed reduced atlantoaxial dislocation with stable construct.
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Affiliation(s)
- Ajay Kumar Singh
- Department of Neurosurgery, Vivekananda Polyclinic and Institute of Medical Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Adiba I Sheikh
- Department of Neurosurgery, Vivekananda Polyclinic and Institute of Medical Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Tarun Kumar Pandey
- Department of Neurosurgery, Vivekananda Polyclinic and Institute of Medical Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Devender Kumar Chabbra
- Department of Neurosurgery, Vivekananda Polyclinic and Institute of Medical Sciences and Hospital, Lucknow, Uttar Pradesh, India
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Salari F, Golpayegani M, Sadeghi-Naini M, Hanaei S, Shokraneh F, Ahmadi A, Khayat-kashani HR, Vacarro AR, Rahimi-Movaghar V. Complete Versus Incomplete Surgical Resection in Intramedullary Ependymomas: A Systematic Review and Meta-analysis. Global Spine J 2021; 11:761-773. [PMID: 32783515 PMCID: PMC8165927 DOI: 10.1177/2192568220939523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To compare outcomes of complete versus incomplete resection in primary intramedullary spinal cord ependymoma. METHODS A comprehensive search of the MEDLINE, CENTRAL, and Embase databases was conducted by 2 independent investigators. Random-effect meta-analysis and meta-regression with seven covariates were performed to evaluate the reason for the heterogeneity among studies. We also used individual patient data in the integrative analysis to compare complete and incomplete resection based on 4 outcomes: progression-free survival (PFS), overall survival (OS), postoperative neurological improvement (PNI), and follow-up neurological improvement (FNI). RESULTS A total of 23 studies were identified, including 407 cases. Significant heterogeneity among included studies was observed in risk estimates (I2 for PFS, FNI, and PNI were 49.5%, 78.3%, and 87.2%, respectively). The mean follow-up time across cases was 48.6 ± 2.35 months. Cox proportional multivariable analysis revealed that the complete resection can prolong PFS (model, hazard ratio = 0.18, CI 0.05-0.54, P = .004,) and improve the FNI (binary logistic regression, adjusted odds ratio = 16.5, CI 1.6-171, P = .019). However, PNI and OS were similar in patients with incomplete resected spinal cord ependymoma compared with complete resection (binary logistic regression respectively and Cox multivariable analysis, P > .5). CONCLUSION The data presented in this study showed that OS was not significantly affected by the degree of surgery. However, complete resection of intramedullary ependymomas provides the optimal outcomes with longer PFS and better long-term neurological outcomes than incomplete resection.
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Affiliation(s)
- Farhad Salari
- Loghman Hakim Hospital, Shahid Beheshti University of medical science, Tehran, Iran
| | - Mehdi Golpayegani
- Loghman Hakim Hospital, Shahid Beheshti University of medical science, Tehran, Iran
| | - Mohsen Sadeghi-Naini
- Emam Hossein Hospital, Shahid Beheshti University of medical science, Tehran, Iran
| | - Sara Hanaei
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Farhad Shokraneh
- Cochrane Schizophrenia Group, the Institute of Mental Health, Nottingham, UK
| | - Ayat Ahmadi
- Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran,Vafa Rahimi-Movaghar, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran 111, Iran.
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14
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Ushirozako H, Yoshida G, Imagama S, Kobayashi K, Ando K, Ando M, Kawabata S, Yamada K, Kanchiku T, Fujiwara Y, Taniguchi S, Iwasaki H, Shigematsu H, Tadokoro N, Takahashi M, Wada K, Yamamoto N, Funaba M, Yasuda A, Hashimoto J, Morito S, Takatani T, Tani T, Matsuyama Y. Efficacy of Transcranial Motor Evoked Potential Monitoring During Intra- and Extramedullary Spinal Cord Tumor Surgery: A Prospective Multicenter Study of the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research. Global Spine J 2021; 13:961-969. [PMID: 34011196 DOI: 10.1177/21925682211011443] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Multicenter prospective study. OBJECTIVES Although intramedullary spinal cord tumor (IMSCT) and extramedullary SCT (EMSCT) surgeries carry high risk of intraoperative motor deficits (MDs), the benefits of transcranial motor evoked potential (TcMEP) monitoring are well-accepted; however, comparisons have not yet been conducted. This study aimed to clarify the efficacy of TcMEP monitoring during IMSCT and EMSCT resection surgeries. METHODS We prospectively reviewed TcMEP monitoring data of 81 consecutive IMSCT and 347 EMSCT patients. We compared the efficacy of interventions based on TcMEP alerts in the IMSCT and EMSCT groups. We defined our alert point as a TcMEP amplitude reduction of ≥70% from baseline. RESULTS In the IMSCT group, TcMEP monitoring revealed 20 true-positive (25%), 8 rescue (10%; rescue rate 29%), 10 false-positive, a false-negative, and 41 true-negative patients, resulting in a sensitivity of 95% and a specificity of 80%. In the EMSCT group, TcMEP monitoring revealed 20 true-positive (6%), 24 rescue (7%; rescue rate 55%), 29 false-positive, 2 false-negative, and 263 true-negative patients, resulting in a sensitivity of 91% and specificity of 90%. The most common TcMEP alert timing was during tumor resection (96% vs. 91%), and suspension surgeries with or without intravenous steroid administration were performed as intervention techniques. CONCLUSIONS Postoperative MD rates in IMSCT and EMSCT surgeries using TcMEP monitoring were 25% and 6%, and rescue rates were 29% and 55%. We believe that the usage of TcMEP monitoring and appropriate intervention techniques during SCT surgeries might have predicted and prevented the occurrence of intraoperative MDs.
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Affiliation(s)
- Hiroki Ushirozako
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Go Yoshida
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Muneharu Ando
- Department of Orthopedic Surgery, Kansai Medical University, Osaka, Japan
| | - Shigenori Kawabata
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kei Yamada
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Tsukasa Kanchiku
- Department of Orthopedic Surgery, Yamaguchi Rosai Hospital, Yamaguchi, Japan
| | - Yasushi Fujiwara
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | | | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hideki Shigematsu
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Nobuaki Tadokoro
- Department of Orthopedic Surgery, Kochi University, Kochi, Japan
| | | | - Kanichiro Wada
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naoya Yamamoto
- Department of Orthopedic Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Masahiro Funaba
- Department of Orthopedic Surgery, Yamaguchi University, Yamaguchi, Japan
| | - Akimasa Yasuda
- Department of Orthopedic Surgery, National Defense Medical College Hospital, Saitama, Japan
| | - Jun Hashimoto
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinji Morito
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Tsunenori Takatani
- Division of Central Clinical Laboratory, Nara Medical University, Nara, Japan
| | - Toshikazu Tani
- Department of Orthopedic Surgery, Kubokawa Hospital, Kochi, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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15
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Marchesini N, Feletti A, Bernasconi R, Ghimenton C, Sala F. Intramedullary spinal cord metastasis from an adenoid cystic carcinoma of the external auditory canal: case report. Br J Neurosurg 2021; 37:1-5. [PMID: 33970733 DOI: 10.1080/02688697.2021.1923653] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND IMPORTANCE Intramedullary spinal cord metastases (ISCMs) are rare and no cases of ISCM from an adenoid cystic carcinoma (ACC) of the external auditory canal (EAC) have been reported. CLINICAL PRESENTATION We report a 54-year old man complaining backpain and worsening myelopathy. He had an ACC of the EAC resected years prior. A spinal MRI demonstrated a contrast-enhancing intramedullary lesion within the conus medullaris. The histopathological diagnosis of the patient was consistent with the patient's primary cancer. At 3 months follow-up, the neurological condition of the patient was unchanged. CONCLUSIONS This is the first reported case of ISCM from a primary ACC of the EAC.
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Affiliation(s)
- N Marchesini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurosurgery, Borgo Trento University Hospital, University of Verona, Verona, Italy
| | - A Feletti
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurosurgery, Borgo Trento University Hospital, University of Verona, Verona, Italy
| | - R Bernasconi
- Department of Pathology, Borgo University Trento Hospital, AOUI Verona, Verona, Italy
| | - C Ghimenton
- Department of Pathology, Borgo University Trento Hospital, AOUI Verona, Verona, Italy
| | - F Sala
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurosurgery, Borgo Trento University Hospital, University of Verona, Verona, Italy
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16
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Abstract
Primary Hodgkin lymphoma of the central nervous system is an exceedingly rare condition with very few cases reported in the literature. Isolated intradural involvement of the spine is rarer still, with only two prior cases located in the extramedullary cervical and lumbosacral spine. We present a 48-year-old female who was presented with back pain, radiculopathy and a short history of sphincter disturbance and was subsequently found to have a lobulated homogenously enhancing exophytic lesion involving the conus medullaris and cauda equina on magnetic resonance imaging. Histopathological examination demonstrated the features of classic Hodgkin lymphoma. In this report, we present a case of primary intramedullary Hodgkin lymphoma involving the conus medullaris and cauda equina.
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Affiliation(s)
| | - Michael Wang
- Medical Imaging Department, Austin Health, Heidelberg, Victoria 3084, Australia
| | - Jonathan Clark
- Department of Anatomical Pathology, Austin Hospital, Heidelberg, Victoria 3084, Australia
| | - Julia Williams
- Medical Imaging Department, Austin Health, Heidelberg, Victoria 3084, Australia
| | - Armin Drnda
- Department of Neurosurgery, Austin Health, Heidelberg, Victoria 3084, Australia
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17
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Abstract
Intramedullary tuberculoma (IMT) is a rare form of spinal cord tuberculosis (TB). Unlike Pott’s spine, IMT is without osseous involvement and is indolent. These features may account for why the diagnosis is often overlooked as a cause of compressive myelopathy. Our case is unique in that we discuss an unusual presentation of a patient who presented with gait disturbance as the first symptom of spinal cord TB without foci of TB infection elsewhere. The patient’s neurological symptoms improved with surgery and multidrug-resistant antituberculosis treatment. Although MRI is the preferred modality to characterize IMT, findings may be nonspecific, ultimately requiring biopsy. When IMT is diagnosed and managed appropriately, it carries a good prognosis. An interdisciplinary approach would provide the best outcomes.
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Affiliation(s)
- Andrew Talon
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
| | - Ericka Charley
- Internal Medicine, Creighton University School of Medicine/St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Arnold N Forlemu
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
| | - Dale Stern
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
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18
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Abstract
BACKGROUND Intramedullary cervical spinal cord teratomas (ICTs) are extremely rare, and diagnosis and treatment are challenging. We conducted a systematic review of the literature on the diagnosis and treatment of ICT. METHOD The presentation, imaging manifestations, diagnosis, management, surgery findings, prognosis and histology were reviewed following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. English-language studies and case reports published from inception to 2018 were retrieved. Data on presentation, imaging characteristics, diagnosis, management, surgery findings, outcomes, and histopathology were extracted. RESULTS Ten articles involving 10 patients were selected. The lesions were located in the upper cervical vertebrae in 4 cases, whereas in the lower cervical vertebrae in the remaining 6 cases. In 5 cases, the lesions were located on the dorsal side of the spinal cord, and in the center of the spinal cord in the remaining 5 cases. Quadriparesis (60%), paraplegia (30%), monoplegia (10%), and neck pain (50%) were the main presentations. The lesion appeared as a intramedullary heterogeneous signal during an MRI scan, and the lesion signal would be partially enhanced after the contrast medium was applied. All patients underwent surgical intervention through a posterior approach. Neurological function improved postoperatively in all patients. Two patients with pathology confirmed to be immature teratomas experienced recurrence. CONCLUSION ICTs are extremely rare entities that are mainly located in the center or dorsal part of the spinal cord which mainly manifest as quadriplegia and neck pain. MRI is a useful modality that provides diagnostic clues. Surgery from a posterior approach is the primary treatment, and the effect of adjuvant therapy remains uncertain. The prognosis is mainly related to the pathological nature of the tumor and not the method of resection.
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Affiliation(s)
- Lishuai Wang
- Department of Oncology, The Second People's Hospital of Yibin
| | - Tongxiang Li
- Department of Orthopedics, The First People's Hospital of Yibin, Yibin City
| | - Min Gong
- Department of Orthopedics, Chengdu
| | - Fei Xing
- Department of Orthopedics, Chengdu
| | - Lang Li
- Department of Pediatric surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, PR China
| | - Rui Xiao
- Department of Orthopedics, The First People's Hospital of Yibin, Yibin City
| | - Qing Guan
- Department of Orthopedics, The First People's Hospital of Yibin, Yibin City
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19
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Yang C, Xu Y, Liu X. Spinal Intramedullary Solitary Fibrous Tumor: A Rare and Challenging Diagnosis. Cancer Manag Res 2019; 11:10321-10326. [PMID: 31849521 PMCID: PMC6911315 DOI: 10.2147/cmar.s231019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/14/2019] [Accepted: 12/03/2019] [Indexed: 11/29/2022] Open
Abstract
Background Solitary fibrous tumor (SFT) is a benign neoplasm arising in the soft tissue, which can occur anywhere in the body, while it is predominantly found in the visceral pleura. Spinal SFT is quite uncommon, with limited cases having been reported in the literature; especially, SFT occurring in the intramedullary site is extremely rare. Case presentation We present a case of a 35-year-old woman presenting with progressive numbness and weakness in the legs and urinary incontinence. Magnetic resonance imaging (MRI) showed an intramedullary lesion with bright enhancement. A diagnosis of spinal hemangioblastoma was suspected, and thus a three-dimensional computed tomographic angiography reconstruction was requested, which also demonstrated an angiomatous lesion. The tumor was completely resected under neurophysiological monitoring. However, histopathological and immunohistochemical examinations revealed an SFT. No adjuvant radiotherapy or chemotherapy was scheduled. The symptoms were relieved completely, and no recurrence or progression was noted during the follow-up. Conclusion Though SFT has been considered similar to malignant hemangiopericytoma and the histological classification has always been controversial, the intramedullary location and benign behavior in the present case add to the current understandings of this extremely rare entity.
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Affiliation(s)
- Chenlong Yang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, People's Republic of China
| | - Yulun Xu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, People's Republic of China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, People's Republic of China
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20
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Abstract
RATIONALE Rosette-forming glioneuronal tumor (RGNT) is a rare tumor which has been first reported as the fourth ventricle tumor by Komori et al and is classified as a distinct clinicopathological entity by the WHO Classification of Tumors of the Central Nervous System as in 2007. Although RGNTs were reported to occur in both supratentorial and inflatentorial sites, only 4 case reports of spinal RGNT have been demonstrated. PATIENT CONCERNS A 37-year-old female presenting with slowly progressing right-sided clumsiness. Cervical magnetic resonance imaging revealed a spinal intramedullary tumor between the C2 and C5 levels. DIAGNOSES Pathological analysis showed unique biphasic cellular architecture consisting of perivascular pseudorosettes dominantly with few neurocytic rosettes and diffuse astrocytoma component. The tumor cells composed of perivascular pseudorosettes showed positivity for both synaptophysin and glial markers such as GFAP and Olig2. Therefore, the diagnosis of RGNT was made. INTERVENTIONS Gross total resection of the tumor was achieved. No adjuvant chemotherapy nor radiotherapy was conducted after operation. OUTCOMES At 2 years after the operation, no recurrence was observed. LESSONS Although RGNT arising from the spinal cord is extremely rare, we need to consider the tumor as a differential diagnosis for intramedullary spinal cord tumors.
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Affiliation(s)
- Shuji Hamauchi
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Hokkaido
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo
| | - Mishie Tanino
- The Department of Surgical Pathology, Asahikawa Medical University, Asahikawa
- Department of Cancer Pathology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Kazutoshi Hida
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Hokkaido
| | - Toru Sasamori
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Hokkaido
| | - Shunsuke Yano
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Hokkaido
| | - Shinya Tanaka
- Department of Cancer Pathology, Hokkaido University Faculty of Medicine, Sapporo, Japan
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Hongo H, Takai K, Komori T, Taniguchi M. Intramedullary spinal cord ependymoma and astrocytoma: intraoperative frozen-section diagnosis, extent of resection, and outcomes. J Neurosurg Spine 2019; 30:133-139. [PMID: 30485241 DOI: 10.3171/2018.7.spine18230] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 02/28/2018] [Accepted: 07/10/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe intraoperative differentiation of ependymomas from astrocytomas is important because neurosurgical strategies differ between these two tumor groups. Previous studies have reported that the diagnostic accuracy of intraoperative frozen sections of intracranial central nervous system (CNS) tumors is higher than 83%-97%, whereas that for spinal intramedullary tumors remains unknown. Herein, authors tested the hypothesis that intraoperative frozen-section diagnosis is the gold standard for a differential diagnosis of intramedullary spinal cord tumors.METHODSThe clinical characteristics, intraoperative histological diagnosis from frozen sections, extent of tumor resection, progression-free survival (PFS), and overall survival (OS) of 49 cases of intramedullary spinal cord ependymomas (n = 32) and astrocytomas (n = 17) were retrospectively evaluated.RESULTSThe frozen-section diagnosis and final diagnosis with permanent sections agreed in 23 (72%) of 32 cases of ependymoma. Of the 9 cases of ependymoma in which the frozen-section diagnosis disagreed with the final diagnosis, 4 were incorrectly diagnosed as astrocytoma and the other 5 cases had a nonspecific diagnosis, such as glioma. Nonetheless, gross-total resection was achieved in 6 of these 9 cases given the presence of a dissection plane. The frozen-section diagnosis and final diagnosis agreed in 12 (71%) of 17 cases of astrocytoma. Of the 5 cases of astrocytoma in which the frozen-section diagnosis disagreed with the final diagnosis, 1 was incorrectly diagnosed as ependymoma and the other 4 had a nonspecific diagnosis. Gross-total resection was achieved in only 1 of these 5 cases.A relationship between the size of tumor specimens and the diagnostic accuracy of frozen sections was not observed. Ependymal rosettes and perivascular pseudorosettes were observed in 30% and 57% of ependymomas, respectively, but were absent in astrocytomas.Progression-free survival and OS were both significantly longer in cases of ependymoma than in cases of astrocytoma (p < 0.001). Gross-total resection was achieved in 69% of ependymomas and was associated with longer PFS (p = 0.041). In the astrocytoma group, gross-total resection was achieved in only 12% and there was no relationship between extent of resection and OS. Tumor grades tended to correlate with OS in astrocytomas (p = 0.079).CONCLUSIONSThe diagnostic accuracy of intraoperative frozen sections was lower for intramedullary spinal cord ependymomas and astrocytomas in the present study than that for intracranial CNS tumors reported on in the literature. Surgical strategies need to be selected based on multiple factors, such as clinical characteristics, preoperative imaging, frozen-section diagnosis, and intraoperative findings of the tumor plane.
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Affiliation(s)
| | | | - Takashi Komori
- 2Laboratory Medicine and Pathology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
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22
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Krüger MT, Steiert C, Gläsker S, Klingler JH. Minimally invasive resection of spinal hemangioblastoma: feasibility and clinical results in a series of 18 patients. J Neurosurg Spine 2019; 31:1-10. [PMID: 31398701 DOI: 10.3171/2019.5.spine1975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/20/2019] [Accepted: 05/28/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Hemangioblastomas are benign, highly vascularized tumors that can occur sporadically or as part of von Hippel-Lindau (VHL) disease. Traditionally, spinal hemangioblastomas have been surgically treated via an open approach. In recent years, however, minimally invasive techniques using tubular retractors have been increasingly applied in spine surgery. Such procedures involve less tissue trauma but are also particularly demanding for the surgeon, especially in cases of highly vascular tumors such as hemangioblastomas. The object of this study was to evaluate the safety and efficacy of minimally invasive resection of selected spinal hemangioblastomas. METHODS The authors conducted a retrospective single-center study of all patients who, between January 2010 and January 2018, had been operated on for spinal hemangioblastoma via a minimally invasive approach performed at the surgeon's discretion. The surgical technique is described and the pre- and postoperative neurological and imaging results were analyzed descriptively. The primary outcome was the postoperative compared to preoperative neurological condition (McCormick grade). The secondary outcomes were the extent of tumor resection and postoperative complications. RESULTS Eighteen patients, 12 female and 6 male, harboring a total of 19 spinal hemangioblastomas underwent surgery in the study period. Seventeen patients had stable neurological findings with stable or improved McCormick grades (94.5%) at a mean of 4.3 months after surgery. One (5.5%) of the 18 patients developed progressive neurological symptoms with a worsened McCormick grade that did not improve in the long-term follow-up. Sixteen of the 18 patients had VHL disease, whereas 2 patients had sporadic spinal hemangioblastomas. In all patients, postoperative MRI showed complete resection of the tumors. No other surgery-related perioperative or postoperative complications were recorded. CONCLUSIONS A minimally invasive approach for the resection of selected spinal hemangioblastomas is safe and allows complete tumor resection with good clinical results in experienced hands.
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Affiliation(s)
- Marie T Krüger
- 1Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- 2Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Christine Steiert
- 1Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sven Gläsker
- 1Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- 3Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jan-Helge Klingler
- 1Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Mikula AL, Paolini MA, Sukov WR, Clarke MJ, Raghunathan A. Subependymoma involving multiple spinal cord levels: A clinicopathological case series with chromosomal microarray analysis. Neuropathology 2019; 39:97-105. [PMID: 30856298 DOI: 10.1111/neup.12543] [Citation(s) in RCA: 2] [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: 08/15/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 12/24/2022]
Abstract
Subependymomas of the spinal cord are rare, do not often involve multiple levels, and very rarely recur. Here, we present a series of spinal cord subependymomas with a detailed description of the clinical, radiological and pathological features, and characterization by chromosomal microarray analysis. Briefly, the four patients included two men and two women, between the ages of 22 and 48 years. The most common presenting symptoms were neck and arm pain with upper extremity weakness. By imaging, the tumors were found to involve multiple spinal levels, including cervical/ cervico-thoracic (three patients) and thoracic (one patient), were all eccentric, and had minimal to no post-contrast enhancement. Two patients underwent gross total resection, one had a sub-total resection, and one underwent biopsy alone with a decompressive laminectomy. Follow up ranged from 6 months to 22 years. One patient (case 4) had recurrence 15 years following gross total resection and chromosomal microarray analysis revealed deletions on the long arm of chromosome 6. Our limited series suggests that spinal cord subependymomas can rarely recur, even following gross total resection, suggesting a possible role for long-term surveillance for these rare tumors.
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Affiliation(s)
- Anthony L Mikula
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael A Paolini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - William R Sukov
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Luque LL, Marchetti M, Seclen D, Sainz A, Platas M, Lambre J. [Intramedullary neuroenteric cyst: Case report and review of the literature]. Surg Neurol Int 2018; 9:S50-S55. [PMID: 29900034 PMCID: PMC5981181 DOI: 10.4103/sni.sni_493_17] [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: 12/29/2017] [Accepted: 01/19/2018] [Indexed: 11/05/2022] Open
Abstract
Neurenteric cysts (NC) are rare, benign, congenital lesions, caused by abnormal or persistent communications between neuroectodermal structures, the notochord and endodermal tissue. They present mainly in the pediatric population or young adults, coexisting with spinal, gastrointestinal or respiratory malformations. They are typically intradural extramedullary tumors, with intramedullary lesions the exception. The objective of this paper is to report the case of a cervical intramedullary neuroenteric cyst in a young adult, without coexisting malformations. According to the literature, surgical treatment is elective though, considering the high recurrence rate, radical resection should be the surgical goal. Follow-up with magnetic resonance imaging is recommended for subtotal surgical resections.
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Affiliation(s)
- Leopoldo Luciano Luque
- Clínica Modelo Lanús, Lanús, Argentina
- Hospital El Cruce, Florencio Varela, Argentina
- Hospital Presidente Perón, Avellaneda, Buenos Aires, Argentina
| | | | | | - Ariel Sainz
- Hospital Presidente Perón, Avellaneda, Buenos Aires, Argentina
| | - Marcelo Platas
- Hospital Presidente Perón, Avellaneda, Buenos Aires, Argentina
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25
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Abstract
Melanocytoma is rare pigmented tumor of the leptomeninges which arise from the neural crest. Intramedullary location of the tumor is extremely rare, and only a few case reports are available in the literature. We report a case of 35-year-old female with the entity who had a near total removal of the intramedullary tumor with good postoperative outcome. The available literature is reviewed.
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Affiliation(s)
- Amitesh Dubey
- Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Rashim Kataria
- Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Vimal R Sardana
- Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
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Evzikov GY, Konovalov NA, Bashlachev MG, Asyutin DS, Onoprienko RA, Korolishin VA, Timonin SY, Panina TN, Belozerskikh KA. [Surgical treatment of intramedullary-extramedullary ependymomas. Two clinical cases and a literature review]. Zh Vopr Neirokhir Im N N Burdenko 2018; 82:48-55. [PMID: 29927425 DOI: 10.17116/neiro201882348] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED Ependymoma is a central nervous system tumor that grows from ependymal cells lining the cerebral ventricles, central canal of the spinal cord, and filum terminale. Regardless of the histological type of ependymomas, they rarely have exophytic growth. Because of an extremely low occurrence rate of this phenomenon, we present two clinical cases of patients with classical intramedullary ependymomas (Grade II) having an extramedullary component. MATERIAL AND METHODS The paper presents two clinical cases of patients with intramedullary-extramedullary ependymomas of the spinal cord. The surgical technique is described. After surgical treatment, the performance status of patients remained unchanged. CONCLUSION Radical removal of complex ependymomas provides conditions for long-term disease-free survival and further neurological recovery.
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Affiliation(s)
- G Yu Evzikov
- Sechenov First Moscow State Medical University, Clinic of Nervous Diseases, Rossolimo Str., 11, Moscow, Russia, 119021
| | - N A Konovalov
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - M G Bashlachev
- Sechenov First Moscow State Medical University, Clinic of Nervous Diseases, Rossolimo Str., 11, Moscow, Russia, 119021
| | - D S Asyutin
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - R A Onoprienko
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - V A Korolishin
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - S Yu Timonin
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - T N Panina
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - K A Belozerskikh
- Sechenov First Moscow State Medical University, Clinic of Nervous Diseases, Rossolimo Str., 11, Moscow, Russia, 119021
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Abstract
STUDY DESIGN Review and technical report. OBJECTIVE Intraoperative ultrasound has been used by spine surgeons since the early 1980s. Since that time, more advanced modes of intraoperative imaging and navigation have become widely available. Although the use of ultrasound during spine surgery has fallen out of favor, it remains the only true real-time imaging modality that allows surgeons to visualize soft tissue anatomy instantly and continuously while operating. It is our objective to demonstrate that for this reason, ultrasound is a useful adjunctive technique for spine surgeons, especially when approaching intradural lesions or when addressing pathology in the ventral spinal canal via a posterior approach. METHODS Using PubMed, the existing literature regarding the use of intraoperative ultrasound during spinal surgery was evaluated. Also, surgical case logs were reviewed to identify spinal operations during which intraoperative ultrasound was used. Illustrative cases were selected and reviewed in detail. RESULTS This article provides a brief review of the history of intraoperative ultrasound in spine surgery and describes certain surgical scenarios during which this technique might be useful. Several illustrative cases are provided from our own experience. CONCLUSIONS Surgeons should consider the use of intraoperative ultrasound when approaching intradural lesions or when addressing pathology ventral to the thecal sac via a posterior approach.
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Affiliation(s)
- Viren S. Vasudeva
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Viren S. Vasudeva, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street AB-136, Boston, MA 02115, USA.
| | | | - Yuri A. Pompeu
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Aditya Karhade
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael W. Groff
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Yi Lu
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
BACKGROUND Primary intramedullary spinal glioblastoma multiforme (GBM) lesions are very rare comprising only 1.5% of all spinal cord tumors. These lesions typically result in rapid neurological deterioration and are associated with a very poor prognosis. CASE DESCRIPTION A 16-year-old male exhibited a slowly progressive paraparesis with urinary incontinence, ultimately resulting in paraplegia. On magnetic resonance (MR), he was diagnosed with an intramedullary GBM of the spinal cord extending from the T9 level through the conus medullaris. Ten months following decompression/partial surgical resection of the intramedullary mass, he remained paraplegic. CONCLUSION GBM of the spinal cord are rare in the pediatric age group. A 16-year-old male presented with a flaccid paraplegia attributed to an MR-documented GBM of the distal thoracic cord extending from the T9 level through the conus medullaris. Despite partial intramedullary tumor resection, 10 months postoperatively, he remained paraplegic.
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Affiliation(s)
- Lakhdar Fayçal
- Department of Neurosurgery, Hassan II Hospital, University Sidi Mohamed Ben Abdellah, Fes, Morocco
| | - Bougrine Mouna
- Department of Neurosurgery, Cheikh Zaid Hospital, Rabat, Morocco
| | - El Abbadi Najia
- Department of Neurosurgery, Cheikh Zaid Hospital, Rabat, Morocco
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29
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Stappers J, Herregods P, Chappel R, Surgeloose DD, Stassijns G. An Achilles tendinosis masking an intramedullary astrocytoma. J Back Musculoskelet Rehabil 2016; 28:599-602. [PMID: 25322734 DOI: 10.3233/bmr-140542] [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] [Indexed: 02/04/2023]
Abstract
We report the case of a 53-year-old male with a right Achilles tendinosis, who complains about a mild gait disorder starting after walking several kilometers. In the following months he develops neurological symptoms. MRI lumbar spine shows an intramedullary tumor at level Th12. A biopsy confirms the diagnosis of an intramedullary astrocytoma. Primary intramedullary tumors are relatively rare. Clinical presentation is often insidious. The authors want to make a point to reconsider a diagnosis in case it does not explain completely the anamnestic or clinical findings. According to the literature there is no optimal approach to the management of these tumors.
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Affiliation(s)
- Jeroen Stappers
- Department of Physical Medicine and Rehabilitation, Antwerp University Hospital, Edegem, Belgium
| | - Piet Herregods
- Department of Physical Medicine and Rehabilitation, ZNA Middelheim Hospital, Antwerp, Belgium
| | - Rudi Chappel
- Department of Physical Medicine and Rehabilitation, ZNA Middelheim Hospital, Antwerp, Belgium
| | | | - Gaëtane Stassijns
- Department of Physical Medicine and Rehabilitation, Antwerp University Hospital, Edegem, Belgium
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30
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Abstract
The authors describe the case of a 48-year-old man found to have the first reported intramedullary spinal cord spindle cell hemangioma. Previous research indicates that spindle cell hemangiomas are rarely found in the spine. Only 3 previous cases exist, all in the intradural, extramedullary space. In the present case, gross-total resection of the tumor was possible with no loss of function from baseline. This report presents the successful resection of the first reported intramedullary spindle cell hemangioma and reports 4-month follow-up, demonstrating the biological behavior of this rare tumor.
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Affiliation(s)
| | | | - Alan D Legatt
- Neurology, and.,Neuroscience, Albert Einstein College of Medicine/Montefiore Medical Center
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31
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Erol İ, Özkale M, Savaş T, Alkan Ö, Çekinmez M, Erbay A. Neuromyelitis optica mimics the morphology of spinal cord tumors. Turk J Pediatr 2016; 58:309-314. [PMID: 28266199 DOI: 10.24953/turkjped.2016.03.014] [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] [Indexed: 06/06/2023]
Abstract
Neuromyelitis optica (NMO) is an autoimmune disorder of the central nervous system, that predominantly affects the spinal cord and the optic nerve. Its key features include transverse myelitis, commonly associated with extensive inflammation spanning three or more consecutive vertebral segments. Longitudinal extensive spinal cord lesions can also occur in systemic autoimmune diseases, infections, vascular and metabolic disorders, subsequent to irradiation, intramedullary tumors and paraneoplastic myelopathies. We present a case study of an 8-year-old girl seropositive for antibodies against the aquaporin 4 who displayed longitudinal extensive spinal cord lesions, that was initially misdiagnosed as an intramedullary tumor.
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Affiliation(s)
- İlknur Erol
- Divisions of Pediatric Neurology, Başkent University Faculty of Medicine, Adana, Turkey
| | - Murat Özkale
- Department of Pediatrics, Başkent University Faculty of Medicine, Adana, Turkey
| | - Tülin Savaş
- Divisions of Pediatric Neurology, Başkent University Faculty of Medicine, Adana, Turkey
| | - Özlem Alkan
- Department of Radiology, Başkent University Faculty of Medicine, Adana, Turkey
| | - Melih Çekinmez
- Department Neurosurgery, Başkent University Faculty of Medicine, Adana, Turkey
| | - Ayşe Erbay
- Divisions of Pediatric Hematology and Oncology, Başkent University Faculty of Medicine, Adana, Turkey
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Alkherayf F, Arab AF, Tsai E. Conus Medullaris Teratoma with Utilization of Fiber Tractography: Case Report. J Neurol Surg Rep 2015; 76:e183-7. [PMID: 26251802 PMCID: PMC4521003 DOI: 10.1055/s-0035-1555134] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/28/2015] [Indexed: 11/17/2022] Open
Abstract
Objective Conus medullaris teratomas are very rare tumors. Traditional preoperative diagnosis depended on the findings from magnetic resonance imaging (MRI). Tractography is a novel technique that has recently been utilized to diagnose spinal cord lesions. This case report shows that fiber tractography has great potential in preoperative diagnosis and postoperative follow-up of teratomas of the conus medullaris. Methods A 50-year-old man with a conus medullaris teratoma underwent tractography with the aim of visualizing the tumor in relation to the white matter tracts. The patient underwent a T12–L2 laminectomy, and the lesion was resected. The histopathology diagnosis was of a mature teratoma. Study Design Case report. Results Diffusion tensor imaging (DTI) and tractography provide more details about the white matter tracts in relation to space-occupying lesions that may be more sensitive than conventional MRI and have recently been utilized in spinal cord lesions. Fiber tracking has the ability to visualize the integrity of the white matter tracts at the level of the conus medullaris in relation to the lesion. The tracts appeared to be displaced by the lesion at the conus medullaris. Tractography also showed no white matter tracts within the lesion. Such findings are consistent with the characteristics of a benign lesion. Exploiting tractography in this case was helpful in predicting the nature of the lesion preoperatively and in planning the surgical intervention. Conclusions Conus medullaris teratomas mostly affect adults. Patients generally present with a long history of clinical symptoms prior to diagnosis. Surgery is required for diagnosis, and the goal should be complete tumor excision without sacrificing any neurologic functions. The use of DTI and tractography, in addition to conventional MRI, has the potential to be very valuable for the diagnosis, surgical planning, and follow-up of patients with conus medullaris teratomas.
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Affiliation(s)
- Fahad Alkherayf
- Spine Program, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada ; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada ; Division of Neurosurgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Abdullah Faisal Arab
- Spine Program, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada ; Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada ; Division of Spine Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Eve Tsai
- Spine Program, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada ; Division of Neurosurgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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33
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Abstract
AIM Intramedullary spinal cord tumors (IMSCT) are rare neoplasms of central nervous system but require proper evaluation and management to ensure a good outcome. This study was carried out to evaluate the functional outcome of IMSCT following surgery and to decipher the factors affecting optimal outcome of these cases. MATERIALS AND METHODS A prospective clinical study was carried out at a tertiary care center from 2003 to 2012. Forty three patients with intramedullary tumors diagnosed on magnetic resonance imaging were included. Their clinical details, neurological findings and demographic data were recorded. The patients were then subjected to surgery and adjuvant radiotherapy. The patients were followedup clinically and radiologically, and all parameters examined and recorded. RESULTS Sensory and motor impairment was present preoperatively in majority of patients (n = 39 and n = 38, 90.7% and 88.4%, respectively). Gross total excision was performed in 30 cases (69.76%). The most common histological diagnosis was ependymoma (n = 21, 48.8%). Postoperatively 32 patients (74.4%) were in McCormick functional Grade I or II improving from 13 cases (30.2%) in Grade I or II preoperatively. Fifteen of 17 patients in Medical Research Council (MRC) Grade III and 10 out of 12 patients in Grade MRC IV improved. No mortality was recorded during the entire period of follow-up (mean: 22, range: 3-96 months). Eight patients (18.6%) had recurrence till the last follow-up visit. CONCLUSIONS Preoperative neurological grade was the most important predictor of functional outcome. Gross tumor excision was the best surgical modality to improve event free survival. High-grade tumors had higher rates of recurrence but no effect on functional outcome.
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Affiliation(s)
- Raj Kumar
- Department of Neurosurgery, AIIMS, Rishikesh, Uttarakhand, India
| | - Sumit Banerjee
- Department of Orthopedics, AIIMS, Rishikesh, Uttarakhand, India
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34
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Abstract
OBJECT Spinal deformity after surgery for intramedullary tumors is a potentially serious complication that may require subsequent fusion. The aim of this study was to determine whether there were risk factors that could be used to predict postoperative sagittal deformity. METHODS The authors conducted a retrospective study of patients harboring an intramedullary tumor who had undergone surgery at a single center between 1985 and 2011. The main outcome of interest was the difference, at the last follow-up, between post- and preoperative measures of the Cobb angle formed by the superior and inferior limits of the laminectomy (ΔCobb). RESULTS Sixty-three patients were eligible for inclusion in the study. The mean sagittal deformity, measured as described above, was 15.9° (range 0°-77°) at a mean follow-up of 85.4 months (range 4-240 months). Univariate analysis showed increased sagittal deformity in patients 30 years old or younger (21.9° vs 13.7°, p = 0.04), undergoing a laminectomy involving 4 or more levels (19.3° vs 12.1°, p = 0.04), and undergoing a laminectomy that included a spinal junction (20.8° vs 12.4°, p = 0.02). Multivariate analysis showed that only age (p = 0.01) and the number of spinal levels involved in the laminectomy (p = 0.014) were significant and independent predictors of postoperative sagittal deformity. The linear regression equation drawn from this model allows one to quantitatively predict sagittal deformity for any follow-up time point after surgery. CONCLUSIONS Authors of this study developed a statistical tool that could be used to plan surgery and follow-up as regards the risk of sagittal spinal deformity in patients undergoing surgery for intramedullary tumors.
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35
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Guarnieri G, Tecame M, Izzo R, Zeccolini F, Genovese L, Muto M. Multisegmental diffuse intradural extramedullary ependymoma. An extremely rare case. Neuroradiol J 2014; 27:179-85. [PMID: 24750706 DOI: 10.15274/nrj-2014-10018] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 01/25/2014] [Indexed: 11/12/2022] Open
Abstract
Ependymoma has been described typically as an intramedullary tumour derived from ependymal cells with a predominance in women in the fifth decade of life. Pain is the most frequent symptom. Intradural extramedullary presentation is rarely described and almost always as a unique lesion. We describe a 53-year-old man with multi-segmental diffuse intradural extramedullary ependymoma with progressive lower leg hypoesthesia with regular motility. The patient's neurologic condition improved after surgery.
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Affiliation(s)
| | - Mario Tecame
- Neuroradiology Service, Second University of Naples; Naples, Italy
| | - Roberto Izzo
- Neuroradiology Service, Cardarelli Hospital; Naples, Italy
| | - Fabio Zeccolini
- Neuroradiology Service, Second University of Naples; Naples, Italy
| | | | - Mario Muto
- Neuroradiology Service, Cardarelli Hospital; Naples, Italy
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36
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Sahoo RK, Tripathy P, Mohapatra D, Mohanty S. Congenital dermal sinus in mid-dorsal spine with large intramedullary dermoid cyst in an 18-months-old child. J Pediatr Neurosci 2014; 8:201-3. [PMID: 24470812 PMCID: PMC3888035 DOI: 10.4103/1817-1745.123663] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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] [Indexed: 11/20/2022] Open
Abstract
Intramedullary dermoid cyst is a rare entity. It is usually associated with spinal dysraphism and dermal sinus. Our case is an 18-months-old female child who presented with history of fever and mild difficulty in moving left leg. She had a sinus in mid dorsal spine since birth with history of intermittent discharge from it. On magnetic resonance imaging of spine she was diagnosed to have large intramedullary epidermoid/dermoid cyst in the D2-7 vertebral level with a sinus tract. A dermoid cyst along with the sinus tract was excised. Post-operative follow up period was uneventful with full recovery.
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Affiliation(s)
- Ranjan K Sahoo
- Department of Radiology, Institute of Medical Science and SUM Hospital, Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha, India
| | - Pradipta Tripathy
- Department of Neurosurgery, Institute of Medical Science and SUM Hospital, Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha, India
| | - Debahuti Mohapatra
- Department of Pathology, Institute of Medical Science and SUM Hospital, Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha, India
| | - Sureswar Mohanty
- Department of Neurosurgery, Institute of Medical Science and SUM Hospital, Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha, India
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37
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Abstract
Hydrocephalus secondary to intraspinal tumors is a well-known but rare condition. We report a case of holocord intramedullary pilocytic astrocytoma associated with hydrocephalus in a 29-year-old male patient. He underwent ventriculoperitoneal shunt followed by subtotal resection of the tumor.
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Affiliation(s)
- Sumit Bansal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin A Borkar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok K Mahapatra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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38
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Zemmoura I, Vourc'h P, Paubel A, Parfait B, Cohen J, Bilan F, Kitzis A, Rousselot C, Parker F, François P, Andres CR. A deletion causing NF2 exon 9 skipping is associated with familial autosomal dominant intramedullary ependymoma. Neuro Oncol 2013; 16:250-5. [PMID: 24357459 DOI: 10.1093/neuonc/not165] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 12/15/2022] Open
Abstract
BACKGROUND Intramedullary ependymomas are rare and benign tumors in the adult. Little is known about their physiopathology, but the implication of the NF2 gene is suspected because of their presence in a third of patients with type 2 neurofibromatosis (NF2), a disorder caused by mutation of the NF2 gene. METHODS We conducted a clinical and genetic study of a family in which 5 of 9 members suffered from intramedullary ependymoma. Karyotyping and CGH array analysis were performed on DNA from peripheral blood lymphocytes from affected participants. The NF2 gene sequences were then determined in DNA from 3 nonaffected and all 5 affected members of the family. RESULTS Karyotype and CGH array findings were normal. Sequencing of NF2 revealed a heterozygous deletion, c.811-39_841del69bp, at the intron 8/exon 9 junction, in all affected members that was absent from all nonaffected members. RT-PCR analysis and sequencing revealed a novel NF2 transcript characterized by a skipping of exon 9 (75 bp). This deletion is predicted to result in a 25-amino acid deletion in the N-terminal FERM domain of neurofibromin 2. Modeling of this mutant domain suggests possible disorganization of the subdomain C. CONCLUSION We report the first family with an NF2 mutation associated with intramedullary ependymomas without other features of NF2 syndrome. This mutation, which has not been described previously, may particularly affect the function of neurofibromin 2 in ependymocytes leading to the development of intramedullary WHO grade II ependymomas. We propose that sporadic intramedullary ependymomas should also be analyzed for this region of NF2 gene.
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Affiliation(s)
- Ilyess Zemmoura
- Corresponding author: Ilyess Zemmoura, MD, Service de Neurochirurgie, CHRU Bretonneau, 2 boulevard Tonnellé, 37004, Tours Cedex, France.
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39
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Abstract
Enterogenous cysts account for 0.7-1.3% of spinal axis tumors. Cervical and thoracic segments are most often affected and they are rare in the lumbar region. Intramedullary variant which comprises less than 5% of enterogenous cysts are densely adherent to the surrounding tissue and preclude total excision. Partial excision is associated with recurrence and is the most common unfavorable outcome in these cysts. Hence, such patients need follow-up with serial imaging. We describe a case of conus medullaris enterogenous cyst presenting as lower limb pain. Due to dense adhesion of the cyst to the surrounding neural tissue, subtotal excision was done. The patient is symptom and tumor free at one year interval. We describe our case, discuss its uniqueness and review the literature on this rare but difficult to cure tumor.
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40
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Abstract
BACKGROUND/OBJECTIVE Glioblastoma multiforme (GBM) is the most common glial cell tumor of the adult brain. However, primary GBM of the spinal cord is a rare condition. METHODS Case report. RESULTS A young man presented with acute onset quadriparesis after a whiplash injury. A magnetic resonance scan showed the typical appearance of a high-grade intramedullary tumor with fusiform expansion of the entire cervical cord. Subtotal decompression and biopsy was done by posterior laminectomy, followed by external beam radiotherapy. Signs and symptoms improved after the completion of radiotherapy but did not resolve completely. Death caused by respiratory failure occurred 3 months later. CONCLUSIONS This presentation of GBM of the cervical cord is rare; an intramedullary tumor should be considered when minor cervical trauma results in disproportionate neurologic deficit. To the best of our knowledge, this is the first reported case of spinal GBM with extensive pan-cervical involvement.
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