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Carr MT, Pain M, Kay K, Houten JK. Intraspinal cervicothoracic junction chondrosarcoma: illustrative case. J Neurosurg Case Lessons 2024; 7:CASE23755. [PMID: 38437684 PMCID: PMC10916849 DOI: 10.3171/case23755] [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: 12/19/2023] [Accepted: 01/29/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Chondrosarcoma is an uncommon spinal tumor that can present as an extraskeletal mass. Rarely, these tumors present as dumbbell tumors through the neural foramina, mimicking schwannomas or neurofibromas. OBSERVATIONS A 46-year-old female presented with 2 years of worsening right-arm radiculopathy. Magnetic resonance imaging of the thoracic spine revealed a peripherally enhancing extramedullary mass through the right T1 foramen and compressing the spinal cord. Computed tomography showed the mass to be partially calcified. She underwent C7-T2 laminectomy and C6-T3 posterior instrumented fusion with gross-total resection of an extradural mass. Pathology revealed a grade I chondrosarcoma. Her symptoms improved postoperatively, with some residual right-arm radicular pain. LESSONS Intraspinal extradural dumbbell conventional chondrosarcoma is rare, with only 9 cases, including ours, reported. Patient ages range from 16 to 72 years old, and male sex is more common in these cases. The most common location is the thoracic spine, and our case is the only reported one in the cervicothoracic junction. These tumors often mimic schwannomas on imaging, but chondrosarcoma should remain in the differential diagnosis, because management of these tumors differs. Chondrosarcoma may benefit from more aggressive resection, including en bloc resection, and may require adjuvant radiotherapy.
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Affiliation(s)
- Matthew T Carr
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Margaret Pain
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Kevin Kay
- 2Department of Pathology, Mount Sinai South Nassau, Oceanside, New York
| | - John K Houten
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
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Corona-Nakamura AL, Arias-Merino MJ, Miranda-Novales MG, Nava-Jiménez D, Delgado-Vázquez JA, Bustos-Mora R, Cisneros-Aréchiga AG, Aguayo-Villaseñor JF, Hernández-Preciado MR, Mireles-Ramírez MA. Intraspinal and Intracranial Neurotuberculosis, Clinical and Imaging Characteristics and Outcomes in Hospitalized Patients: A Cohort Study (2000-2022). J Clin Med 2023; 12:4533. [PMID: 37445568 DOI: 10.3390/jcm12134533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
Neurotuberculosis (neuroTB) is a devastating disease, and is difficult to diagnose. The aim of this study was to analyze the clinical and imaging characteristics, and outcomes of a retrospective cohort (2000-2022) of hospitalized patients diagnosed with intraspinal and intracranial neuroTB. This work was designed through clinical, laboratory and imaging findings. Variables included: demographic data, history of tuberculosis, neurological complications, comorbidities and outcomes. Morbi-mortality risk factors were identified by univariate analysis. The cohort included: 103 patients with intraspinal and 82 with intracranial neuroTB. During the study period, in-hospital mortality of 3% for intraspinal and 29.6% for intracranial neuroTB was estimated. Motor deficit was found in all patients with intraspinal neuroTB. Risk factors for the unfavorable outcome of patients with intraspinal neuroTB were: age ≥ 40 years, diabetes mellitus (DM), diagnostic delay, kyphosis and spondylodiscitis ≥ 3 levels of involvement. Among the patients with intracranial neuroTB, 79/82 (96.3%) had meningitis and 22 patients had HIV infection (10 of them died). Risk factors for mortality from intracranial neuroTB were: HIV infection, hydrocephalus, stroke, lymphopenia and disseminated and gastrointestinal TB. Patients with intraspinal neuroTB had a significant number of destroyed vertebrae that determined their neurological deficit status. The mortality burden in intracranial neuroTB was conditioned by HIV infection and renal transplantation patients.
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Affiliation(s)
- Ana Luisa Corona-Nakamura
- High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44340, Mexico
| | | | - María Guadalupe Miranda-Novales
- Analysis and Synthesis of the Evidence Research Unit, National Medical Center, XXI Century (IMSS), Mexico City 06720, Mexico
| | - David Nava-Jiménez
- High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44340, Mexico
| | - Juan Antonio Delgado-Vázquez
- High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44340, Mexico
| | - Rafael Bustos-Mora
- High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44340, Mexico
| | - Aldo Guadalupe Cisneros-Aréchiga
- High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44340, Mexico
| | - José Francisco Aguayo-Villaseñor
- High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44340, Mexico
| | - Martha Rocio Hernández-Preciado
- High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44340, Mexico
- Department of Philosophical and Methodological Disciplines, University Health Sciences Center, University of Guadalajara, Guadalajara 44340, Mexico
| | - Mario Alberto Mireles-Ramírez
- High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44340, Mexico
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Sugita T, Tomari S, Kitahara D, Ito Y, Kato G. Ligamentum Flavum Hematoma Accompanied by Intraspinal and Extraspinal Hematomas: A Case Report. Cureus 2023; 15:e38250. [PMID: 37252556 PMCID: PMC10225151 DOI: 10.7759/cureus.38250] [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: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
Studies on ligamentum flavum hematoma (LFH) have been gradually increasing; however, no study has reported an LFH spreading to the intraspinal and extraspinal spaces. The purpose of this report is to discuss this rare condition and report that extraspinal hematoma can be formed by LFH. The authors present the case of a 78-year-old man presented with right L5 radiculopathy caused by a space-occupying lesion with intraspinal and extraspinal expansions at the L4-L5 vertebral levels demonstrated on MRI. We tentatively diagnosed these lesions as intraspinal and extraspinal hematomas originating from the ligamentum flavum based on the chronological changes seen on MRI and computed tomography-based needle biopsy. After the extirpation of these lesions, the symptoms were relieved. Three months later, the patient could walk without a cane. From the intraoperative findings and pathological examination, we concluded that the extraspinal hematoma in paravertebral muscle was caused by an LFH of unknown etiology. This case report describes the difficulty in diagnosing LFH accompanied by an extraspinal hematoma with wide-spreading expansion and highlights the usefulness of repetitive MRI over time in capturing chronological changes of the hematoma. As far as we know, this is the first study on an LFH accompanied by an extraspinal hematoma in the multifidus.
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Affiliation(s)
- Toshiaki Sugita
- Orthopedic Surgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, JPN
| | - Shinji Tomari
- Orthopedic Surgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, JPN
| | - Daichi Kitahara
- Pathology, Japanese Red Cross Fukuoka Hospital, Fukuoka, JPN
| | - Yasumasa Ito
- Orthopedic Surgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, JPN
| | - Go Kato
- Orthopedic Surgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, JPN
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Thakre PP, Rana S, Benevides ES, Fuller DD. Targeting drug or gene delivery to the phrenic motoneuron pool. J Neurophysiol 2023; 129:144-158. [PMID: 36416447 PMCID: PMC9829468 DOI: 10.1152/jn.00432.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/19/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022] Open
Abstract
Phrenic motoneurons (PhrMNs) innervate diaphragm myofibers. Located in the ventral gray matter (lamina IX), PhrMNs form a column extending from approximately the third to sixth cervical spinal segment. Phrenic motor output and diaphragm activation are impaired in many neuromuscular diseases, and targeted delivery of drugs and/or genetic material to PhrMNs may have therapeutic application. Studies of phrenic motor control and/or neuroplasticity mechanisms also typically require targeting of PhrMNs with drugs, viral vectors, or tracers. The location of the phrenic motoneuron pool, however, poses a challenge. Selective PhrMN targeting is possible with molecules that move retrogradely upon uptake into phrenic axons subsequent to diaphragm or phrenic nerve delivery. However, nonspecific approaches that use intrathecal or intravenous delivery have considerably advanced the understanding of PhrMN control. New opportunities for targeted PhrMN gene expression may be possible with intersectional genetic methods. This article provides an overview of methods for targeting the phrenic motoneuron pool for studies of PhrMNs in health and disease.
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Affiliation(s)
- Prajwal P Thakre
- Department of Physical Therapy, University of Florida, Gainesville, Florida
- McKnight Brain Institute, University of Florida, Gainesville, Florida
- Breathing Research and Therapeutics Center, Gainesville, Florida
| | - Sabhya Rana
- Department of Physical Therapy, University of Florida, Gainesville, Florida
- McKnight Brain Institute, University of Florida, Gainesville, Florida
- Breathing Research and Therapeutics Center, Gainesville, Florida
| | - Ethan S Benevides
- Department of Physical Therapy, University of Florida, Gainesville, Florida
- McKnight Brain Institute, University of Florida, Gainesville, Florida
- Breathing Research and Therapeutics Center, Gainesville, Florida
| | - David D Fuller
- Department of Physical Therapy, University of Florida, Gainesville, Florida
- McKnight Brain Institute, University of Florida, Gainesville, Florida
- Breathing Research and Therapeutics Center, Gainesville, Florida
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Joanna Knapik, Elke Vereecke, Lieve Morbée. Intraspinal Azygos Vein. J Belg Soc Radiol 2022; 106:99. [PMID: 36382019 DOI: 10.5334/jbsr.2911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/13/2022] [Indexed: 01/25/2023] Open
Abstract
Teaching Point: Intraspinal azygos vein is an extremely rare anatomical variant; knowledge is important for correct imaging interpretation.
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Sharma R, Kaur K, Sasidharan A, Gupta R, Laythalling RK. IgG4-Related Disease in Intradural Extramedullary Location- Detailed Case Illustration and Literature Review with Special Emphasis on Role of Surgery in its Management. Neurol India 2021; 69:1176-1183. [PMID: 34747781 DOI: 10.4103/0028-3886.329549] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background IgG4-related disease (IgG4RD) is a multisystemic progressive fibroinflammatory and lymphoproliferative autoimmune disorder of unknown etiopathogenesis; and its occurrence in intradural extramedullary (IDEM) location is extremely rare. Aim and Objective The aim of this study was to review all IDEM IgG4RD cases described in English literature and to signify the role of surgery in its management at this rare location along with the surgical technique and intraoperative findings. Methods An Internet-based search (PubMed) for the published reports describing spinal cases of IgG4RD with IDEM involvement was done using the keyword: spinal IgG4-related disease. An illustration of a case of cranial IgG4-related disease in a young man who developed metachronous cervical involvement in intradural extramedullary (IDEM) location is also presented. Results Amongst 45 spinal IgG4RD cases reported in English Literature, only 3 cases were IDEM IgG4RD. In the illustrated case, portion of the cervical lesion causing cervical cord encasement was intradural but extraarachnoidal- located between arachnoid and dura, without any pial involvement. All these 4 cases improved following surgery. Conclusion Timely meticulous resection of mass lesion in situations of medical treatment failure or progressive neurological decline can lead to reversibility of mass effect-associated neurological manifestations of IgG4RD.
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Affiliation(s)
| | - Kavneet Kaur
- Department of Pathology, AIIMS, New Delhi, India
| | | | - Ranjan Gupta
- Department of Rheumatology, AIIMS, New Delhi, India
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Yeole U, Rao KVLN, Beniwal M, Sivakoti S, Santosh V, Somanna S. Cranial and Spinal Malignant Peripheral Nerve Sheath Tumor: A Pathological Enigma. J Neurosci Rural Pract 2021; 12:770-779. [PMID: 34737514 PMCID: PMC8558969 DOI: 10.1055/s-0041-1735325] [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] [Indexed: 12/02/2022] Open
Abstract
Objective
Malignant peripheral nerve sheath tumor (MPNST) arises from nerve sheaths, mostly seen in peripheral nerves but rare in craniospinal nerves. The information available in the literature to build up treatment strategy and improve clinical outcomes is scarce. We are reviewing cases from our institute, with emphasis on radiological features for early differentiation from its benign variants.
Methods
We analyzed pathologically diagnosed cases retrospectively from January 2007 to December 2018 at our institute. Clinicoradiological details and treatment parameters were collected from medical records for evaluation. Each case was contacted telephonically for final clinical follow-up at the time of writing the manuscript.
Results
A total of seven cases of MPNST were diagnosed in the last 10 years. It included four intracranial and three spinal cases. The mean age for the cohort was 34.3 years, with five females. We could achieve gross total resection (GTR) and subtotal resection in four (57.1%) and two (28.6%) cases, respectively. We could achieve an overall survival of 57.1% in the average follow-up of 28.2 months (range: 8–84 months).
Conclusion
MPNST is a rare tumor with a bad prognosis. Radical surgical resection is the mainstay of the treatment, but it is not always possible to achieve it because of the inaccessible location and large size of lesions. Preoperative diagnosis is challenging; however, few radiological findings may give a clue toward it. As a disease entity overall, it has a poor outcome with a high rate of fatality.
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Affiliation(s)
- Ujwal Yeole
- Neurosurgery Services, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - K V L Narsinga Rao
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Manish Beniwal
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sumitra Sivakoti
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Nalgonda, Telangana, India
| | - Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sampath Somanna
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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8
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Young J, Pleasants-Terashita H. From Sacrum to Spine: A Complex Case of Sacrococcygeal Teratoma. Neonatal Netw 2021; 39:147-157. [PMID: 32457189 DOI: 10.1891/0730-0832.39.3.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2020] [Indexed: 11/25/2022]
Abstract
Neonatal tumors occur infrequently; sacrococcygeal teratoma (SCT) is a rare and abnormal mass often diagnosed on antenatal ultrasound. An SCT may cause serious antenatal complications, requires surgery in the neonatal period, and can lead to various long-term sequelae including fecal incontinence or constipation, urinary incontinence, and lower extremity mobility impairment. Even rarer are SCTs that include intraspinal extension necessitating complex neurosurgical intervention to relieve possible spinal cord compression or tumor tissue resection. A comprehensive understanding of the natural history of SCT provides frontline neonatal nurses and nurse practitioners with the expertise and language to support families during an infant's NICU admission. A glossary of key terms accompanied by a case review of a premature infant born with a large external SCT with intrapelvic and intraspinal components aids in enhancing knowledge related to the potential impact of an SCT on the central nervous system.
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Abstract
PURPOSE The purpose of this study was to review the clinical features in a cohort of Chinese patients with primary intraspinal benign tumors. METHODS This retrospective study included a consecutive series of patients with intraspinal benign lesions who received surgery between January 2014 and October 2018 at our hospital. We collected each patient's clinical data, including age, gender, presenting symptoms, the spinal level (cervical, thoracic, lumbar, or sacral), and location (intramedullary or extramedullary) of the tumor. RESULTS A total of 66 patients were included in this study, of whom 24 were men and 42 (63.6%) were women. The mean age was 52.5 years (range, 21-76 years). The most common symptom was sensory deficits. The most common tumor type, found in 56.1% patients, was schwannoma, followed by meningioma in 33.3% patients. The commonly performed surgery included decompression of spinal canal and excision of spinal lesions. CONCLUSION Primary intraspinal benign tumors occur in elderly and female population and at the thoracic region. Schwannoma and meningioma are the two with higher incidence. The surgical outcome in terms of tumor excision and functional recovery is good.
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Affiliation(s)
- Lin-Lin Xia
- Medical Equipment Management Office, the Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China.,Departments of Radiology, the Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Jian Tang
- Departments of Radiology, the Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Sheng-Li Huang
- Department of Orthopaedics, the Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
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Yan S, Feng HW, Cao LQ, Feng Q. [Thoracic Intraspinal Ganglioneuroma with Cough as Its Main Symptom:Report of One Case]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2020; 42:566-569. [PMID: 32895113 DOI: 10.3881/j.issn.1000-503x.11762] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The ganglioneuroma is a benign tumor originating from sympathetic ganglion cells.It often locates in the posterior mediastinum,retroperitoneum,and adrenal medulla.The intraspinal ganglioneuromas is relatively rare in clinical practice,which mainly locates in the cervical and thoracolumbar segments.A patient with main symptom of cough was examined by magnetic resonance imaging before operation in our center.Intraspinal ganglioneuromas was confirmed in the left intervertebral cavity area.Total resection of the tumor via the posterior median approach was performed.HE staining showed the mature ganglion cells were scattered.The patient was followed up for three months and no tumor recurrence occured.
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Affiliation(s)
- Shi Yan
- Department of Orthopedics, Cangzhou People's Hospital,Cangzhou,Hebei 061000,China
| | - Hong-Wei Feng
- Department of Orthopedics, Cangzhou People's Hospital,Cangzhou,Hebei 061000,China
| | - Li-Qiu Cao
- Department of Respiratory Medicine,Cangzhou People's Hospital,Cangzhou,Hebei 061000,China
| | - Qing Feng
- Department of Orthopedics, Cangzhou People's Hospital,Cangzhou,Hebei 061000,China
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Haviarová Z, Matejčík V, Kuruc R, Líška J, Halgaš F. Intraspinal characteristics of thoracic spinal nerve roots anomalies. Br J Neurosurg 2019; 34:72-75. [PMID: 31668095 DOI: 10.1080/02688697.2019.1681360] [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: 10/25/2022]
Abstract
Purpose: The anomalous anatomical arrangement of the thoracic spinal nerve roots within the spinal canal can complicate the surgical treatment of several pathologies. The aim of this work was to reveal intraspinal anatomical variations of the thoracic spinal nerve roots.Methods: Anatomical study on 43 cadavers with a mean age of 53.7. After opening the spinal canal and dural sac, intradural and extradural anomalies of the thoracic spinal nerve roots were documented. Extradural communicating branches were excised, histologically processed and examined for the presence of nervous tissue.Results: We found 14 cases (32.6%) of intraspinal thoracic nerve root variations: intradural in 8 cases (18.6%), intradural communicating branches in 3 cases (6.97%), extradural anatomical variations occurred 6 cases (13.95%), 2 cases (4.65%) had extradural communicating branches between the nerve roots, 1 case had simultaneous occurrence of intradural and extradural communications (0.23%). All the results are differentiated according to the plexus type. In macroscopic extradural thoracic communicating branch had no nervous tissue on microscopy.Conclusions: This study describes intraspinal anatomical variations of thoracic spinal nerve roots. Knowledge of these variables should help prevent the failure of several medical procedures.
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Affiliation(s)
- Zora Haviarová
- Institute of Anatomy, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Viktor Matejčík
- Department of Neurosurgery, Faculty of Medicine, University Hospital, Comenius University, Bratislava, Slovakia
| | - Roman Kuruc
- Institute of Pathological Anatomy, Health Care Surveillance Authority, Bratislava, Slovakia
| | - Ján Líška
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Filip Halgaš
- Department of Neurosurgery, Faculty of Medicine, University Hospital, Comenius University, Bratislava, Slovakia
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Mariscal G, Nuñez JH, Bhatia S, Marsh R, Barrios C, Domenech-Fernández P. Frequency and characteristics of congenital intraspinal abnormalities in a cohort of 128 patients with congenital scoliosis. J Craniovertebr Junction Spine 2019; 10:229-233. [PMID: 32089616 PMCID: PMC7008656 DOI: 10.4103/jcvjs.jcvjs_116_19] [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: 12/11/2019] [Accepted: 12/18/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The aims of this study were to determine the incidence and main characteristics of associated intraspinal anomalies in patients with congenital scoliosis (CS) and to analyze the different factors that influence the curve progression. DESIGN This was a retrospective comparative study. METHODS This was a retrospective study of 128 patients with CS. MAIN OUTCOME MEASUREMENTS The incidence of the patients with intraspinal anomalies and their demographic, clinical, and radiological values was described. RESULTS Intraspinal anomalies were present in 13.3% of the patients. Among them, the most frequent anomaly was syringomyelia. The most frequent curve was the thoracic curve. The main deformity based on McMaster classification was formation failure. The curve progression during follow-up did not show significant differences between vertebral anomalies, syringomyelia, presence of thoracic anomalies, and gender (P > 0.05). CONCLUSIONS Our study showed a lower percentage of spinal anomalies compared to other series. As other studies, the progression of the scoliosis curve in patients with spinal anomalies seems primarily to be determined by the type of vertebral malformation. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Gonzalo Mariscal
- Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain
| | - Jorge H Nuñez
- Department of Traumatology and Orthopedic Surgery, Spine Unit, University Hospital of Mutua Terrassa, Barcelona, Spain
| | - Sanjay Bhatia
- Department of Neurosurgery, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Robert Marsh
- Department of Neurosurgery, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain
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Sobti S, Bhaskar S, Sharma RK, Choudhary A. Pneumorrhachis following Chest Injury: A Rare Entity. Asian J Neurosurg 2018; 13:440-441. [PMID: 29682055 PMCID: PMC5898126 DOI: 10.4103/ajns.ajns_81_16] [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] [Indexed: 11/05/2022] Open
Abstract
Pneumorrhachis (PR) – the phenomenon of intraspinal air – is a rare radiological finding. The presence of intraspinal air is usually after epidural injections, spinal manipulations, synovial cysts, degenerative disc disease, and epidural abscess. PR is mostly asymptomatic but can also be symptomatic. We report a case with PR after chest trauma and attempt to explain its development.
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Affiliation(s)
- Shivender Sobti
- Department of Neurosurgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - S Bhaskar
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Dr. RML Hospital, New Delhi, India
| | - Rajesh K Sharma
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Dr. RML Hospital, New Delhi, India
| | - Ajay Choudhary
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Dr. RML Hospital, New Delhi, India
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Abstract
Juvenile xanthogranuloma (JXG) is a benign, non-Langerhans cell histiocytic proliferative disorder. We report a case of solitary JXG in an infant presenting as an intraspinal mass. Awareness of this mode of presentation is very important as subsequent prognosis differs from other tumors at the same location. JXG is a self-limiting dermatologic disorder usually occurring in first two decades of life. On rare occasion, it has been reported at extra-cutaneous sites such as central nervous system (CNS), eyes, liver, spleen, lungs and kidneys, and in other age groups. Isolated CNS involvement is extremely rare, especially in the spinal cord.
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Affiliation(s)
- Asha Shenoy
- Department of Pathology, Topiwala National Medical College and B. Y. L. Nair Hospital, Mumbai, Maharashtra, India
| | - Shruti Shribhagwan Singhal
- Department of Pathology, Topiwala National Medical College and B. Y. L. Nair Hospital, Mumbai, Maharashtra, India
| | - Sweety Shinde
- Department of Pathology, Topiwala National Medical College and B. Y. L. Nair Hospital, Mumbai, Maharashtra, India
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Abstract
INTRODUCTION Adeno-associated viral (AAV) vector-mediated gene delivery to the spinal cord has finally entered the pathway towards regulatory approval. Phase 1 clinical trials using AAV gene therapy for pediatric disorders - spinal muscular atrophy (SMA) and giant axonal neuropathy (GAN) - are now underway. AREAS COVERED This review addresses the latest progress in the field of AAV gene delivery to the spinal cord, particularly focusing on the most prominent AAV serotypes and delivery methodologies to the spinal cord. Candidate diseases and scaling up experiments in large animals are also discussed. EXPERT OPINION Intravenous (IV) and intrathecal (IT) deliveries seem to undoubtedly be the preferred routes of administration for diffuse spinal cord delivery of therapeutic AAV vectors that can cross the blood-brain barrier (BBB) and correct inherited genetic disorders. Conversely, intraparenchymal delivery is still an undervalued but very viable approach for segmental therapy in afflictions such as ALS or Pompe Disease as a means to prevent respiratory dysfunction.
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Affiliation(s)
- Nathan Hardcastle
- a Department of Neurosurgery , Emory University , Atlanta , GA , USA
| | - Nicholas M Boulis
- a Department of Neurosurgery , Emory University , Atlanta , GA , USA
| | - Thais Federici
- a Department of Neurosurgery , Emory University , Atlanta , GA , USA
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Chang PF, Qu LM, Li M, Qi B. Striated muscle-derived intraspinal choristoma: A case report. Oncol Lett 2017; 14:1787-1789. [PMID: 28789410 DOI: 10.3892/ol.2017.6302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 03/17/2017] [Indexed: 11/06/2022] Open
Abstract
Choristoma is a mass of tissue that is histologically normal for the organ or part of the body from which it originates, but is located at an abnormal site. Choristoma of the nervous system involves the occurrence of residual dysplastic tissues outside the nervous system and exhibits a low incidence. Thus far, there has been no prior report of intraspinal choristoma originating from the striated muscle. The patient in the present case was a young man who was admitted to the hospital wing to intermittent lumbago. A lumbar magnetic resonance imaging examination revealed a cystic-solid lesion in the spinal canal at the S1 level. Preoperatively, the lesion was suspected to be a teratoma and was therefore completely removed. The postoperative pathological report suggested that the mass was an intraspinal choristoma, a benign lesion associated with a good prognosis, which had originated from striated muscle. Early diagnosis and treatment can prevent progression of nerve dysfunction. The patient recovered well postoperatively and the symptoms of lower back pain disappeared. Although intraspinal choristomas are rare, when a lesion in the spinal canal is diagnosed, it should be considered in the differential diagnosis tumors.
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Affiliation(s)
- Peng-Fei Chang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Li-Mei Qu
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Ming Li
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Bin Qi
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Ito K, Imagama S, Ando K, Kobayashi K, Shido Y, Go Y, Arima H, Kanbara S, Hirose T, Matsuyama Y, Nishida Y, Ishiguro N. Intraspinal meningioma with malignant transformation and distant metastasis. Nagoya J Med Sci 2017; 79:97-102. [PMID: 28303067 PMCID: PMC5346626 DOI: 10.18999/nagjms.79.1.97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Meningioma is typically considered to be a benign tumor. Malignant transformation and metastasis of meningiomas are rare. Moreover, most meningiomas are intracranial, and there are few reports on intraspinal meningiomas. This report aimed to describe the clinical features and pathological findings of a case of malignant transformation and distant metastasis of intraspinal meningioma, with a review of the literature. A 44-year-old man with a bilateral lower limb paresis was diagnosed with an intradural extramedullary tumor of the thoracic spine. Primary tumor resection was performed, and the histological findings revealed atypical meningioma. The meningioma recurred 2 years after the primary surgery, and a second resection was performed, but only partial resection was possible because of decreased motor evoked potential. At age 48, the patient’s lower limb weakness returned, and a third resection was performed, and the histological finding remained atypical meningioma. At age 54, the tumor increased and stereotactic irradiation was performed. At age 60, the patient was diagnosed with metastatic tumors of the rib, lumbar vertebra, cervical spine, and sacrum. Biopsy of the rib metastatic tumor was performed, and the histological findings revealed anaplastic meningioma. This case is the first report of an intraspinal meningioma that transformed from atypical to anaplastic meningioma with distant hematogenous metastasis.
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Affiliation(s)
- Kenyu Ito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- 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
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoji Shido
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshida Go
- Department of Orthopaedic Surgery, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Hideyuki Arima
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shunsuke Kanbara
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshihiro Nishida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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18
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Veizi IE, Hayek SM, Hanes M, Galica R, Katta S, Yaksh T. Primary Hydromorphone-Related Intrathecal Catheter Tip Granulomas: Is There a Role for Dose and Concentration? Neuromodulation 2016; 19:760-769. [PMID: 27505059 DOI: 10.1111/ner.12481] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/05/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intrathecal drug delivery therapy has been used effectively in treating patients with intractable chronic pain. The development of an intrathecal catheter tip granuloma (ICTG) related to delivery of intrathecal opiates is a relatively infrequent, but potentially devastating complication. While there are many morphine-related ICTG cases described, reports of hydromorphone-related ICTG are limited. In addition, studies suggest a strong correlation between the use of higher doses and concentrations of intrathecal opiates and ICTG formation. OBJECTIVE The objective of this study is to determine the incidence and the association of intrathecal hydromorphone dose, concentration, duration of treatment and concomitant agents with ICTG formation. STUDY DESIGN This is a retrospective analysis of 101 consecutive patients implanted with intrathecal infusion delivery devices. Data were collected from chart review, and records of pump refills from the division of Pain Medicine of University Hospitals or outsourced to a home pump refill service. RESULTS From a cohort of 101 consecutively implanted patients, 69 were treated with intrathecal hydromorphone and followed up postimplant for an average of 33.5 ± 24 months (range 0-93 months; 95% CI of 27-39 months). The incidence of ICTG in our patient population was 8.7% during this period of time postimplant with mean time to granuloma detection 35.1 ± 7.9 months. Patients developing granuloma (n = 6) were treated with a combination of intrathecal hydromorphone and bupivacaine infusion. Exposure time to intrathecal agents was not different between the granuloma and nongranuloma group. Monthly dose increase of hydromorphone was higher in granuloma group vs. non-granuloma group (58 ± 34 mcg/month n = 6 vs. 25 ± 8 mcg/month n = 63). Four out of six granuloma cases occurred with low dose and concentration of IT hydromorphone (160-370 mcg/day; 0.75-1.0 mg/mL concentration). Intrathecal bupivacaine dose was not different between groups. A subset of patients was treated with intrathecal fentanyl and bupivacaine. No intrathecal granulomas occurred in this patient cohort. CONCLUSION This is the first clinical report demonstrating an association of hydromorphone with intrathecal granulomas, particularly at low doses and concentrations of hydromorphone. This study supports the notion that using low dose of IT opioids might not protect against ICTG development but that the level of exposure and type of opioid used in IT space might be highly correlated with ICTG development. Further research and recommendations related to chronic intrathecal opioid infusions are necessary to raise awareness of significant incidence of ICTG and development of tests to isolate patient populations at high risk.
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Affiliation(s)
- I Elias Veizi
- Case Western Reserve University, Cleveland, OH, USA.,Louis Stokes Veterans Administration Medical Center, Cleveland, OH, USA
| | - Salim M Hayek
- Case Western Reserve University, Cleveland, OH, USA. .,University Hospitals Case Medical Center, Cleveland, OH, USA.
| | - Michael Hanes
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Ryan Galica
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Sivakanth Katta
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Tony Yaksh
- University of California, San Diego, La Jolla, CA, USA
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19
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Marzban AN, Saxena A, Bhattacharyya D, Ivanov M. Hydrocephalus and Papilledema in Spinal Cord Tumors: A Report of Two Cases. Surg J (N Y) 2016; 2:e51-e58. [PMID: 28824991 PMCID: PMC5553482 DOI: 10.1055/s-0036-1584584] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/26/2016] [Indexed: 01/30/2023] Open
Abstract
Background
The association between spinal cord tumors and hydrocephalus is a rarely reported phenomenon. Diagnosis in this group of patients is difficult as they present with findings of an intracranial pathology and the symptoms of a spinal lesion may be absent.
Case Report
We report two cases of spinal cord tumors presenting with visual disturbance and findings of increased intracranial pressure.
Discussions
Mechanisms describing the relationship between spinal cord tumors and increased intracranial pressure have been explained. Most of the literature reported marked regression of these manifestations after tumor excision.
Conclusions
Spinal cord tumors associated with hydrocephalus and papilledema are rare conditions. The diagnosis of these conditions may be difficult or confusing because the symptoms referable to the spinal lesion may be minimal. Meticulous history taking, examination, and investigations are mandatory to diagnose this entity.
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Affiliation(s)
| | - Ankur Saxena
- Department of Neurosurgery, Salford Royal Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Dev Bhattacharyya
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Marcel Ivanov
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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Abstract
Meningiomas are benign in nature and arise from the arachnoid cells. They are mostly situated in the intracranial compartment, whereas spinal meningiomas are rare. Approximately, in 10% of cases, an extradural component is seen but an exclusively extradural meningioma is quite uncommon. However, WHO Grade II (atypical) and Grade III (anaplastic) tumors can behave aggressively. We reported a case of purely extradural psammomatous meningioma in an adult male affecting the dorsal spine although uncommon meningiomas should be included in the differential diagnosis of extradural intraspinal masses.
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Affiliation(s)
- Sharad Pandey
- Department of Neuro Surgery, Sir Sunderlal Hospital, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Kulwant Singh
- Department of Neuro Surgery, Sir Sunderlal Hospital, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vivek Sharma
- Department of Neuro Surgery, Sir Sunderlal Hospital, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Amrita Ghosh
- Department of Pathology, Sir Sunderlal Hospital, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Saurabh Suman
- Department of Anaesthesia, Sir Sunderlal Hospital, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Abstract
The authors present a case of intraspinal malignant psammomatous melanotic schwannoma (PMS) not associated with Carney complex and review all reported cases not associated with this syndrome. The focus of this review paper is on the characteristics of the malignant progression of PMS. A 54-year-old man had a history of squamous cell carcinoma of the neck and tonsillar carcinoma. The patient's serial CT scanning study showed a mass in the left C-5 foramen. On presentation he was neurologically intact. After 18 months, the patient developed radiating pain down the left arm with decreased sensation. MRI of the cervical spine showed an enhancing 2.1 × 1.5 × 1.9-cm mass in the left C5-6 foramen. A C5-6 hemilaminectomy was performed with gross-total removal of the tumor. At 3 months postoperatively, the patient developed new-onset pain and weakness. MRI showed a dumbbell-shaped mass in the left C-7 foramen. MRI of the pelvis showed a 1.4 × 1.0-cm lesion on the right ischium and a 1.1 × 2.8-cm lesion on the right inferior pubic ramus. Anterior cervical discectomy of C5-6 and C6-7 with corpectomy of C-6 with subtotal resection of the tumor was completed. PMS should not be considered a benign tumor because in 41.1% of patients, including the patient in this report, the tumor progresses to malignancy. Long-term follow-up is needed in these patients. New surgical treatment plans should be considered.
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Affiliation(s)
- Saman Shabani
- Department of Neurological Surgery and the Neurosciences Institute, and.,Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Susan M Fiore
- Department of Neurological Surgery and the Neurosciences Institute, and
| | - Roberta Seidman
- Department of Pathology, Stony Brook University, Stony Brook, New York; and
| | - Raphael P Davis
- Department of Neurological Surgery and the Neurosciences Institute, and
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22
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Fawzy M, El-Beltagy M, Shafei ME, Zaghloul MS, Kinaai NA, Refaat A, Azmy S. Intraspinal neuroblastoma: Treatment options and neurological outcome of spinal cord compression. Oncol Lett 2014; 9:907-911. [PMID: 25624912 PMCID: PMC4301531 DOI: 10.3892/ol.2014.2795] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 02/26/2014] [Indexed: 11/21/2022] Open
Abstract
Malignant spinal cord compression (MSCC) is a common complication of cancer. Paraspinal neuroblastoma (NB) in the thoracic, abdominal and pelvic regions may extend into the neural foramina causing compression of nerve roots and even the spinal cord. The prompt initiation of specific treatment can improve the neurological outcome. The aim of the present study was to review the clinical features, the management received and the factors that may affect the outcome of patients with MSCC caused by paraspinal NB. During a period between July 2007 and December 2012, a total of 576 NB patients were treated at the Children’s Cancer Hospital (Cairo, Egypt). Intraspinal disease extension was present in 51 patients (9%). The children with intraspinal disease extension were reviewed for disease pattern, neurological manifestations and treatment outcome. Children with intraspinal disease extension had an equal male to female ratio (1:1), and approximately two-thirds of patients (34/51) had a clinically manifested cord compression. The duration of neurological manifestations was >4 weeks in 58.8% (20/34) of symptomatic patients and ≤4 weeks in 41.2% (14/34). Subsequent to starting treatment, neurological manifestations showed a complete recovery in 16 patients (47.1%), partial in 11 (32.4%), and stationary course was found in 7 (20.6%). Manifestations of ≤4 weeks in duration carried an improved outcome compared with longer time compression, with a complete recovery in 78.6%, versus 25% for patients with a longer symptom duration (P=0.008). The upfront treatment, patient age and site of the primary tumor did not significantly affect the neurological outcome. Spinal cord compression in NB can be effectively managed with upfront chemotherapy. Initial surgical decompression should be reserved for benign variants only, including ganglioneuroma. Neurological manifestations of <4 weeks duration upon presentation are usually reversible.
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Affiliation(s)
- Mohamed Fawzy
- Pediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt ; Department of Pediatric Oncology, Children's Cancer Hospital of Egypt (CCHE/57357), Cairo, Egypt
| | - Mohamed El-Beltagy
- Department of Neurosurgery, Kasr El-Aini Faculty of Medicine, Cairo, Egypt ; Department of Neurosurgery, Children's Cancer Hospital of Egypt (CCHE/57357), Cairo, Egypt
| | - Maged El Shafei
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt ; Department of Surgical Oncology, Children's Cancer Hospital of Egypt (CCHE/57357), Cairo, Egypt
| | - Mohamed Saad Zaghloul
- Department of Radiotherapy, National Cancer Institute, Cairo University, Cairo, Egypt ; Department of Radiotherapy, Children's Cancer Hospital of Egypt (CCHE/57357), Cairo, Egypt
| | - Naglaa Al Kinaai
- Department of Pathology, National Cancer Institute, Cairo University, Cairo, Egypt ; Department of Pathology, Children's Cancer Hospital of Egypt (CCHE/57357), Cairo, Egypt
| | - Amal Refaat
- Department of Radiology, National Cancer Institute, Cairo University, Cairo, Egypt ; Department of Radiology, Children's Cancer Hospital of Egypt (CCHE/57357), Cairo, Egypt
| | - Sarah Azmy
- Department of Research, Children's Cancer Hospital of Egypt (CCHE/57357), Cairo, Egypt
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Kumar S, Satija B, Mittal MK, Thukral BB. Unusual mediastinal dumbbell tumor mimicking an aggressive malignancy. J Clin Imaging Sci 2012; 2:67. [PMID: 23230549 PMCID: PMC3515951 DOI: 10.4103/2156-7514.103057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 08/26/2012] [Indexed: 11/16/2022] Open
Abstract
Hydatid cyst is known to affect all possible anatomical locations of the human body. However, the mediastinal localization is extremely rare. This benign, commonly asymptomatic and incidentally detected disease, at times may simulate an aggressive malignancy by its potential to cause osseous destruction and intraspinal extension. A young female, farmer by occupation, presented with complaints of left chest pain and monoparesis of the left lower limb. Radiograph followed by computed tomography (CT) of the chest demonstrated a cystic mass within the posterior mediastinum, eroding and scalloping overlying ribs and extending into the spinal canal by causing destruction of adjoining vertebra, and assuming a dumbbell shape. The serology was positive for echinococcosis. The patient underwent surgery and the postoperative histopathology confirmed the diagnosis of hydatid cyst. The patient recovered with no complications or recurrence. Hydatid cyst should always be considered in the differential diagnosis of mediastinal cystic lesions, however aggressive the lessions may appear.
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Affiliation(s)
- Sanyal Kumar
- Department of Radiology, Employees' State Insurance Hospital and Post Graduate Institute of Medical Science and Research, New Delhi, India
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24
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Abstract
Primary spinal epidural hydatid cyst without bony involvement is extremely rare. Authors report the case of a 44-year-old female brought to their attention for a rapidly progressive paraplegia. Magnetic resonance imaging (MRI) revealed extradural multiple cysts with “bunch of grapes” appearance extended to the paraspinal muscles through neural foramina without bony involvement on computed tomography (CT) scan. Histopathologic examination after a surgical approach confirmed the diagnosis of hydatid cyst. The early postoperative period showed a progressive improvement of her neurological deficit. The long-term follow-up under discontinued antihelminthic chemotherapy was uneventful.
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Affiliation(s)
- Omar Boulahroud
- Department of Neurosurgery, Mohammed V Military Teaching Hospital, Hay Riad, Rabat, Morocco
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25
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Samadi N, Ahmadi SA. Meningioma: a clinicopathological evaluation. Malays J Med Sci 2007; 14:46-52. [PMID: 22593651 PMCID: PMC3351217] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Accepted: 12/03/2006] [Indexed: 05/31/2023] Open
Abstract
As yet no unifying grading system for meningiomas has been adopted. We evaluate epidemiologic factors of meningioma in Iran & degree of agreement between the two commonly used grading systems namely WHO (2000) and Mahmood systems. During a 6-year period 238 meningiomas were selected and reviewed by two independent pathologists using both grading systems. 205(86.1%) cases were benign, 19(8%) atypical and 14(5.9%) malignant. 181(18%) cases were primary and 51(27%) secondary; 35(68%) of the latter benign, 7(14%) atypical and 9(18%) malignant. All intraspinal meningiomas were benign. In benign cranial and spinal types female to male ratios were 1.9: 1 and 1.3: 1 ; while in atypical and malignant types were 1 :1.4 and 1:3.1 respectively. Mean ages were 49.9 for benign. 41.1 for atypical and 50 for malignant types. The most frequent site of involvement in all grades of intracranial tumors was cerebral convexity (31.1 %). The most common subtype was menigothelial (65.1%). Female preponderance seen in benign nonrecurrent meningioma became increasingly less prominent and even reversed in recurrent, atypical and malignant forms. Benign recurrent tumors were similar to non-recurrent tumors microscopically. Kappa value comparing two grading systems was 0.947, so good agreements were found between Mahmood and WHO grading systems.
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Affiliation(s)
- Nasrin Samadi
- Corresponding Author : Dr. Nasrin Samadi MD, Resident of Pathology, Department of Pathology, Sina Hospital, School of Medicine, Tehran University of Medical Sciences ; Department of Pathology, Sina Hospital, Hassan Abad Square, Tehran 11364, IRAN, Tel: +9821-66702051, Fax: +9821-66716545
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