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Yamaguchi Y, Morimoto T, Toda Y, Tsukamoto M, Yoshihara T, Hirata H, Kobayashi T, Mawatari M. The first case of methotrexate-associated lymphoproliferative disorder in the sacrum: a case report. BJR Case Rep 2024; 10:uaae002. [PMID: 38352263 PMCID: PMC10860500 DOI: 10.1093/bjrcr/uaae002] [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: 05/31/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 02/16/2024] Open
Abstract
Methotrexate (MTX) is a drug used for treating rheumatoid arthritis. Recently, the reported incidence of methotrexate-associated lymphoproliferative disease (MTX-LPD) has increased, especially in Japan. Extranodal involvement is observed in half of MTX-LPD cases. However, only a few spinal lesions have been reported, with none in the sacrum. Additionally, Epstein-Barr virus (EBV) infection has also been implicated in the pathogenesis of MTX-LPD. Herein, we describe the case of a 74-year-old woman with MTX-LPD in the sacral spine who complained of severe back pain and nocturnal pain. Radiographs revealed a tumour on the right wing of the sacrum and a positive EBV immunoglobulin G antibody titre. MTX-LPD was suspected based on imaging findings and a history of MTX administration. A pathological examination was performed on the CT-guided biopsy specimen. The histopathological diagnosis was MTX-LPD, and MTX was discontinued. Three months after MTX administration ended, the tumour tended to shrink, and 1 year later, significant tumour shrinkage was observed. This experience suggests that MTX-LPD can be treated by discontinuing MTX administration. Therefore, early and accurate diagnosis is required, as is avoiding unnecessary treatment such as surgery. MTX-LPD should be considered, especially in spinal origin tumours in EBV-infected patients on MTX.
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Affiliation(s)
- Yuichi Yamaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Yu Toda
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Masatsugu Tsukamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Tomohito Yoshihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Hirohito Hirata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
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Toda Y, Morimoto T, Matsumoto Y, Setsu N, Yoshihara T, Aishima S, Oda Y, Nakashima Y, Mawatari M. Application of contralateral osteotomy for the en bloc resection of paraspinal and spinal tumours: a report of three cases. Br J Neurosurg 2022:1-7. [PMID: 35587144 DOI: 10.1080/02688697.2022.2076809] [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: 04/04/2022] [Revised: 04/27/2022] [Accepted: 05/09/2022] [Indexed: 11/02/2022]
Abstract
We herein report the effectiveness of contralateral osteotomy of the pedicle and posterolateral elements for en bloc resection (COPPER) of paraspinal and spinal tumours. This surgical method allows for complete resection of the localized tumour in the lateral posterior lesion without removing the entire vertebral body, as in total en bloc spondylectomy. Complete resection of paraspinal and spinal tumours is challenging for spinal surgeons because of anatomical complexities. Although the COPPER method has been introduced as a less invasive surgical procedure for wide resection of spinal tumours, no studies have reported the usefulness of this technique. We identified three patients with paraspinal or spinal tumours who underwent wide resection using the COPPER method and reviewed their clinical, radiological, and pathological outcomes. In all cases, we resected the spinal and paraspinal tumours extending to the anterior column and extravertebral component using the modified COPPER method. All patients underwent en bloc resection with a negative margin. We report three cases of spinal and paraspinal tumours extending to the anterior column and extravertebral component.
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Affiliation(s)
- Yu Toda
- Faculty of Medicine, Department of Orthopaedic Surgery, Saga University, Saga, Japan
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tadatsugu Morimoto
- Faculty of Medicine, Department of Orthopaedic Surgery, Saga University, Saga, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nokitaka Setsu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohito Yoshihara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinichi Aishima
- Faculty of Medicine, Department of Pathology & Microbiology, Saga University, Saga, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaaki Mawatari
- Faculty of Medicine, Department of Orthopaedic Surgery, Saga University, Saga, Japan
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Marchesini N, Ricci UM, Pinna G. Sporadic cauda equina hemangioblastoma: surgical management in a pregnant woman. Br J Neurosurg 2021; 37:1-5. [PMID: 33877021 DOI: 10.1080/02688697.2021.1914820] [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: 01/18/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
Hemangioblastoma is a rare benign vascular tumour of the central nervous system that occurs either sporadically or in association with Von Hippel-Lindau syndrome. Hemangioblastoma can be found throughout the central nervous system and usually present with late manifestations due to their slow growth rate. Cauda equina hemangioblastomas are extremely rare, and in the literature, no cases are reported on the surgical management of pregnant patients with this condition. We report the case of a young woman with back pain and sphincter dysfunctions in whom an L1-L2 hemangioblastoma was diagnosed. We describe the perioperative and surgical strategies we adopted to successfully treat the patient and preserve the fetus well-being.
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Affiliation(s)
- Nicolò Marchesini
- Department of Neurosurgery, Borgo Trento Hospital, University of Verona, Verona, Italy
| | - Umberto Maria Ricci
- Department of Neurosurgery, Borgo Trento Hospital, AOUI Verona, Verona, Italy
| | - Giampietro Pinna
- Department of Neurosurgery, Borgo Trento Hospital, AOUI Verona, Verona, Italy
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Hespel AM, de Swarte M, Anderson K, Weiss R, Hathcock J. Features of a rare peripheral primitive neuroectodermal tumour arising from the thoracic spine in a juvenile canine patient. Vet Med Sci 2021; 7:680-685. [PMID: 33620146 PMCID: PMC8136921 DOI: 10.1002/vms3.449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/08/2021] [Accepted: 02/02/2021] [Indexed: 12/18/2022] Open
Abstract
Peripheral primitive neuroectodermal tumours are rare tumours in juveniles. The current patient was a paraplegic 8‐month‐old Scottish deerhound with a suspected pulmonary mass. Radiographically, there was a large extrapleural mass within the mid‐left hemithorax. On MRI, the mass was mainly hyperintense on T2‐weighted images, isointense on T1‐weighted images and was heterogeneously strongly contrast enhancing with a multilobulated appearance, spinal cord compression, paraspinal musculature invasion and intrathoracic extension. Those changes were confirmed on post‐mortem, and the mass diagnosed based on immunohistochemistry.
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Affiliation(s)
- Adrien-Maxence Hespel
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA
| | - Marie de Swarte
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA
| | - Kimberly Anderson
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA
| | - Richard Weiss
- Department of Clinical Pathology, Auburn University, College of Veterinary Medicine, Auburn, AL, USA
| | - John Hathcock
- Department of Radiology, Auburn University, College of Veterinary Medicine, Auburn, AL, USA
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Coşkun D, Mahli A, Sabuncu Ü, Özdemir R, Emmez H, Günaydın DB. Anaesthetic Management in Successive Spinal Surgeries During Pregnancy and Postpartum. Turk J Anaesthesiol Reanim 2020; 48:420-422. [PMID: 33103149 PMCID: PMC7556636 DOI: 10.5152/tjar.2020.31698] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 08/21/2019] [Indexed: 11/22/2022] Open
Abstract
In this case report, we present a parturient with spinal tumour who required neurosurgery before and after caesarean delivery under general anaesthesia. A 25-year-old woman at 30 weeks of gestation and suffering from bilateral lower-limb weakness and sensory deficit due to spinal tumour underwent emergent laminectomy and decompression surgery under general anaesthesia. In this case, total intravenous anaesthesia was used. Two weeks later, the patient underwent emergent caesarean delivery under general anaesthesia due to preterm labour and gave birth to a healthy new-born. Meanwhile, pathological exam revealed soft tissue sarcoma requiring re-operation for gross total excision in the postpartum Week 4, which was followed by multisession chemoradiotherapy. The patient survived for 3 years, that is, until generalised systemic and neural metastasis. General anaesthesia management in surgeries before and after caesarean delivery in patients with spinal tumours is of utmost importance in providing optimal maternal, foetal and neonatal safety using a multidisciplinary team approach.
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Affiliation(s)
- Demet Coşkun
- Department of Anaesthesiology and Reanimation, Gazi University School of Medicine, Ankara, Turkey
| | - Ahmet Mahli
- Department of Anaesthesiology and Reanimation, Yüksek İhtisas University School of Medicine, Ankara, Turkey
| | - Ülkü Sabuncu
- Department of Anaesthesiology and Reanimation, Gazi University School of Medicine, Ankara, Turkey
| | - Rabia Özdemir
- Department of Anaesthesiology and Reanimation, Gazi University School of Medicine, Ankara, Turkey
| | - Hakan Emmez
- Department of Neurosurgery, Gazi University School of Medicine, Ankara, Turkey
| | - Dudu Berrin Günaydın
- Department of Anaesthesiology and Reanimation, Gazi University School of Medicine, Ankara, Turkey
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Ala RT, Yener G, Özer E, Men S, Bülbül HM, Yaman A, Söylev Bajin M, Colakoglu BD, Akdal G, Halmágyi GM. Adult Spinal Primary Leptomeningeal Medulloblastoma Presenting as Pseudotumour Cerebri Syndrome. Neuroophthalmology 2020; 45:205-210. [PMID: 34194127 DOI: 10.1080/01658107.2020.1791191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
A previously well 34-year-old man presented with severe pseudotumour cerebri. Imaging showed that he had a cauda equina tumour which proved to be a medulloblastoma. There was no tumour mass in the posterior fossa so we assume that this was a primary leptomeningeal medulloblastoma. In patients with somewhat atypical pseudotumour, spinal imaging should always be considered.
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Affiliation(s)
- Rahmi Tümay Ala
- Department of Neurology, Dokuz Eylül University, Izmir, Turkey
| | - Görsev Yener
- Department of Neurology, Dokuz Eylül University, Izmir, Turkey.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Erdener Özer
- International Biomedicine and Genome Center, Dokuz Eylül University, Izmir, Turkey
| | - Süleyman Men
- Department of Pathology, Dokuz Eylül University, Izmir, Turkey
| | | | - Aylin Yaman
- Department of Radiology, Dokuz Eylül University, Izmir, Turkey
| | | | | | - Gülden Akdal
- Department of Neurology, Dokuz Eylül University, Izmir, Turkey.,Department of Ophthalmology, Dokuz Eylül University, Izmir, Turkey
| | - Gábor Michael Halmágyi
- Department of Neuroscience, Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
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Marchesini N, Soda C, Ricci UM, Pinna G, Alessandrini F, Ghimenton C, Bernasconi R, Paolino G, Teli M. Giant intradural extramedullary spinal ependymoma, a rare arachnoiditis-mimicking condition: case report and literature review. Br J Neurosurg 2019:1-6. [PMID: 31213094 DOI: 10.1080/02688697.2019.1630551] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background and importance: Ependymomas are tumours arising from the ependymal cells lining the ventricles and the central canal of the spinal cord. They represent the most common intramedullary spinal cord tumour in adults and are very rarely encountered in an extramedullary location. Only 40 cases of intradural extramedullary (IDEM) ependymomas have been reported, all of which were diagnosed pre-operatively as IDEM ependymomas on contrast-enhanced MRI. Clinical presentation: We report a 23-year old male presenting with rapidly worsening signs and symptoms of spinal cord disease. A spinal MRI demonstrated a posterior multi-cystic dilatation extended between T1 and T12. Post-contrast sequences showed peri-medullar leptomeningeal enhancement and the diagnosis of spinal arachnoiditis was made. The patient underwent surgery and the spinal cord appeared circumferentially wrapped by an irregular soft tissue. The tissue was sub-totally removed and the pathological diagnosis was ependymoma WHO grade II. The patient experienced an excellent neurological recovery and no further treatments were administered. A small residue is now stable at 2.5 years follow-up. Conclusions: Giant IDEM ependymomas are rare entities and pre-operative diagnosis can be challenging in some cases. Surgery represents the main treatment option being resolutive in most cases.
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Affiliation(s)
- Nicolò Marchesini
- a Department of Neurosurgery , University of Verona , Verona , Italy
| | - Christian Soda
- b Department of Neurosurgery , AOUI Borgo Trento Hospital , Verona , Italy
| | | | - Giampietro Pinna
- b Department of Neurosurgery , AOUI Borgo Trento Hospital , Verona , Italy
| | - Franco Alessandrini
- c Department of Neuroradiology , AOUI Borgo Trento Hospital , Verona , Italy
| | - Claudio Ghimenton
- d Department of Pathology , AOUI Borgo Trento Hospital , Verona , Italy
| | | | - Gaetano Paolino
- e Department of Pathology , University of Verona , Verona , Italy
| | - Marco Teli
- f Department of Neurosurgery , Walton Centre NHS Foudation Trust , Liverpool , UK
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Toescu SM, Ibrahim M, O'Donovan DG, Balasubramaniam G, David KM. Complex spinal fixation of a cervical vertebra Brown tumour: report of an unusual case. Br J Neurosurg 2017; 33:684-686. [PMID: 29160114 DOI: 10.1080/02688697.2017.1406059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/18/2022]
Abstract
Brown tumours affecting the cervical spine are a rare but recognised complication of renal failure-related secondary hyperparathyroidism. We present a case of a 26 year-old female with radiculopathy who was managed successfully with 360° cervical spine fixation and parathyroidectomy.
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Affiliation(s)
| | - Maria Ibrahim
- Department of Nephrology, Southend University Hospital, Southend-on-Sea, UK
| | | | | | - Karoly M David
- Department of Neurosurgery, Essex Neurosciences Centre, Queens Hospital, Romford, UK
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9
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Abstract
Secondary spinal manifestations of esthesioneuroblastoma are rare. A 67-year-old woman was presented with an extradural spinal manifestation at the vertebra Th7 within 8 weeks after resection of an esthesioneuroblastoma. Subtotal removal of the epidural tumour was achieved combined with dorsal transpedicular stabilization. Early screening for distant metastases may be considered in patients with esthesioneuroblastoma.
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10
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Albakr A, Schell M, Drew B, Cenic A. Epithelioid hemangioendothelioma of the spine: case report and review of the literature. J Spine Surg 2017; 3:250-259. [PMID: 28744509 DOI: 10.21037/jss.2017.05.05] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) has been described as a rare vascular bone lesion with histological features between hemangioma and high-grade angiosarcoma. Spinal EHE is a quite rare disease with few case reports and series reported in the literature. The tumor cells are positive for vimentin, CD31and CD34, factor VIII related antigen, ERG, and FLI1. Radiological features are not specific; it may appear as an osteolytic lesion. It can present as a multifocal disease in 40% of cases. No clear correlation with age and sex; however, it is slightly more common in males. Focal neck or back pain is the most common presenting symptom. The natural history of spinal EHE is unpredictable, and currently, there is no standard of care for treatment. Treatment options include preoperative embolization, and surgical resection followed by radiotherapy and/or chemotherapy. A 34-year-old previously healthy male presented with mid-thoracic back pain. Magnetic resonance imaging (MRI) of the spine revealed a decrease in vertebral body height at T5 with an enhancing mass. He underwent T5 balloon kyphoplasty and needle vertebral body biopsy. Results of the biopsy samples were non-diagnostic. Approximately 3 months after surgery, the patient presented with unsteady gait. A subsequent MRI revealed progression of the T5 compression fracture with cord compression. The patient subsequently underwent T4-T6 bilateral posterior decompression for epidural tumor and T3-T7 posterior instrumentation with pedicle screws. Pathology of the lesion revealed EHE. The patient was started on local radiation therapy (RT). On follow-up, 3 months after the second surgery, the thoracic spinal pain had improved dramatically. Our review highlights the diagnosis, clinical presentation, and treatment of spinal EHE. Complete resection is associated with good outcome. Radiotherapy has been used in partially resected lesions. However, the role of radiotherapy as primary treatment is not yet defined. Further studies should develop a treatment algorithm for this rare tumour.
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Affiliation(s)
- Abdulrahman Albakr
- Division of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
Tanycytic ependymoma is an unusual morphological variant of WHO grade II ependymoma, typically arising from the cervical or thoracic spinal cord. Although the literature deals extensively with pathological features of this tumour entity, imaging features have not been well characterised. The purpose of this study was to review magnetic resonance imaging (MRI) features of spinal tanycytic ependymomas reported in the literature to date, exemplified by a case of a patient with tanycytic ependymoma of the conus medullaris presenting to our hospital. A Medline search of the English literature for all previously published cases of spinal tanycytic ependymoma was carried out and the reported MRI features reviewed. The tumours were found to be typically well-demarcated masses, predominantly showing isointensity on T1-weighted signal, and T2-weighted hyperintensity, with variable patterns of contrast enhancement. A cystic component was seen in half of the cases, and in a minority a mural nodule was present within the cyst wall. Associated syrinx formation was observed in one-third of the cases and haemorrhage was rare, which may be helpful pointers in differentiating the lesion from other ependymoma subtypes. In conclusion, MRI characteristics of spinal tanycytic ependymoma are variable and non-specific, and radiological diagnosis thus remains challenging, although certain predominant features are identified in this report. Knowledge of these is important in the diagnostic differentiation from other intramedullary and extramedullary spinal tumours in order to guide appropriate surgical management.
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Affiliation(s)
- Michal Tomek
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UK
| | | | - Sebastian Brandner
- Department of Pathology, National Hospital for Neurology and Neurosurgery, UK
| | - Zane Jaunmuktane
- Department of Pathology, National Hospital for Neurology and Neurosurgery, UK
| | - Cheong Hung Lee
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, UK
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UK
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Sahin S, Atabey C, Simşek M, Naderi S. Spinal textiloma (gossypiboma): a report of three cases misdiagnosed as tumour. Balkan Med J 2013; 30:422-8. [PMID: 25207152 DOI: 10.5152/balkanmedj.2013.8732] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 04/29/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Textile products commonly used in surgery (e.g., sponges or gauze) have been known to cause complications after spinal surgery. Associated complications usually arise months or even years after the primary surgery. In case of spine surgery, these bodies are often detected during neuroradiological evaluations to investigate reported back pain; however, this complication often remains asymptomatic. AIMS The research is intended to increase awareness among both spinal surgeons and neuroradiologists of this potential complication. STUDY DESIGN Retrospective study. METHODS This study is a retrospective case series of three patients with retained surgical textile products who had been misdiagnosed with spinal tumour. The medical records of the patients were reviewed and demographic data, clinical aspects, initial diagnosis, surgical procedures, time interval between previous operation and onset of symptoms, laboratory findings, radiological findings, treatment, and outcome were analysed. RESULTS The three patients included two women and one man aged between 64 and 67 years. All patients had a previous surgery for lumbar disc herniation. The time from the previous surgical procedures to presentation ranged from 3 to 17 years. All patients presented with non-specific lower back pain and/or radiculopathy without clinical findings of infection. Laboratory parameters were otherwise normal. All three cases had been misdiagnosed as a spinal tumor based on magnetic resonance imaging findings. During new surgical procedures, gauze bandages, i.e., surgical textiles left during a previous operation, were found. CONCLUSION Textiloma is an important and rarely mentioned potential neurosurgical complication that may remain asymptomatic for years. They are more common in obese patients, after emergency surgery, and with unplanned changes in surgical procedure such as bleeding and unintended neurosurgical complications. Neuroradiological findings are variable and non-specific; thus, patients could be misdiagnosed with a spinal tumor or abscess. Likewise, in patients with a history of spinal surgery, spinal abscesses, haematomas, hypertrophic scars, fibrosarcomas, rhabdomyosarcomas, and schwannomas should definitely be considered in the differential diagnosis and considered when planning diagnostic procedures. Appropriate antibiotic therapy is recommended when a suppurative complication is present or suspected. Textiloma is a medico-legal complication that can be prevented by the education of surgical staff, the counting method (preoperatively, at closure, and at the end), and use of products with radiopaque barcodes.
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Affiliation(s)
- Soner Sahin
- Department of Neurosurgery, Kocaeli Derince Research and Teaching Hospital, Kocaeli, Turkey
| | - Cem Atabey
- Department of Neurosurgery, Gülhane Military Academy Haydarpaşa Training Hospital, İstanbul, Turkey
| | - Mehmet Simşek
- Department of Neurosurgery, Ümraniye Research and Teaching Hospital, İstanbul, Turkey
| | - Sait Naderi
- Department of Neurosurgery, Ümraniye Research and Teaching Hospital, İstanbul, Turkey
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Quan GMY, Vital JM, Aurouer N, Obeid I, Palussière J, Diallo A, Pointillart V. Surgery improves pain, function and quality of life in patients with spinal metastases: a prospective study on 118 patients. Eur Spine J 2011; 20:1970-8. [PMID: 21706361 PMCID: PMC3207332 DOI: 10.1007/s00586-011-1867-6] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 05/29/2011] [Indexed: 01/11/2023]
Abstract
PURPOSE There are few prospective studies on surgical outcomes and survival in patients with metastatic disease to the spine. The magnitude and duration of effect of surgery on pain relief and quality of life remains uncertain. Therefore, the aim of this clinical study was to prospectively evaluate clinical, functional, quality of life and survival outcomes after palliative surgery for vertebral metastases. METHODS 118 consecutive patients who underwent spinal surgery for symptomatic vertebral metastases were prospectively followed up for 12 months or until death. Clinical data and data from the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire were obtained pre- and post-operatively and at regular follow-up intervals. RESULTS Surgery was effective in achieving rapid improvement in axial and radicular pain, neurological deficit, sphincteric dysfunction and ambulatory status, with a complication rate of 26% and a 12 month mortality rate of 48%. Almost 50% of patients had complete resolution of back pain, radiculopathy and neurological deficit. Of the patients who were non-ambulant and incontinent, over 50% regained ambulatory ability and recovered urinary continence. The overall incidence of wound infection or breakdown was 6.8% and the local recurrence rate was 8.5%. There was a highly significant improvement in physical, role, cognitive and emotional functioning and global health status post-operatively. Greatest improvement in pain, function and overall quality of life occurred in the early post-operative period and was maintained until death or during the 12 month prospective follow-up period. CONCLUSION The potential for immediate and prolonged improvement in pain, function and quality of life in patients with symptomatic vertebral metastases should be considered during the decision-making process when selecting and counselling patients for surgery.
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Affiliation(s)
- Gerald M. Y. Quan
- Spinal Unit, Department of Orthopaedic Surgery, University Hospital of Bordeaux, Bordeaux, France
- Unité de Pathologie Rachidienne, Le Service d’Orthopédie-Traumatologie, Centre Hospitalo-Universitaire Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France
| | - Jean-Marc Vital
- Spinal Unit, Department of Orthopaedic Surgery, University Hospital of Bordeaux, Bordeaux, France
| | - Nicholas Aurouer
- Spinal Unit, Department of Orthopaedic Surgery, University Hospital of Bordeaux, Bordeaux, France
| | - Ibrahim Obeid
- Spinal Unit, Department of Orthopaedic Surgery, University Hospital of Bordeaux, Bordeaux, France
| | - Jean Palussière
- Department of Radiology, Bergonié Institute, Bordeaux, France
| | - Abou Diallo
- Department of Epidemiology, ISPED, Université Victor Segalen, Bordeaux 2, France
| | - Vincent Pointillart
- Spinal Unit, Department of Orthopaedic Surgery, University Hospital of Bordeaux, Bordeaux, France
- Unité de Pathologie Rachidienne, Le Service d’Orthopédie-Traumatologie, Centre Hospitalo-Universitaire Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France
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