Cervical dystonia due to spinal cord ependymoma: Involvement of cervical cord segments in the pathogenesis of dystonia

Abstract OBJECTIVE Several authors have noted increased neurological deficits and worsening dysesthesia in the postoperative period in patients with spinal cord ependymoma. We describe the neurological progression and pain evolution of these patients over the 1-year period after surgery. In addition, our favored method of en bloc tumor resection is illustrated, and the rate of complications, recurrence, and survival in this group of patients is addressed. METHODS We operated on 26 patients (12 male and 14 female) with low-grade spinal cord ependymomas between 1975 and 2001. The median age at diagnosis was 42 years. Tumors extended into the cervical cord in 13 patients, the thoracic cord in 7 patients, and the conus medullaris in 6 patients. Eleven patients had previous surgery and/or radiation therapy. RESULTS We achieved a gross total resection in 88% of patients, whereas 8% had a subtotal resection and 4% had a biopsy. Only 1 patient developed a recurrence over a mean follow-up period of 31 months. CONCLUSION We conclude that radical surgical resection of spinal cord ependymomas can be safely achieved in the majority of patients. A trend toward neurological improvement from a postoperative deficit can be expected between 1 and 3 months after surgery and continues up to 1 year. Postoperative dysesthesias begin to improve within 1 month of surgery and are significantly better by 1 year after surgery. The best predictor of outcome is the preoperative neurological status.

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Are subjects with spondylotic cervical cord encroachment at increased risk of cervical spinal cord injury after minor trauma?

Yearbook of Neurology and Neurosurgery ◽

10.1016/j.yneu.2011.12.006 ◽

2012 ◽

Vol 2012 ◽

pp. 282-283

Author(s):

R. Riesenburger

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spinal Cord ◽

Cervical Spinal Cord Injury ◽

Cervical Cord ◽

Minor Trauma ◽

Increased Risk ◽

Cord Injury

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Microsurgical resection of intramedullary spinal cord ependymoma

Neurosurgical FOCUS ◽

10.3171/2014.v3.focus14276 ◽

2014 ◽

Vol 37 (v2supplement) ◽

pp. Video9

Author(s):

Paul C. McCormick

Keyword(s):

Spinal Cord ◽

Growth Rate ◽

Spinal Cord Tumor ◽

Intramedullary Spinal Cord ◽

Clear Margin ◽

Intramedullary Spinal Cord Tumor ◽

Link Type ◽

Microsurgical Resection ◽

Spinal Cord Ependymoma ◽

Posterior Midline

Ependymomas are the most commonly occurring intramedullary spinal cord tumor in adults. With few exceptions these tumors are histologically benign, although they exhibit some biologic variability with respect to growth rate. While unencapsulated, spinal ependymomas are non-infiltrative and present a clear margin of demarcation from the surrounding spinal cord that serves as an effective dissection plane. This video demonstrates the technique of microsurgical resection of an intramedullary ependymoma through a posterior midline myelotomy.The video can be found here: http://youtu.be/lcHhymSvSqU.

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Arrow-Shot Injury to Pediatric Spinal Cord

Indian Journal of Neurotrauma ◽

10.1055/s-0041-1724142 ◽

2021 ◽

Author(s):

Vijayveer Singh ◽

Sharad Thanvi

Keyword(s):

Spinal Cord ◽

Spinal Cord Injuries ◽

Pediatric Population ◽

Cervical Region ◽

Cervical Cord ◽

Cord Injury ◽

Dural Suturing ◽

Stab Injuries ◽

Early Surgical Intervention

AbstractPenetrating spinal cord injuries (PSCI) in cervical region are extremely rare in pediatric population. Most injuries in pediatric population are accidental due to gunshot or a stab injury with a sharp or pointed object. Gun shots may result into a severe wound which is usually fatal and may result in death, quadriplegia, or serious long-term disability. Stab injuries are less severe and may result in neurological sequalae. In this paper, an unusual case of pediatric arrow shot partial cervical cord injury is reported which was managed by aggressive neurosurgical management. The arrow lodged in the cervical cord was very near to the vertebral artery leading to parapariesis which recovered well without any complications. Diagnostic imaging at admission included radiographs, computed tomography (CT), and CT angiography of the cervical region. The patient underwent early surgical intervention with removal of foreign body from the cord and subsequent dural suturing.

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Cervical Cord-Canal Mismatch: A New Method for Identifying Predisposition to Spinal Cord Injury

World Neurosurgery ◽

10.1016/j.wneu.2017.08.018 ◽

2017 ◽

Vol 108 ◽

pp. 112-117 ◽

Cited By ~ 3

Author(s):

Aria Nouri ◽

Julio Montejo ◽

Xin Sun ◽

Justin Virojanapa ◽

Luis E. Kolb ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

New Method ◽

Cervical Cord ◽

Cord Injury

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Ascending pathways in the spinal cord involved in the activation of subnucleus reticularis dorsalis neurons in the medulla of the rat

Journal of Neurophysiology ◽

10.1152/jn.1990.63.3.424 ◽

1990 ◽

Vol 63 (3) ◽

pp. 424-438 ◽

Cited By ~ 32

Author(s):

Z. Bing ◽

L. Villanueva ◽

D. Le Bars

Keyword(s):

Spinal Cord ◽

Electrical Stimulation ◽

The Body ◽

Cervical Cord ◽

Lateral Part ◽

Neuronal Responses ◽

C Fiber ◽

Dorsal Columns ◽

Dorsolateral Funiculus ◽

The Right

1. Recordings were made from neurons in the left medullary subnucleus reticularis dorsalis (SRD) of anesthetized rats. Two populations of neurons were recorded: neurons with total nociceptive convergence (TNC), which gave responses to A delta- and C-fiber activation from the entire body after percutaneous electrical stimulation, and neurons with partial nociceptive convergence (PNC), which responded to identical stimuli with an A delta-peak regardless of which part of the body was stimulated and with a C-fiber peak of activation from some, mainly contralateral, parts of the body. 2. The effects of various, acute, transverse sections of the cervical (C4-C5) spinal cord on the A delta- and C-fiber-evoked responses were investigated by building poststimulus histograms (PSHs) after 50 trials of supramaximal percutaneous electrical stimulation of the extremity of either hindpaw (2-ms duration; 3 times threshold for C-fiber responses), before and 30-40 min after making the spinal lesion. 3. In the case of TNC neurons, hemisections of the left cervical cord blocked the responses elicited from the right hindpaw and slightly, but not significantly, diminished those evoked from the left hindpaw. Conversely, hemisections of the right cervical cord abolished TNC responses elicited from the left hindpaw without significantly affecting the responses elicited from the right hindpaw. 4. Lesioning the dorsal columns or the left dorsolateral funiculus was found not to affect the TNC neuronal responses elicited from either hindpaw. By contrast, lesioning the left lateral funiculus or the most lateral part of the ventrolateral funiculus, respectively, reduced and blocked the responses elicited from the right hindpaw without affecting those evoked from the left hindpaw. 5. After lesions that included the most lateral parts of the left ventral funiculus, PNC neuronal responses elicited from the right hindpaw were also abolished, whereas those elicited from the left hindpaw remained unchanged. 6. We conclude that the signals responsible for the activation of SRD neurons travel principally in the lateral parts of the ventrolateral quadrant, a region that classically has been implicated in the transmission of noxious information. Both a crossed and a double-crossed pathway are involved in this process. The postsynaptic fibers of the dorsal columns and the spinocervical and spinomesencephalic tracts do not appear to convey signals that activate SRD neurons. 7. The findings also suggest that lamina I nociceptive specific neurons, the axons of which travel within the dorsolateral funiculus, do not contribute very much to the activation of SRD neurons.

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Somatotopic studies on red nucleus: spinal projection level and respective receptive fields

Journal of Neurophysiology ◽

10.1152/jn.1975.38.4.965 ◽

1975 ◽

Vol 38 (4) ◽

pp. 965-980 ◽

Cited By ~ 16

Author(s):

J. C. Eccles ◽

T. Rantucci ◽

P. Scheid ◽

H. Taborikova

Keyword(s):

Spinal Cord ◽

Red Nucleus ◽

Receptive Fields ◽

Anterior Lobe ◽

Cervical Cord ◽

Pars Intermedia ◽

Interpositus Nucleus ◽

Rubrospinal Tract ◽

Testing Procedures ◽

Axonal Projections

The somatotopic inputs into red nucleus (RN) neurons have been studied with special reference to their level of projection in the spinal cord. As inputs we employed either volleys in predominantly cutaneous nerves of forelimb and hindlimb or cutaneous mechanoreceptor discharges evoked by taps to footpads of forelimb and hindlimb. There has been physiological confirmation of the anatomical findings that RD neurons projecting to the lumbar cord are located in the ventrolateral zone of the pars magnocellularis, whereas in the dorsomedial zone are RN neurons with cervical but not lumbar projection. Somatotopically there was found to be a differentiation of input to RN neurons according as they projected to the lumbar or only to the cervical cord. This finding was presented in the form both of tables and of somatotopic maps. As expected, this discrimination was more restrictive for the more selective inputs from pad taps than for nerve inputs. Nevertheless, forelimb inputs often had a considerable excitatory and inhibitory action on lumbar-projecting RN neurons, and vice versa for cervical-projecting neurons. There were two notable somatotopic findings that suggest specificities of connectivities. First, despite the large convergence of IP neurons onto RN neurons (about 50-fold), the degree of somatotopic discrimination was about the same for interpositus and RN neurons with two testing procedures: between inputs from forelimb and hindlimb; and between inputs from pads on one foot. Second, although there was in the interpositus nucleus a considerable topographical admixture of neurons with dominant forelimb or hindlimb inputs, the axonal projections of these neurons were apparently unscrambled on the way to the target RN neurons, so as to deliver the somatotopic specificities observed for two classes of RN neurons; those projecting down the spinal cord beyond L2 level, and those projecting to C2 but not L2. Finally, there is a general discussion of motor control with reference to the pathway; pars intermedia of anterior lobe of cerebellum leads to interpositus nucleus leads to red nucleus leads to rubrospinal tract leads to spinal motoneurons.

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Surgical treatment of primary intramedullary spinal cord tumors in adult patients

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2008000100014 ◽

2008 ◽

Vol 66 (1) ◽

pp. 59-63 ◽

Cited By ~ 4

Author(s):

Mario Augusto Taricco ◽

Vinicius Monteiro de Paula Guirado ◽

Ricardo Bragança de Vasconcellos Fontes ◽

José Pindaro Pereira Plese

Keyword(s):

Spinal Cord ◽

Previous Treatment ◽

Cervical Cord ◽

Spinal Cord Tumors ◽

Intramedullary Tumors ◽

Treatment Protocols ◽

Intramedullary Spinal Cord ◽

Neurological Outcomes ◽

Neurological Morbidity ◽

Microsurgical Resection

BACKGROUND: Primary spinal cord intramedullary tumors are rare and present with insidious symptoms. Previous treatment protocols emphasized biopsy and radiation/chemotherapy but more aggressive protocols have emerged. OBJECTIVE: To report our experience. METHOD: Forty-eight patients were diagnosed with primary intramedullary tumors. The cervical cord was involved in 27% and thoracic in 42% of patients. Complete microsurgical removal was attempted whenever possible without added neurological morbidity. RESULTS: Complete resection was obtained in 33 (71%) patients. Neurological function remained stable or improved in 32 patients (66.7%). Ependymoma was the most frequent tumor (66.7%). CONCLUSION: Neurological outcome is superior in patients with subtle findings; aggressive microsurgical resection should be pursued with acceptable neurological outcomes.

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EPCO-01. MOLECULAR PROFILING OF SPINAL CORD EPENDYMOMA

Neuro-Oncology ◽

10.1093/neuonc/noab196.000 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi1-vi1

Author(s):

Erika Yamazawa ◽

Shota Tanaka ◽

Genta Nagae ◽

Takayoshi Umeda ◽

Taijun Hana ◽

...

Keyword(s):

Spinal Cord ◽

Dna Methylation ◽

Methylation Status ◽

Neurofibromatosis Type ◽

Methylation Pattern ◽

Who Grade ◽

Spinal Ependymoma ◽

Fresh Frozen ◽

Spinal Cord Ependymoma ◽

The Difference

Abstract BACKGROUND Ependymomas are currently classified into 9 subgroups by DNA methylation profiles. Although spinal cord ependymoma (SP-EPN) is distinct from other tumors, diversity within SP-EPN is still unclear. Here, we used transcriptomic and epigenomic profiles to investigate the diversity among Japanese SP-EPN cases. MATERIALS AND METHODS We analyzed 57 SP-EPN patients (32 males and 25 females, aged from 18 to 78 years, median: 52), including two cases of neurofibromatosis type 2, five cases of grade 3 (WHO grade). We obtained transcriptome (RNA-seq) and DNA methylation (Infinium Methylation EPIC array) data from fresh frozen specimens of SP-EPN resected at the University of Tokyo Hospital and our collaborative groups. RESULTS Three cases had a previous intracranial ependymoma operation. Hierarchical clustering of the DNA methylation data showed that these three cases of intracranial origin as a different cluster from spinal origin. The 45 grade 2 spinal ependymoma showed a relatively homogenous methylation pattern. However, the methylation status of HOX gene cluster regions is compatible with the segment of origin, which reflects the cells of origins are derived after the determination of segment identity. RNA sequencing of 57 cases revealed two subgroups within grade 2. Gene ontology analysis of differentially expressed genes suggested the difference in metabolic state such as rRNA translation and mitochondrial respiration between the two expression subgroups. CONCLUSION Epigenetic analysis indicated the accurate body segment origin of SP-EPN. We observed that metabolic states could divide grade 2 spinal cord ependymoma into 2 subgroups and will present the relationship to clinicopathological information.

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