Management of Spinal Cord and Cauda Equina Compression Secondary to Epidural Metastatic Disease in Adults with Malignant Germ Cell Tumours

2002 ◽  
Vol 14 (6) ◽  
pp. 481-490 ◽  
Author(s):  
J. Gale ◽  
G.M. Mead ◽  
P.D. Simmonds
Keyword(s):  
Spinal Cord ◽  
Germ Cell ◽  
Metastatic Disease ◽  
Cauda Equina ◽  
Germ Cell Tumours ◽  
Cauda Equina Compression

scholarly journals Alteration of the lysophosphatidic acid and its precursor lysophosphatidylcholine levels in spinal cord stenosis: A study using a rat cauda equina compression model

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Baasanjav Uranbileg ◽  
Nobuko Ito ◽  
Makoto Kurano ◽  
Daisuke Saigusa ◽  
Ritsumi Saito ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Lysophosphatidic Acid ◽  
Mass Spectrometry Imaging ◽  
Cauda Equina ◽  
Motor Dysfunction ◽  
Lipid Mediator ◽  
Neurogenic Claudication ◽  
Imaging Analysis ◽  
Cauda Equina Compression ◽  
Tissue Damages

Abstract Cauda equina compression (CEC) is a major cause of neurogenic claudication and progresses to neuropathic pain (NP). A lipid mediator, lysophosphatidic acid (LPA), is known to induce NP via the LPA1 receptor. To know a possible mechanism of LPA production in neurogenic claudication, we determined the levels of LPA, lysophosphatidylcholine (LPC) and LPA-producing enzyme autotaxin (ATX), in the cerebrospinal fluid (CSF) and spinal cord (SC) using a CEC as a possible model of neurogenic claudication. Using silicon blocks within the lumbar epidural space, we developed a CEC model in rats with motor dysfunction. LPC and LPA levels in the CSF were significantly increased from day 1. Importantly, specific LPA species (16:0, 18:2, 20:4) were upregulated, which have been shown to produce by ATX detected in the CSF, without changes on its level. In SC, the LPC and LPA levels did not change, but mass spectrometry imaging analysis revealed that LPC was present in a region where the silicon blocks were inserted. These results propose a model for LPA production in SC and CSF upon neurogenic claudication that LPC produced locally by tissue damages is converted to LPA by ATX, which then leak out into the CSF.

Spinal arterial malformation in a child with hereditary hemorrhagic telangiectasia

1976 ◽  
Vol 44 (5) ◽  
pp. 613-616 ◽  
Author(s):  
Glen S. Merry ◽  
D. Barry Appleton
Keyword(s):  
Spinal Cord ◽  
Family History ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Cauda Equina ◽  
Content Type ◽  
Cauda Equina Compression ◽  
History Of ◽  
Spinal Aneurysm ◽  
Arterial Malformation ◽  
Fine Print

✓ A case is reported of spinal aneurysm in a child with a family history of hereditary hemorrhagic telangiectasia causing spinal cord and cauda equina compression. The operative approach is discussed.

scholarly journals Symptom interval and treatment burden for patients with malignant central nervous system germ cell tumours

2019 ◽  
Vol 105 (3) ◽  
pp. 247-252 ◽  
Author(s):  
James Hayden ◽  
Matthew J Murray ◽  
Ute Bartels ◽  
Thankamma Ajithkumar ◽  
Brinda Muthusamy ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Germ Cell ◽  
Metastatic Disease ◽  
Delayed Diagnosis ◽  
Paediatric Oncology ◽  
Time Interval ◽  
Study Cohort ◽  
Germ Cell Tumours ◽  
Treatment Burden

ObjectivePatients with central nervous system germ cell tumours (CNS-GCTs) commonly initially present to primary care or general paediatricians. Prolonged symptom intervals (SI) are frequently seen in CNS-GCTs and have been associated with inferior outcomes in other brain tumours. This study reviewed the clinical presentation of CNS-GCTs and examined the effect of prolonged SI.Design/Setting/Patients/OutcomesInternational multicentre 10-year retrospective study (2002–2011 inclusive), across six international paediatric oncology treatment centres. All newly diagnosed patients with CNS-GCT were included. Main outcome measure was time interval from first symptom to diagnosis.ResultsThe study cohort included 86 (58 males:28 female) patients (59 ‘germinoma’ and 27 ‘non-germinomatous’ GCTs), with tumours being pineal (n=33), suprasellar (n=25), bifocal (pineal+suprasellar; n=24) and ‘other’ site (n=4), of which 16 (19%) were metastatic. Median age at diagnosis was 14 years (0–23 years). The time to diagnosis from first symptom (SI) was 0–69 months (median 3 months, mean 9 months). A prolonged SI (>6 months) was observed in 28/86 patients (33%) and significantly associated with metastatic disease (11/28 (39%) vs 5/58 (9%); p=0.002)) at diagnosis, but not overall survival. With prolonged SI, endocrine symptoms, particularly diabetes insipidus, were more common (21/28 (75%) vs 14/58 (24%) patients; p<0.002), but raised intracranial pressure (RICP) was less frequent (4/28 (14%) vs 43/58 (74%) patients; p<0.001)) at first symptom.ConclusionsOne-third of patients with CNS-GCT have >6 months of symptoms prior to diagnosis. Delayed diagnosis is associated with metastatic disease. Early symptom recognition, particularly related to visual and hormonal disturbances in the absence of RICP, may improve timely diagnosis, reduce metastatic disease frequency and consequently reduce treatment burden and late effects.

Central nervous system tumours

2019 ◽  
pp. 351-404
Author(s):  
Neil G Burnet ◽  
Fiona Harris ◽  
Mark B Pinkham ◽  
Kate E Burton ◽  
Gillian A Whitfield
Keyword(s):  
Spinal Cord ◽  
Central Nervous System ◽  
Nervous System ◽  
Germ Cell ◽  
Dose Distribution ◽  
Low Grade ◽  
Germ Cell Tumours ◽  
Central Nervous System Tumours ◽  
Acoustic Schwannoma ◽  
Spinal Cord Tumours

Chapter 17 discusses central nervous system tumours, including principles, planning volumes, dose distribution, high- and low-grade glioma, ependymoma, medulloblastoma, germ cell tumours , vestibular (acoustic) schwannoma, pituitary tumours (including craniopharyngioma), meningioma, and primary spinal cord tumours.

scholarly journals P3.13-025 Spinal Cord and Cauda Equina Compression in Lung Cancer

2017 ◽  
Vol 12 (11) ◽  
pp. S2325
Author(s):  
H. Neji ◽  
M.A. Haouari ◽  
M. Attia ◽  
M. Affes ◽  
I. Baccouche ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Spinal Cord ◽  
Cauda Equina ◽  
Cauda Equina Compression

scholarly journals Spinal shortening and monosegmental posterior spondylodesis in the management of dorsal and lumbar unstable injuries

2011 ◽  
Vol 02 (01) ◽  
pp. 017-022 ◽  
Author(s):  
Tarek A Aly
Keyword(s):  
Spinal Cord ◽  
Interbody Fusion ◽  
Cauda Equina ◽  
Fracture Dislocation ◽  
Primary Indication ◽  
Cauda Equina Compression ◽  
Solid Fusion ◽  
Bone Fragments ◽  
Local Kyphosis ◽  
Sagittal Index

ABSTRACT Introduction: Patients with spinal injuries have been treated in the past by laminectomy in an attempt to decompress the spinal cord. The results have shown insignificant improvement or even a worsening of neurologic function and decreased stability without effectively removing the anterior bone and disc fragments compressing the spinal cord. The primary indication for anterior decompression and grafting is narrowing of the spinal canal with neurologic deficits that cannot be resolved by any other approach. One must think of subsequent surgical intervention for increased stability and compressive posterior fusion with short-armed internal fi xators. Aim: To analyze the results and efficacy of spinal shortening combined with interbody fusion technique for the management of dorsal and lumbar unstable injuries. Materials and Methods: Twenty-three patients with traumatic fractures and or fracture-dislocation of dorsolumbar spine with neurologic deficit are presented. All had radiologic evidence of spinal cord or cauda equina compression, with either paraplegia or paraparesis. Patients underwent recapping laminoplasty in the thoracic or lumbar spine for decompression of spinal cord. The T-saw was used for division of the posterior elements. After decompression of the cord and removal of the extruded bone fragments and disc material, the excised laminae were replaced exactly in situ to their original anatomic position. Then application of a compression force via monosegmental transpedicular fixation was done, allowing vertebral end-plate compression and interbody fusion. Results: Lateral Cobb angle (T10–L2) was reduced from 26 to 4 degrees after surgery. The shortened vertebral body united and no or minimal loss of correction was seen. The preoperative vertebral kyphosis averaged +17 degrees and was corrected to +7 degrees at follow-up with the sagittal index improving from 0.59 to 0.86. The segmental local kyphosis was reduced from +15 degrees to −3 degrees. Radiography demonstrated anatomically correct reconstruction in all patients, as well as solid fusion. Conclusion: This technique permits circumferential decompression of the spinal cord through a posterior approach and posterior interbody fusion.

scholarly journals Dorsal migration of lumbar disc fragments causing cauda equina syndromes: A three case series and literature review

2020 ◽  
Vol 11 ◽  
pp. 175
Author(s):  
Shawn Singh Rai ◽  
Carlos Rodrigo Goulart ◽  
Sepehr Lalezari ◽  
Michael Anthony Galgano ◽  
Satish Krishnamurthy
Keyword(s):  
Spinal Cord ◽  
Literature Review ◽  
Current Literature ◽  
Lumbar Disc ◽  
Correct Diagnosis ◽  
Cauda Equina ◽  
Case Series ◽  
Surgical Decompression ◽  
Case Description ◽  
Cauda Equina Compression

Background: Dorsal migration of an intervertebral lumbar disc fragment is exceedingly rare and may result in spinal cord or cauda equina compression. Radiologically, these lesions may be misdiagnosed as extradural masses or epidural hematomas. Case Description: We present three cases involving dorsal migration of sequestered lumbar disc fragments resulting in cauda equina syndromes. A 31-year-old male, 79-year-old female, and 47-year-old female presented with cauda equina syndromes attributed to the migration of dorsal sequestered lumbar disc fragments. Prompt surgical decompression resulted in adequate outcomes. Here, we review the three cases and the current literature for such lesions. Conclusion: Dorsal migration of sequestered lumbar disc fragments is exceedingly rare, and these lesions are frequently misdiagnosed as extradural masses of other origin or epidural hematomas. Here and in the literature, prompt epidural decompression both confirmed the correct diagnosis and resulted in excellent outcomes.

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