scholarly journals Multiple spinal extradural cysts causing progressive paraparesia: case report and review of literature

2012 ◽  
Vol 31 (01) ◽  
pp. 46-49
Author(s):  
Elton Gomes da Silva ◽  
Vinícius Teixeira Ribeiro ◽  
Bruno Vieira Scarpim ◽  
Yvens Barbosa Fernandes
Keyword(s):  
Spinal Cord ◽  
Clinical Presentation ◽  
Cord Compression ◽  
Subtotal Resection ◽  
Review Of Literature ◽  
Partial Removal ◽  
Asymptomatic Patients ◽  
History Of ◽  
Progressive Paraparesis

AbstractMultiple meningeal extradural cysts are extremely rare. The clinical presentation varies from asymptomatic patients to important symptoms due to spinal cord compression. This article reports the case of a girl with multiple meningeal extradural cysts with progressive paraparesis and hypoesthesia on inferior limbs. The MRI showed multiple extradural cysts between C7 and L1. A partial resection was made at the cystis, reflecting a improve at the postoperative follow up of the patient. The management of asymptomatic cases is usually followed up clinical and radiologically. At the management of the symptomatic cases, the resection of the cysts is the most indicated treatment, even for patients with a long-standing history of compression. However the partial removal has as good results as the total one. The authors review the literature and show a subtotal resection of the cysts did not change the evolution of the presentation.

scholarly journals The Natural History and Clinical Presentation of Cervical Spondylotic Myelopathy

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Chester K. Yarbrough ◽  
Rory K. J. Murphy ◽  
Wilson Z. Ray ◽  
Todd J. Stewart
Keyword(s):  
Spinal Cord ◽  
Natural History ◽  
Cervical Spondylotic Myelopathy ◽  
Clinical Presentation ◽  
Clinical Course ◽  
The United States ◽  
Cord Compression ◽  
Asymptomatic Patients ◽  
History Of ◽  
Electrophysiologic Studies

Cervical spondylotic myelopathy (CSM) refers to impaired function of the spinal cord caused by degenerative changes of the cervical spine resulting in spinal cord compression. It is the most common disorder in the United States causing dysfunction of the spinal cord. A literature review of the natural history of mild cervical myelopathy is undertaken. Clinical presentation and current concepts of pathophysiology are also discussed. While many patients with mild signs of CSM will stabilize or improve over time with conservative treatment, the clinical course of a specific individual patient cannot be predicted. Asymptomatic patients with cervical stenosis and abnormalities on electrophysiologic studies may be at higher risk for developing myelopathy.

scholarly journals Spinal Angiolipoma

2001 ◽  
Vol 28 (1) ◽  
pp. 82-88 ◽  
Author(s):  
Daryl R. Fourney ◽  
Karen A. Tong ◽  
Robert J.B. Macaulay ◽  
Robert W. Griebel
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Complete Excision ◽  
Aggressive Approach ◽  
History Of ◽  
Epidural Fat ◽  
Spinal Angiolipomas ◽  
Spinal Epidural

ABSTRACT:Background:Spinal epidural angiolipoma is a rare cause of spinal cord compression. We present a case and review the clinical presentation, radiological appearance, pathological aspects and treatment of this distinct clinico-pathological entity.Methods:A case of a 46-year-old woman with a five-month history of progressive myelopathy affecting her lower extremities is presented. CT and MRI revealed a large epidural fat-containing mass compressing the spinal cord dorsally at the T7-T8 level. A laminectomy was performed with gross total resection of the lesion.Results:The patient's neurologic symptoms improved postoperatively. A two-year follow-up period has revealed no signs of tumor recurrence and no neurological deficit.Conclusion:The diagnosis of spinal angiolipoma should be considered in the differential diagnosis of spinal cord compression. Magnetic resonance imaging is the investigation of choice. The surgical objective is complete excision but, for anterior lesions involving bone, an overly aggressive approach should be tempered by an awareness of the overall indolent natural history of so-called "infiltrating" spinal angiolipomas that are only partially excised.

Spinal Cord Compression from a Thoracic Paraganglioma: Case Report

Neurosurgery ◽  
1991 ◽  
Vol 28 (2) ◽  
pp. 306-309 ◽  
Author(s):  
George R. Cybulski ◽  
Eduardo Nijensohn ◽  
Betty A. Brody ◽  
Paul R. Meyer ◽  
Bruce Cohen
Keyword(s):  
Spinal Cord ◽  
Spinous Process ◽  
Vascular Tumor ◽  
Cord Compression ◽  
Subtotal Resection ◽  
Recent Onset ◽  
Computed Tomographic ◽  
Second Stage ◽  
History Of ◽  
Probable Origin

Abstract A 34-year-old man with a 4-month history of midthoracic back pain sought treatment for a recent onset of lower extremity paresthesia and stiffness. A myelogram and computed tomographic myelogram disclosed an extradural block at the level of the 8th thoracic vertebral body with involvement of the pedicles, lamina, and spinous process. A posterior decompression of the spinal cord with subtotal resection of a highly vascular tumor was performed. The tumor was identified as a paraganglioma. In a second stage, the remainder of the tumor was embolized preoperatively, and gross total excision and sequential stabilization of the spine with a Luque rectangle and sublaminar wires were performed. The patient has been symptom free and without signs of a recurrence in the spine for over 13 months. A large abdominal paraganglioma was recently resected from its probable origin from the adventitia of the abdominal aorta.

scholarly journals Spinal cord compression secondary to metastasis of malignant chondroid syringoma: case report

2015 ◽  
Vol 22 (3) ◽  
pp. 310-313 ◽  
Author(s):  
Ricardo H. Menéndez ◽  
Santiago G. Erice ◽  
Carlos A. Bas ◽  
Gabriel Casas ◽  
Horacio S. Dillon
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Progression Free Survival ◽  
Cord Compression ◽  
Chondroid Syringoma ◽  
History Of ◽  
Epidural Metastasis ◽  
Histological Results

The authors describe a case of spinal cord compression due to an epidural metastasis of malignant chondroid syringoma. Chondroid syringoma is a rare mixed tumor of the skin composed of both epithelial and mesenchymal elements. Although most are benign, malignant forms have been reported. Malignant chondroid syringoma may progress very slowly and the metastatic spread occurs late, appearing years after the original diagnosis. There is only one other report of spinal cord compression secondary to metastasis of malignant chondroid syringoma, which was finally diagnosed by microscopic examination of an autopsy specimen. This 63-year-old woman presented with a 4-week history of progressive paraparesis. Admission MRI of the thoracic spine showed an extradural mass arising from the posterior elements and left pedicle of T-9, which caused posterior compression of the spinal cord. Surgical decompression resulted in resolution of the neurological impairments. The histological results were consistent with metastasis of malignant chondroid syringoma. The patient underwent adjuvant radiotherapy and a favorable outcome was noted at the 2-year follow-up visit. This represents the first reported case of spinal cord compression from a metastasis of a malignant chondroid syringoma histologically confirmed in vivo. The authors' experience in this case suggests that resection followed by radiotherapy might be an acceptable means for achieving short-term, progression-free survival.

Primary Intracranial Melanocytic Tumor Simulating Pituitary Macroadenoma: Case Report and Review of the Literature

Neurosurgery ◽  
2005 ◽  
Vol 57 (2) ◽  
pp. E369-E369 ◽  
Author(s):  
Audrey Rousseau ◽  
Michèle Bernier ◽  
Michèle Kujas ◽  
Pascale Varlet
Keyword(s):  
Clinical Presentation ◽  
Careful Consideration ◽  
Caucasian Woman ◽  
Subtotal Resection ◽  
Pituitary Macroadenoma ◽  
Melanocytic Tumors ◽  
Melanocytic Tumor ◽  
S 100 ◽  
History Of

ABSTRACT OBJECTIVE AND IMPORTANCE: Primary intracranial melanocytic tumors are rare lesions, sellar ones being even more exceptional. So far, six melanomas and two melanocytomas have been described in an intrasellar and/or suprasellar location. CLINICAL PRESENTATION: We report on the case of a 25-year-old Caucasian woman presenting with a 4-year history of amenorrhea and an intrasellar mass with suprasellar extension suggestive of a pituitary macroadenoma. INTERVENTION: A gross subtotal resection of a hemorrhagic tumor was performed. Histological examination revealed melanin-laden pleomorphic tumor cells that tested positive for HMB-45 and S-100 and negative for cytokeratins, thus demonstrating that the tumor was a melanocytic neoplasm. An extensive workup failed to find evidence of any other primary site. The patient received no further treatment and is alive and well after 24 months of follow-up. CONCLUSION: Primary sellar melanocytic neoplasms are extremely rare lesions and present with few differential diagnoses. Deciding whether the tumor is best classified as a melanocytoma or a melanoma may prove difficult. Wide histological variations in both melanocytomas and melanomas render careful consideration of the clinical, radiological, and gross features essential in distinguishing one from the other.

Intradural Extramedullary Surgical Lysis of an Arachnoid Web of the Spine: 2-Dimensional Operative Video

2019 ◽  
Author(s):  
Ibrahim Hussain ◽  
Peyton L Nisson ◽  
Samuel Kim ◽  
Ali A Baaj
Keyword(s):  
Spinal Cord ◽  
Cord Compression ◽  
Preoperative Imaging ◽  
Rapid Improvement ◽  
Left Lower Extremity ◽  
History Of ◽  
Intradural Extramedullary ◽  
Computed Topography ◽  
Neurologically Intact

Abstract Arachnoid web of the spine (AWS) is a rare and subtle lesion that can have severe neurological consequences. Patients typically present with progressive myelopathic symptoms and have no more than a slight indentation of spinal cord on imaging, commonly referred to as the “scalpel sign.” A unique feature associated with this lesion is the extent of (and sometimes the rapidity of) the recovery that occurs following treatment. In this operative video, we highlight the treatment of a 32-yr-old male with a history of lumbar spondylosis, who, over a 2 wk period, developed progressive spasticity and weakness of the entire left lower extremity and left foot numbness. Magnetic resonance imaging revealed a T4-T5 “scalpel sign” and spinal cord compression on computed topography myelogram, which was subsequently taken to the operating theater. The major steps in this video include the following: A) a summary of the patient's presentation and preoperative imaging, B) the technical steps in the surgical lysis of the AWS, and C) his postoperative course. The patient tolerated the procedure well, demonstrating a rapid improvement in symptoms postoperative day 1. At the time of most recent follow-up (4 mo), the patient remains neurologically intact with a full return to his neurologic baseline. Surgical lysis of AWS demonstrated to be a curative procedure with rapid neurological recovery, showing no signs of recurrence or regression. Consent was given by the patient for the use of deidentified images and the intraoperative video for educational purposes at the time consent was obtained for the surgical procedure, in accordance with our institution's policy.

scholarly journals When less is more: a daring conservative approach to postpneumonectomy oesophago-pleural fistula

2019 ◽  
Vol 30 (1) ◽  
pp. 146-148
Author(s):  
Lara Girelli ◽  
Elena Prisciandaro ◽  
Niccolò Filippi ◽  
Lorenzo Spaggiari
Keyword(s):  
Clinical Presentation ◽  
Clinical Status ◽  
High Morbidity ◽  
Conservative Approach ◽  
Chronic Fistula ◽  
Less Is More ◽  
Primary Surgery ◽  
History Of ◽  
Uncommon Complication

Abstract Oesophago-pleural fistula is an uncommon complication after pneumonectomy, usually related to high morbidity and mortality. Due to its rarity and heterogeneous clinical presentation, its diagnosis and management are challenging issues. Here, we report the case of a patient with a history of pneumonectomy for a tracheal tumour, who developed an asymptomatic oesophago-pleural fistula 7 years after primary surgery. In consideration of the patient’s good clinical status and after verifying the preservation of respiratory and digestive functions, a bold conservative approach was adopted. Five-year follow-up computed tomography did not disclose any sign of recurrence of disease and showed a stable, chronic fistula.

scholarly journals Utilization of laser interstitial thermotherapy guided by real-time thermal MRI as an alternative to separation surgery in the management of spinal metastasis

2015 ◽  
Vol 23 (4) ◽  
pp. 400-411 ◽  
Author(s):  
Claudio E. Tatsui ◽  
R. Jason Stafford ◽  
Jing Li ◽  
Jonathan N. Sellin ◽  
Behrang Amini ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Real Time ◽  
Spinal Cord Compression ◽  
Spinal Metastasis ◽  
Cord Compression ◽  
The Mean ◽  
Interstitial Thermotherapy

OBJECT High-grade malignant spinal cord compression is commonly managed with a combination of surgery aimed at removing the epidural tumor, followed by spinal stereotactic radiosurgery (SSRS) aimed at local tumor control. The authors here introduce the use of spinal laser interstitial thermotherapy (SLITT) as an alternative to surgery prior to SSRS. METHODS Patients with a high degree of epidural malignant compression due to radioresistant tumors were selected for study. Visual analog scale (VAS) scores for pain and quality of life were obtained before and within 30 and 60 days after treatment. A laser probe was percutaneously placed in the epidural space. Real-time thermal MRI was used to monitor tissue damage in the region of interest. All patients received postoperative SSRS. The maximum thickness of the epidural tumor was measured, and the degree of epidural spinal cord compression (ESCC) was scored in pre- and postprocedure MRI. RESULTS In the 11 patients eligible for study, the mean VAS score for pain decreased from 6.18 in the preoperative period to 4.27 within 30 days and 2.8 within 60 days after the procedure. A similar VAS interrogating the percentage of quality of life demonstrated improvement from 60% preoperatively to 70% within both 30 and 60 days after treatment. Imaging follow-up 2 months after the procedure demonstrated a significant reduction in the mean thickness of the epidural tumor from 8.82 mm (95% CI 7.38–10.25) before treatment to 6.36 mm (95% CI 4.65–8.07) after SLITT and SSRS (p = 0.0001). The median preoperative ESCC Grade 2 was scored as 4, which was significantly higher than the score of 2 for Grade 1b (p = 0.04) on imaging follow-up 2 months after the procedure. CONCLUTIONS The authors present the first report on an innovative minimally invasive alternative to surgery in the management of spinal metastasis. In their early experience, SLITT has provided local control with low morbidity and improvement in both pain and the quality of life of patients.

Pott Disease in a 13-Month-Old: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 68 (5) ◽  
pp. E1485-E1490 ◽  
Author(s):  
Giac Consigilieri ◽  
Udaya K. Kakarla ◽  
Nicholas Theodore
Keyword(s):  
Clinical Presentation ◽  
Posterior Instrumentation ◽  
The United States ◽  
Cord Compression ◽  
Common Disease ◽  
Unique Challenge ◽  
Very Young Children ◽  
Anterior Tibial ◽  
Steinmann Pin

Abstract BACKGROUND AND IMPORTANCE: Tuberculosis (TB) is a common disease worldwide that is caused by Mycobacterium tuberculosis. TB of the spine is the most common site of bony infection and is often referred to as Pott disease. To the best of our knowledge, our case represents the youngest patient with naturally acquired Pott disease in the United States. CLINICAL PRESENTATION: A 13-month-old boy presented with paraplegia and a known diagnosis of TB. His evaluation revealed a kyphotic gibbus deformity in the midthoracic region associated with severe spinal cord compression. The patient underwent urgent decompressive laminectomies, T2-T4 transpedicular corpectomies, placement of an anterior tibial strut graft, and posterior instrumentation with sublaminar wires and a Steinmann pin. At his 18-month follow-up, the patient was ambulating 5 steps at a time independently, and his kyphotic deformity showed no sign of progression. CONCLUSION: Pott disease can occur in very young children and presents a unique challenge when a patient presents with a neurological deficit and unstable deformity requiring surgical intervention.

scholarly journals Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3244
Author(s):  
Jenny Pettersson-Segerlind ◽  
Alexander Fletcher-Sandersjöö ◽  
Charles Tatter ◽  
Gustav Burström ◽  
Oscar Persson ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Magnetic Resonance Images ◽  
Motor Deficit ◽  
Tumor Control ◽  
Time To Surgery ◽  
Spinal Meningiomas

Spinal meningiomas are the most common adult primary spinal tumor, constituting 24–45% of spinal intradural tumors and 2% of all meningiomas. The aim of this study was to assess postoperative complications, long-term outcomes, predictors of functional improvement and differences between elderly (≥70 years) and non-elderly (18–69 years) patients surgically treated for spinal meningiomas. Variables were retrospectively collected from patient charts and magnetic resonance images. Baseline comparisons, paired testing and regression analyses were used. In conclusion, 129 patients were included, with a median follow-up time of 8.2 years. Motor deficit was the most common presenting symptom (66%). The median time between diagnosis and surgery was 1.3 months. A postoperative complication occurred in 10 (7.8%) and tumor growth or recurrence in 6 (4.7%) patients. Surgery was associated with significant improvement of motor and sensory deficit, gait disturbance, bladder dysfunction and pain. Time to surgery, tumor area and the degree of spinal cord compression significantly predicted postoperative improvement in a modified McCormick scale (mMCs) in the univariable regression analysis, and spinal cord compression showed independent risk association in multivariable analysis. There was no difference in improvement, complications or tumor control between elderly and non-elderly patients. We concluded that surgery of spinal meningiomas was associated with significant long-term neurological improvement, which could be predicted by time to surgery, tumor size and spinal cord compression.

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