Magnetic Resonance Imaging of Intramedullary Spinal Cord Lesions: A Pictorial Review

Abstract OBJECTIVE: Intramedullary spinal cord arteriovenous malformations (AVMs) have an unfavorable natural history that characteristically involves myelopathy secondary to progressive ischemia and/or recurrent hemorrhage. Although some lesions can be managed successfully with embolization and surgery, AVM size, location, and angioarchitecture precludes treatment in many circumstances. Given the poor outlook for such patients, and building on the successful experience with radiosurgical ablation of cerebral AVMs, our group at Stanford University has used CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) to treat selected spinal cord AVMs since 1997. In this article, we retrospectively analyze our preliminary experience with this technique. METHODS: Fifteen patients with intramedullary spinal cord AVMs (nine cervical, three thoracic, and three conus medullaris) were treated by image-guided SRS between 1997 and 2005. SRS was delivered in two to five sessions with an average marginal dose of 20.5 Gy. The biologically effective dose used in individual patients was escalated gradually over the course of this study. Clinical and magnetic resonance imaging follow-up were carried out annually, and spinal angiography was repeated at 3 years. RESULTS: After a mean follow-up period of 27.9 months (range, 3–59 mo), six of the seven patients who were more than 3 years from SRS had significant reductions in AVM volumes on interim magnetic resonance imaging examinations. In four of the five patients who underwent postoperative spinal angiography, persistent AVM was confirmed, albeit reduced in size. One patient demonstrated complete angiographic obliteration of a conus medullaris AVM 26 months after radiosurgery. There was no evidence of further hemorrhage after CyberKnife treatment or neurological deterioration attributable to SRS. CONCLUSION: This description of CyberKnife radiosurgical ablation demonstrates its feasibility and apparent safety for selected intramedullary spinal cord AVMs. Additional experience is necessary to ascertain the optimal radiosurgical dose and ultimate efficacy of this technique.

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A Survey of 65 Tumors within the Spinal Cord: Surgical Results and the Importance of Preoperative Magnetic Resonance Imaging

Neurosurgery ◽

10.1227/00006123-199111000-00002 ◽

1991 ◽

Vol 29 (5) ◽

pp. 651-657 ◽

Cited By ~ 82

Author(s):

Jacques Brotchi ◽

Olivier Dewitte ◽

Danielle Balériaux ◽

Arlette Vandesteene ◽

Christian Raftopoulos ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Surgical Results ◽

Resonance Imaging ◽

Intramedullary Spinal Cord ◽

Cavitron Ultrasonic Surgical Aspirator ◽

Highly Sensitive ◽

Previously Treated ◽

Ultrasonic Surgical Aspirator

Abstract Between January 1984 and December 1990. 65 intramedullary spinal cord tumors were diagnosed and operated on. In this series, all patients underwent magnetic resonance imaging investigations and were operated on with the Cavitron ultrasonic surgical aspirator whenever necessary. Major surgical difficulties have been found in patients previously treated by radiotherapy with or without biopsy. We found magnetic resonance imaging to be a highly sensitive imaging procedure and the method of choice for visualizing tumors within the spinal cord. Nevertheless, accurate diagnosis may only be suggested by magnetic resonance imaging, rather than made definitively. Surgery is necessary in every case in order to obtain a definite diagnosis. Radical surgery can be performed when a plane exists between the tumor and the normal spinal cord: biopsy or debulking with the Cavitron ultrasonic surgical aspirator should be performed when the tumor is infiltrative. We have performed 33 so-called total resections, 22 partial resections, and 10 biopsies, among which 5 were performed on lipomas. Surgical results were assessed at 3 months after surgery, showing 35 improvements (53%), 24 stabilizations (37%), and 6 deteriorations (10%).

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Feasibility of a novel diagnostic chart of intramedullary spinal cord tumors in magnetic resonance imaging

Spinal Cord ◽

10.1038/sc.2014.127 ◽

2014 ◽

Vol 52 (10) ◽

pp. 769-773 ◽

Cited By ~ 13

Author(s):

H Arima ◽

T Hasegawa ◽

D Togawa ◽

Y Yamato ◽

S Kobayashi ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Resonance Imaging ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord

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Sequential Magnetic Resonance Imaging Finding of Intramedullary Spinal Cord Abscess including Diffusion Weighted Image: a Case Report

Korean Journal of Radiology ◽

10.3348/kjr.2011.12.2.241 ◽

2011 ◽

Vol 12 (2) ◽

pp. 241 ◽

Cited By ~ 5

Author(s):

Jae Eun Roh ◽

Seung Young Lee ◽

Sang-Hoon Cha ◽

Bum Sang Cho ◽

Min Hee Jeon ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Case Report ◽

Magnetic Resonance ◽

Imaging Finding ◽

Magnetic Resonance Imaging Finding ◽

Diffusion Weighted Image ◽

Resonance Imaging ◽

Intramedullary Spinal Cord ◽

Intramedullary Spinal Cord Abscess

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Spinal Cord Biopsy: A Review of 38 Cases

Neurosurgery ◽

10.1227/01.neu.0000053223.77641.5e ◽

2003 ◽

Vol 52 (4) ◽

pp. 806-816 ◽

Cited By ~ 37

Author(s):

Aaron A. Cohen-Gadol ◽

Ofer M. Zikel ◽

Gary M. Miller ◽

Allen J. Aksamit ◽

Bernd W. Scheithauer ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Preoperative Magnetic Resonance Imaging ◽

Resonance Imaging ◽

Imaging Studies ◽

Benign Lesions ◽

Spinal Cord Lesions ◽

Clinicopathological Findings ◽

Preoperative Magnetic Resonance

Abstract OBJECTIVE Neurosurgeons are frequently asked to evaluate patients for spinal cord biopsies when preoperative magnetic resonance imaging studies demonstrate nonspecific features. These lesions often appear unresectable, but surgeons must decide whether a biopsy is warranted. To determine the best approach to these cases, we evaluated the clinicopathological findings for patients with unknown spinal cord lesions who underwent spinal cord biopsies. METHODS Thirty-eight consecutive patients who underwent spinal cord biopsies at the Mayo Clinic (Rochester, MN) between August 1988 and July 1998 were studied. A detailed review of the case histories, radiological results, surgical notes, histological findings, and outcomes was performed. RESULTS Spinal cord biopsies were performed for 21 male and 17 female patients (mean age, 42.1 yr) with progressive neurological deficits related to spinal cord lesions. All patients underwent preoperative magnetic resonance imaging evaluations. High T2-weighted signal intensity and spinal cord expansion were identified in 92 and 87% of cases, respectively. After gadolinium infusion, the majority (94%) of the inflammatory lesions demonstrated patchy and often peripherally situated enhancement. This neuroradiological pattern was less common for neoplasms (50%) and benign lesions (40%). The most common pathological findings were inflammatory changes of demyelination or sarcoidosis, which together accounted for 13 cases (34%). Nonspecific changes or benign lesions were observed in 10 cases (26%). Neoplasms were identified in eight cases (21%). One case of tuberculosis and one of schistosomiasis were found. Overall, 47% of the preoperative diagnoses made by the attending surgeon were correct. For 26% of the patients, specific treatment was based on the biopsy results. The average follow-up period was 12 months (standard deviation, 14 mo; range, 0–50 mo). CONCLUSION Preoperative laboratory and imaging studies are often diagnostically inconclusive in cases of spinal cord lesions with nonspecific features. Biopsies should be considered for patients with progressive symptomatic lesions.

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