MR imaging of ventriculus terminalis of the conus medullaris: A report of two operated patients and review of the literature

2003 ◽  
Vol 44 (4) ◽  
pp. 444-446
Author(s):  
R. Dullerud ◽  
A. Server ◽  
J. Berg-Johnsen
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Signal Intensity ◽  
Incidental Finding ◽  
Conus Medullaris ◽  
Review Of The Literature ◽  
Per Se ◽  
Specific Symptoms ◽  
Work Up

We report on 2 patients in whom a cystic dilation of the conus medullaris was incidentally found at MR imaging carried out in the work-up for sciatica. The cysts were well circumscribed and had signal intensity identical to the CSF on both T1- and T2-weighted images. There was no evidence of contrast enhancement. None of the patients had specific symptoms related to the spinal cord. At surgery, no evidence of malignancy was seen in any of the patients. A benign cystic dilation, also called dilated ventriculus terminalis, occasionally can be seen in the conus medullaris as an incidental finding at thoracolumbar MR imaging. Unless the expansion per se indicates cyst drainage, these patients may be monitored by clinical and MR follow-up, avoiding surgery in a substantial number of cases.

Multisession CyberKnife Radiosurgery for Intramedullary Spinal Cord Arteriovenous Malformations

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1081-1089 ◽  
Author(s):  
John Sinclair ◽  
Steven D. Chang ◽  
Iris C. Gibbs ◽  
John R. Adler
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Arteriovenous Malformations ◽  
Conus Medullaris ◽  
Spinal Angiography ◽  
Resonance Imaging ◽  
Intramedullary Spinal Cord ◽  
Cyberknife Radiosurgery

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.

scholarly journals Intramedullary spinal cysticercosis simulating a conus medullaris tumor: case report

2006 ◽  
Vol 64 (1) ◽  
pp. 149-152 ◽  
Author(s):  
José Fernando Guedes-Corrêa ◽  
Ricardo Caratta Macedo ◽  
Rafael Pereira Vaitsman ◽  
Jorge Gomes de Mattos ◽  
Jovita Marques Agra
Keyword(s):  
Spinal Cord ◽  
Daily Living ◽  
Conus Medullaris ◽  
Acute Onset ◽  
Pathological Examination ◽  
Low Back ◽  
The Central Nervous System ◽  
Intradural Extramedullary ◽  
Magnetic Resonance Imaging Mri

Cysticercosis is an endemic condition in many developing countries. Although it is the most common parasitic disease of the central nervous system, cysticercal involvement of the spinal cord is rare. It may occur as intradural extramedullary, intramedullary, intramedullary associated with intradural-extramedullary or as the vertebral presentation. We report the case of a 53-year-old woman who presented with low back pain of acute onset and no other symptoms. Magnetic resonance imaging (MRI) showed an intramedullary cyst of the conus medullaris region which, at pathological examination, was diagnosed as a cysticercal cyst. She refused anticysticercal agents and steroids postoperatively. After an eight-year follow-up, the patient performs the activities of her daily living with no difficulties, and annual spinal MRIs show no residual signs of the disease. Clinical, pathofisiological, diagnostic and therapeutic aspects of spinal cord intramedullary cysticercosis are discussed.

Management of incidental lumboiliac hernia during spinal cord stimulator implant: a case report

2019 ◽  
Vol 44 (11) ◽  
pp. 1033-1034
Author(s):  
David Hao ◽  
Charles Odonkor ◽  
Shane Volney ◽  
Mihir Kamdar ◽  
Shihab Ahmed
Keyword(s):  
Spinal Cord ◽  
Pulse Generator ◽  
Incidental Finding ◽  
Correct Diagnosis ◽  
Synthetic Mesh ◽  
Lumbar Hernia ◽  
Spinal Cord Stimulator ◽  
Operative Repair ◽  
Lumbar Triangle

Lumboiliac or lumbar hernia is a rare defect in the posterolateral abdominal wall that may be inadvertently misidentified and interfere with the implantable pulse generator (IPG) portion of spinal cord stimulator (SCS) implants. We report the case of a 54-year-old Caucasian man with an incidental finding of a lumboiliac hernia in the inferior lumbar triangle of Petit with placement of an IPG in a SCS implant. With the assistance of surgical colleagues, the correct diagnosis was made intraoperatively. We describe the operative repair of the lumboiliac hernia with a synthetic mesh. A new IPG pocket was created above the mesh prior to proceeding with IPG placement. No recurrence of the hernia defect was observed on 2-month follow-up. It is important that pain physicians and neurosurgeons who perform SCS implants are aware of lumboiliac hernias to avoid potential diagnostic or management errors. Lumboiliac hernias should be included on the differential diagnosis of lumbar or flank masses. Confirmation with imaging may be necessary and definitive surgical treatment should be pursued.

Intramedullary ependymoma of the spinal cord

1990 ◽  
Vol 72 (4) ◽  
pp. 523-532 ◽  
Author(s):  
Paul C. McCormick ◽  
Roland Torres ◽  
Kalmon D. Post ◽  
Bennett M. Stein
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Tumor Recurrence ◽  
Neurological Deficits ◽  
Functional Improvement ◽  
Consecutive Series ◽  
Intramedullary Spinal Cord ◽  
Content Type ◽  
Fine Print

✓ A consecutive series of 23 patients underwent operative removal of an intramedullary spinal cord ependymoma between January, 1976, and September, 1988. Thirteen women and 10 men between the age of 19 and 70 years experienced symptoms for a mean of 34 months preceding initial diagnosis. Eight patients had undergone treatment prior to tumor recurrence and referral. Mild neurological deficits were present in 22 patients on initial examination. The location of the tumors was predominantly cervical or cervicothoracic. Radiological evaluation revealed a wide spinal cord in all cases. Magnetic resonance (MR) imaging was the single most important radiological procedure. At operation, a complete removal was achieved in all patients. No patient received postoperative radiation therapy. Histological examination revealed a benign ependymoma in all cases. The follow-up period ranged from 6 to 159 months (mean 62 months) with seven patients followed for a minimum of 10 years after surgery. Fourteen patients underwent postoperative MR imaging at intervals ranging from 8 months to 10 years postoperatively. No patient has been lost to follow-up review and there were no deaths. No patient showed definite clinical or radiological evidence of tumor recurrence during the follow-up period. Recent neurological evaluation revealed functional improvement from initial preoperative clinical status in eight patients, no significant change in 12 patients, and deterioration in three patients. The data support the belief that long-term disease-free control of intramedullary spinal ependymomas with acceptable morbidity may be achieved utilizing microsurgical removal alone.

scholarly journals Intramedullary Spinal Capillary Hemangioma: Case Report

2015 ◽  
Vol 36 (02) ◽  
pp. 125-127
Author(s):  
Leonardo Welling ◽  
Mariana Welling ◽  
Eberval Figueiredo
Keyword(s):  
Spinal Cord ◽  
Complete Removal ◽  
Conus Medullaris ◽  
Capillary Hemangioma ◽  
The Body ◽  
Accurate Information ◽  
Histopathological Diagnosis ◽  
Intramedullary Lesion ◽  
History Of

AbstractCapillary hemangiomas involving the neuraxis are very uncommon. In the spinal cord, they are located mainly intradural and extramedullary. To our knowledge, only four cases in conus medullaris have been previously described. In our case, a 46-year-old man was admitted with back pain, sphincter disturbances, as well as progressive weakness and numbness on the lower extremities. Magnetic resonance imaging revealed an undefined intramedullary lesion on the conus medullaris. The patient underwent microsurgery, which achieved complete removal. Histopathological diagnosis was compatible with capillary hemangioma. His postoperative course was uneventful and all symptoms, including bladder dysfunction clearly regressed. The treatment of intramedullary capillary hemangiomas is very critical in preventing unnecessary morbidity, providing accurate information with respect to prognosis, and establishes a regular outpatient follow-up. The natural history of this lesion involving the spinal cord is not well described, although they are common elsewhere in the body.

Prospective cohort study of mild cervical spondylotic myelopathy without surgical treatment

2012 ◽  
Vol 16 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Masatoshi Sumi ◽  
Hiroshi Miyamoto ◽  
Teppei Suzuki ◽  
Shuichi Kaneyama ◽  
Takako Kanatani ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Mr Imaging ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Rank Test ◽  
Imaging Findings ◽  
Significant Difference ◽  
The Mean

Object Because the main pathology of cervical spondylotic myelopathy (CSM) is spinal cord damage due to compression, surgical treatment is usually recommended to improve patient symptoms and prevent exacerbation. However, lack of clarity of prognosis in cases that present with insignificant symptoms, particularly those of mild CSM, lead one to question the veracity of this course of action. The purpose of this study was to elucidate the prognosis of mild CSM without surgical intervention by evaluation of clinical symptoms and MR imaging findings. Methods Sixty cases of mild CSM (42 males and 18 females, average age 57.2 years) presenting with scores of 13 or higher on the Japanese Orthopaedic Association (JOA) scale were treated initially by in-bed Good Samaritan cervical traction without surgery. These patients were enrolled between 1995 and 2003 and followed up periodically until the date of myelopathy deterioration or until the end of March 2009. The deterioration of myelopathy was defined as a decline in JOA score to less than 13 with a decrease of at least 2 points. As a prognostic factor, the authors used their classification of spinal cord shapes at their lateral sides on axial T1-weighted MR imaging. “Ovoid deformity” was classified as a situation in which both sides were round and convex, and “angular-edged deformity” where one or both sides exhibited an acute-angled lateral corner. The duration of follow-up was assessed as the tolerance rate of mild CSM using Kaplan-Meier survival analysis and compared between 2 groups classified by MR imaging findings. Furthermore, differences between groups were analyzed by various applications of the log-rank test. Results Of the initial 60 cases, follow-up records existed for 55, giving a follow-up rate of 91.7% (38 males and 17 females, average age 56.1 years). The mean JOA score at end point was 14.1, which was not statistically different from the mean of 14.5 at the initial visit. Deterioration in myelopathy was observed in 14 (25.5%) of 55 cases, whereas 41 (74.5%) of 55 cases maintained mild extent myelopathy without deterioration through the follow-up period (mean 94.3 months). The total tolerance rate of mild CSM was 70%. However, there was a significant difference in the tolerance rate between the cases with angular-edged deformity (58%) and cases with ovoid deformity (95%; p = 0.049). Conclusions The tolerance rate of mild CSM was 70% in this study, which proved that the prognosis of mild CSM without surgical treatment was relatively good. However, the tolerance rate of the cases with angular-edged deformity was 58%. Therefore, surgical treatment should be considered when mild CSM cases show angular-edged deformity on axial MR imaging, even if patients lack significant symptoms.

Subcutaneous and Intramuscular Injection of Petrol (Hydrocarbon): A Case Report and Review of the Literature

2018 ◽  
Vol 23 (01) ◽  
pp. 149-152
Author(s):  
Evelyn Patricia Murphy ◽  
Deirdre Seoighe ◽  
Suzanne Beecher ◽  
Joseph F. Baker ◽  
Alan Hussey
Keyword(s):  
Case Report ◽  
Intramuscular Injection ◽  
Review Of The Literature ◽  
Hand Therapy ◽  
Long Term Outcomes ◽  
Anterior Compartment ◽  
Self Harm ◽  
Work Up

Deliberate injection of hydrocarbon remains an uncommon method of self harm. There is a paucity of information pertaining to soft tissue toxicity throughout the literature. Prompt recognition of the potential ramifications is needed to try salvage limb function. Hydrocarbon toxicity can result in multi organ failure. This case report demonstrates the recommended diagnostic approach, work up and treatment involved in such a case. A 26 year old male deliberately injected petrol into the anterior compartment of his non dominant forearm in a suicide attempt. Multidisciplinary involvement from surgeons, psychiatrists and hand therapists was needed to maximize functional outcome. He avoided systemic toxicity but required an urgent fasciotomy. He required significant follow up with hand therapy to regain usage of the limb. However his long term outcomes were poor with a power grading 3/5 in the anterior compartment muscles.

Prevalence and natural history of arachnoid cysts in children

2010 ◽  
Vol 5 (6) ◽  
pp. 578-585 ◽  
Author(s):  
Wajd N. Al-Holou ◽  
Andrew Y. Yew ◽  
Zackary E. Boomsaad ◽  
Hugh J. L. Garton ◽  
Karin M. Muraszko ◽  
...  
Keyword(s):  
Natural History ◽  
Mr Imaging ◽  
Incidental Finding ◽  
Arachnoid Cysts ◽  
Consecutive Series ◽  
Imaging Characteristics ◽  
History Analysis ◽  
History Of ◽  
Over Time

Object Arachnoid cysts are a frequent finding on intracranial imaging in children. The prevalence and natural history of these cysts are not well defined. The authors studied a large consecutive series of children undergoing MR imaging to better define both the MR imaging–demonstrated prevalence and behavior of these lesions over time. Methods The authors reviewed a consecutive series of 11,738 patients who were 18 years of age or younger and had undergone brain MR imaging at a single institution during an 11-year period. In the patients in whom intracranial arachnoid cysts were identified, clinical and demographic information was recorded and imaging characteristics, such as cyst size and location, were evaluated. Prevalence data were analyzed using univariate and multivariate logistic regression, linear regression, and ANOVA. All patients with sufficient data (repeat MR imaging studies as well as repeated clinical evaluation over at least 5 months) for a natural history analysis were identified. This group was assessed for any change in symptoms or imaging appearance during the follow-up interval. Results Three hundred nine arachnoid cysts (2.6% prevalence rate) were identified. There was an increased prevalence of arachnoid cysts in males (p < 0.000001). One hundred eleven patients met all criteria for inclusion in the natural history analysis. After a mean follow-up of 3.5 years, 11 arachnoid cysts increased in size, 13 decreased, and 87 remained stable. A younger age at presentation was significantly associated with cyst enlargement (p = 0.001) and the need for surgery (p = 0.05). No patient older than 4 years of age at the time of initial diagnosis had cyst enlargement, demonstrated new symptoms, or underwent surgical treatment. Conclusions Arachnoid cysts are a common incidental finding on intracranial imaging in pediatric patients. An older age at the time of presentation is associated with a lack of clinical or imaging changes over time.

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