Dumbbell C2 Schwannomas Involving Both Sensory and Motor Rootlets: Report of Two Cases

Neurosurgery ◽  
2003 ◽  
Vol 53 (2) ◽  
pp. 436-440 ◽  
Author(s):  
Kazuhiko Kyoshima ◽  
Takashi Uehara ◽  
Junichi Koyama ◽  
Koji Idomari ◽  
Shoji Yomo
Keyword(s):  
Spinal Cord ◽  
Posterior Approach ◽  
Clinical Presentation ◽  
Symptomatic Improvement ◽  
Sensory Impairment ◽  
Nerve Sheath ◽  
Shoulder Muscles ◽  
Sensory Disturbances ◽  
C2 Nerve Root ◽  
The Right

Abstract OBJECTIVE AND IMPORTANCE Intradural-extradural dumbbell C2 schwannomas are rare. This report concerns two such cases with the intradural compartment located ventral to the spinal cord and involving both sensory and motor rootlets. CLINICAL PRESENTATION One patient was a 57-year-old woman with sensory disturbances in the right extremities and hyperreflexia in the left extremities. The other patient was a 73-year-old man who presented with tetraparesis, walking disability, atrophy of the nuchal and bilateral shoulder muscles, and pain in the right C2 dermatome. INTERVENTION The extradural component of the tumor was removed first; next, the intradural component was removed successfully via the posterior approach combined with a C1–C2 laminectomy. The patients experienced symptomatic improvement without further deficits except for sensory impairment of the C2 dermatome in one of the patients. CONCLUSION Intradural-extradural dumbbell C2 schwannomas can be satisfactorily managed with a posterior approach. Removal of the extradural component and opening of the dural ring of the C2 nerve root are necessary for safe extraction of the intradural ventrally located component after debulking. These tumors may arise extradurally within the nerve sheath, extend intradurally and ventrally toward the spinal cord, and involve both sensory and motor rootlets.

Malignant Nerve Sheath Tumor of the Right Cerebral Peduncle: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 54 (2) ◽  
pp. 500-504 ◽  
Author(s):  
Patrick Beauchesne ◽  
Jean-François Mosnier ◽  
Thierry Schmitt ◽  
Jacques Brunon
Keyword(s):  
Stereotactic Biopsy ◽  
Clinical Presentation ◽  
Positive Response ◽  
Cerebral Peduncle ◽  
Nerve Sheath Tumor ◽  
Chemotherapy Treatment ◽  
Nerve Sheath Tumors ◽  
Nerve Sheath ◽  
The Right ◽  
First Time

Abstract OBJECTIVE AND IMPORTANCE Schwannomas occurring in the neuraxis are very rare. Usually, these tumors are benign. Primary malignant intracerebral nerve sheath tumors are extremely rare, with only five documented cases in the international literature. We report one case of a primary malignant intracerebral nerve sheath tumor occurring in the right cerebral peduncle of a 35-year-old man. CLINICAL PRESENTATION Magnetic resonance imaging revealed a heterogeneous peripherally enhancing mass of the right cerebral peduncle, surrounded by a small edema. INTERVENTION Unlike the five cases previously reported, this is the first time a stereotactic biopsy has been performed, and this is the only patient who responded to cranial radiation therapy for approximately 2 years. When the tumor recurred, a systemic chemotherapy treatment was prescribed. No positive response was seen, and the patient died 29 months after the initial diagnosis. CONCLUSION An accurate diagnosis and planned aggressive treatment seem to be the key elements in the management of the disease.

scholarly journals Involvement of the Spinal Cord in Mitochondrial Disorders

2018 ◽  
Vol 09 (02) ◽  
pp. 245-251 ◽  
Author(s):  
Josef Finsterer ◽  
Sinda Zarrouk-Mahjoub
Keyword(s):  
Spinal Cord ◽  
Clinical Presentation ◽  
Spinal Column ◽  
Mitochondrial Disorders ◽  
Current Status ◽  
Spinal Cord Involvement ◽  
Search Terms ◽  
Sensory Disturbances ◽  
Sensory Evoked Potentials ◽  
Sensory Evoked

ABSTRACTThis review aims at summarising and discussing the current status concerning the clinical presentation, pathogenesis, diagnosis, and treatment of spinal cord affection in mitochondrial disorders (MIDs). A literature search using the database Pubmed was carried out by application of appropriate search terms and their combinations. Involvement of the spinal cord in MIDs is more frequent than anticipated. It occurs in specific and non-specific MIDs. Among the specific MIDs it has been most frequently described in LBSL, LS, MERRF, KSS, IOSCA, MIRAS, and PCH and only rarely in MELAS, CPEO, and LHON. Clinically, spinal cord involvement manifests as monoparesis, paraparesis, quadruparesis, sensory disturbances, hypotonia, spasticity, urinary or defecation dysfunction, spinal column deformities, or as transverse syndrome. Diagnosing spinal cord involvement in MIDs requires a thoroughly taken history, clinical exam, and imaging studies. Additionally, transcranial magnetic stimulation, somato-sensory-evoked potentials, and cerebrospinal fluid can be supportive. Treatment is generally not at variance compared to the underlying MID but occasionally surgical stabilisation of the spinal column may be necessary. It is concluded that spinal cord involvement in MIDs is more frequent than anticipated but may be missed if cerebral manifestations prevail. Spinal cord involvement in MIDs may strongly determine the mobility of these patients.

NEUROLOGICAL IMPROVEMENT AFTER SURGICAL TREATMENT OF INTRADURAL SCHWANNOMA T9-10 WITH PARAPLEGIA INFERIOR — A CASE REPORT

2021 ◽  
pp. 2172002
Author(s):  
Rieva Ermawan ◽  
Denny Adriansyah
Keyword(s):  
Spinal Cord ◽  
Intraoperative Monitoring ◽  
Posterior Approach ◽  
Benign Tumor ◽  
Neurological Deficits ◽  
Nerve Sheath Tumor ◽  
Tumor Excision ◽  
Peripheral Nerve Sheath Tumor ◽  
Neurological Improvement ◽  
Nerve Sheath

Schwannoma is a peripheral nerve sheath tumor, a benign tumor that grows slowly from neural fairy cells in the nerve sheath. These tumors can cause neurological deficits because of their intradural location and suppress the spinal cord so it needs to be decompressed to prevent permanent nerve damage. We reported one case of intradural thoracal schwannoma with a neurologic deficit of paraplegia inferior. We have performed a laminectomy — posterior durotomy and tumor excision with a posterior approach without intraoperative monitoring. The result is a return of motoric and sensory improvement. The patient was satisfied with the result.

scholarly journals Cervical Intramedullary Schwannoma with Syrinx: Case Report and Review of the Literature

2017 ◽  
Vol 07 (03) ◽  
pp. 239-248
Author(s):  
Abdulaziz AlQarni ◽  
A. AlArifi ◽  
Ali Alassiri ◽  
Amjed Kouli ◽  
M. Abbas
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Lower Limbs ◽  
Nerve Sheath Tumor ◽  
Resonance Imaging ◽  
Spinal Cord Tumors ◽  
Nerve Sheath ◽  
Spindle Cells ◽  
The Right ◽  
Intramedullary Schwannoma

AbstractSchwannoma is a nerve sheath tumor originating from the Schwann cell. It is benign in nature and it arises from anywhere where Schwann cells can be found. It is rarely found in the parenchyma of the spinal cord. Intramedullary schwannomas (or neurilemmomas) without evidence of neurofibromatosis are rare spinal cord tumors. Intramedullary schwannoma was first reported in 1932 by Penfield. Our patient presented with neck pain, gradually worsening, weakness in the right upper and lower limbs, numbness in both shoulders, and a decrease in the grasping strength of both hands over a 4-year period. A magnetic resonance imaging of the spine showed a heterogeneously enhancing mass in the cervical spinal cord extending from the C2 to T1 levels with associated hemorrhagic changes. Histologically, the tumor was found to be composed of bland spindle cells with blunt-ended and sometimes wavy nuclei admixed with hyalinized vasculature. Surrounding reactive spinal cord parenchyma with frequent Rosenthal fibers was also observed. Focal Verocay bodies were evident, and with immunohistochemistry, there was diffuse and strong positivity for S100, which is confirmatory for the diagnosis of schwannoma. We report a case of cervical intramedullary schwannoma presented with syringobulbia in a young adult.

Intraoperative Use of Indocyanine Green Fluorescence Videography for Resection of a Spinal Cord Hemangioblastoma

2010 ◽  
Vol 67 (3) ◽  
pp. ons-ons ◽  
Author(s):  
Steven W. Hwang ◽  
Adel M. Malek ◽  
Robert Schapiro ◽  
Julian K. Wu
Keyword(s):  
Spinal Cord ◽  
Indocyanine Green ◽  
Clinical Presentation ◽  
Cerebral Aneurysms ◽  
Symptomatic Improvement ◽  
Resonance Imaging ◽  
Green Fluorescence ◽  
Indocyanine Green Fluorescence ◽  
Surgical Tool ◽  
Residual Lesions

Abstract BACKGROUND AND IMPORTANCE: Indocyanine green (ICG) fluorescence videography has been recently applied to the neurosurgical field, mostly in the management of cerebral aneurysms, but has had limited description in the subspecialty of spine or oncological neurosurgery. We describe a novel application of this previously defined surgical tool to assist in the resection of a residual spinal cord hemangioblastoma. CLINICAL PRESENTATION: Our patient is a 49-year-old woman with a residual symptomatic cervical hemangioblastoma that was previously embolized and resected at another institution. After initial symptomatic improvement, she returned with progressive symptoms, increasing radiographic spinal cord edema, and a residual lesion at the level of C1. We resected the remaining tumor with the adjuvant use of ICG fluorescence videography. Intraoperative injection of ICG clearly identified a component of the tumor underlying adhesive, opaque arachnoid that was not visualized by direct microscopy. Immediate postresection ICG videography suggested a complete resection was achieved which was later corroborated by postoperative magnetic resonance imaging. CONCLUSION: The adjuvant use of ICG videography is a useful surgical tool that permits greater visualization of the complete extent of the lesion, particularly in managing recurrent or residual lesions obscured by adhesions.

scholarly journals Case Report: Acute Transverse Myelitis

2021 ◽  
Vol 9 (T3) ◽  
pp. 182-185
Author(s):  
Petrus Nilwan Ginting ◽  
Kiking Ritarwan
Keyword(s):  
Spinal Cord ◽  
Motor Neuron ◽  
Transverse Myelitis ◽  
Magnetic Resonance Imaging Examination ◽  
Inflammatory Disorder ◽  
Case Presentation ◽  
Acute Transverse Myelitis ◽  
Sensory Disturbances ◽  
The Right ◽  
Whole Spine

BACKGROUND: Acute transverse myelitis (ATM) could be a pathogenetically heterogeneous inflammatory disorder affecting the spinal cord at one or more segments [1]. CASE PRESENTATION: We report a 69-year-old man presented with complaints of weakness of the arms and legs since 3 weeks before hospital admission. On physical and neurological examination was found Tetraparese, lower motor neuron in the superior limb and upper motor neuron in the inferior limb, sensory disturbances at C6-C7 levels, and autonomic impairment retention of urine and bladder dysfunction. On magnetic resonance imaging examination of the whole spine vertebra, a diffuse process was found in the spinal cord along with the cervical 7 to Th12-L1. Differential diagnosis is with transverse myelitis, multiple sclerosis, and no picture of syringomyelia. The patient was treated with steroids. Acute transverse myelitis is an inflammatory disorder of the spinal cord with various causes. CONCLUSION: Clinical examination and investigations are very important to establish the diagnosis and determine the right management so that the expected outcome is obtained.

Posterior Approach for a Ventral Intradural Extramedullary Meningioma: 2-Dimensional Operative Video

2020 ◽  
Vol 20 (1) ◽  
pp. E50-E50
Author(s):  
Elena Solli ◽  
Vincent Dodson ◽  
Fareed Jumah ◽  
Nitesh V Patel ◽  
Simon Hanft
Keyword(s):  
Spinal Cord ◽  
Posterior Approach ◽  
Complete Resection ◽  
Surgical Access ◽  
Patient Consent ◽  
Bilateral Approach ◽  
Intradural Extramedullary ◽  
Multiple Levels ◽  
The Right ◽  
Dentate Ligament

Abstract Ventral thoracic meningiomas are rare entities in which the spinal cord is attenuated and draped over the meningioma symmetrically. This is a challenging surgical entity compared to typical intradural meningiomas, which nearly always eccentrically displace the cord. In these more common meningiomas, surgical access is fairly straightforward as the meningioma is often visualized upon opening the meninges. Resection can be more safely performed with the cord largely shifted. In cases of ventral meningioma, the tumor is hidden ventral to the spinal cord, and techniques to safely mobilize the spinal cord must be utilized. We demonstrate that an entirely posterior approach allows complete resection of a ventrally situated mass. After careful identification and sectioning of the dentate ligament at multiple levels on the right side of the canal, we then suture and rotate the dentate ligament at each site, thereby allowing progressive visualization of the ventral meningioma. A narrow, but viable, working corridor to the tumor allows safe debulking. Once it is felt that the tumor can no longer be safely excised through the created corridor, we then disconnect our dentate sutures and move to the other side of the canal. Similarly, the dentate is sectioned and sutured so that the contralateral aspect of the meningioma can be visualized and debulked. The tumor can then be safely removed. A standard posterior approach and midline durotomy allows this bilateral approach to a ventrally situated meningioma and, therefore, in our mind, represents a safe and also highly effective road to resection.  Patient consent was obtained prior to publication.

Spinal Dural Arteriovenous Fistula: Diagnosis and Treatment

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Nur Setiawan Suroto
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Vascular Malformation ◽  
Dural Arteriovenous Fistula ◽  
Motor Symptoms ◽  
Elderly Men ◽  
Spinal Dural Arteriovenous Fistula ◽  
Sensory Disturbances ◽  
Av Fistulas ◽  
Low Rate

Spinal dural arteriovenous (AV) fistulas are the most commonly encountered vascular malformation of the spinal cord and a treatable cause for progressive paraplegia or tetraplegia. They most commonly affected are elderly men and are classically found in the thoracolumbar region.Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances.

CASE REPORT: SURGICAL MANAGEMENT OF LUMBAR COMPRESSION FRACTURE

2019 ◽  
Vol 1 (4) ◽  
Author(s):  
Yustinus Robby Budiman Gondowardojo ◽  
Tjokorda Gde Bagus Mahadewa
Keyword(s):  
Spinal Cord ◽  
Left Lung ◽  
Lumbar Vertebrae ◽  
Compression Fracture ◽  
High Mobility ◽  
Early Mobilization ◽  
Cord Injury ◽  
Cardiothoracic Surgeon ◽  
The Right

The lumbar vertebrae are the most common site for fracture incident because of its high mobility. The spinal cord injury usually happened as a result of a direct traumatic blow to the spine causing fractured and compressed spinal cord. A 38-year-old man presented with lumbar spine’s compression fracture at L2 level. In this patient, decompression laminectomy, stabilization, and fusion were done by posterior approach. The operation was successful, according to the X-Ray and patient’s early mobilization. Pneumothorax of the right lung and pleural effusion of the left lung occurred in this patient, so consultation was made to a cardiothoracic surgeon. Chest tube and WSD insertion were performed to treat the comorbidities. Although the patient had multiple trauma that threat a patient’s life, the management was done quickly, so the problems could be solved thus saving the patient’s life. After two months follow up, the patient could already walk and do daily activities independently.

Posterior approach for cervical intramedullary arteriovenous malformation with diffuse-type nidus

1999 ◽  
Vol 91 (1) ◽  
pp. 105-111 ◽  
Author(s):  
Kenji Ohata ◽  
Toshihiro Takami ◽  
Alaa El-Naggar ◽  
Michiharu Morino ◽  
Akimasa Nishio ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Poor Prognosis ◽  
Posterior Approach ◽  
The Other ◽  
Anterior Spinal Artery ◽  
Neural Element ◽  
Feeding Artery ◽  
Diffuse Type ◽  
Content Type ◽  
Fine Print

✓ The treatment of spinal intramedullary arteriovenous malformations (AVMs) with a diffuse-type nidus that contains a neural element poses different challenges compared with a glomus-type nidus. The surgical elimination of such lesions involves the risk of spinal cord ischemia that results from coagulation of the feeding artery that, at the same time, supplies cord parenchyma. However, based on evaluation of the risks involved in performing embolization, together with the frequent occurrence of reperfusion, which necessitates frequent reembolization, the authors consider surgery to be a one-stage solution to a disease that otherwise has a very poor prognosis. Magnetic resonance (MR) imaging revealed diffuse-type intramedullary AVMs in the cervical spinal cords of three patients who subsequently underwent surgery via the posterior approach. The AVM was supplied by the anterior spinal artery in one case and by both the anterior and posterior spinal arteries in the other two cases. In all three cases, a posterior median myelotomy was performed up to the vicinity of the anterior median fissure that divided the spinal cord together with the nidus, and the feeding artery was coagulated and severed at its origin from the anterior spinal artery. In the two cases in which the posterior spinal artery fed the AVM, the feeding artery was coagulated on the dorsal surface of the spinal cord. Neurological outcome improved in one patient and deteriorated slightly to mildly in the other two patients. Postoperative angiography demonstrated complete disappearance of the AVM in all cases. Because of the extremely poor prognosis of patients with spinal intramedullary AVMs, this surgical technique for the treatment of diffuse-type AVMs provides acceptable operative outcome. Surgical intervention should be considered when managing a patient with a diffuse-type intramedullary AVM in the cervical spinal cord.

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