Metastases to the Craniovertebral Junction

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A113-A118 ◽  
Author(s):  
Hugh D. Moulding ◽  
Mark H. Bilsky
Keyword(s):  
Cervical Spine ◽  
Surgical Techniques ◽  
Spinal Metastases ◽  
Case Series ◽  
Craniovertebral Junction ◽  
External Beam Radiation ◽  
Functional Improvement ◽  
X Rays ◽  
Beam Radiation ◽  
Flexion Extension

Abstract OBJECTIVE This study reviews the relevant literature regarding the management of craniovertebral junction (CVJ) metastases. These rare tumors present significant diagnostic and treatment challenges. METHODS A PubMed search of cervical spine, cervical spine metastasis, craniovertebral junction, atlantoaxial spine, and metastasis radiation was conducted to define the epidemiology, imaging, and treatment protocols in the management of metastatic CVJ tumors. RESULTS CVJ tumors represent less than 1% of spinal metastases, and the literature is limited to small case series. CVJ tumors present with flexion, extension, and rotational pain, often associated with occipital neuralgia. Magnetic resonance imaging is the most sensitive imaging modality for the detection of spinal metastases, but plain x-rays, computed tomography, and [18F]2-fluoro-2-deoxy-D-glucose play a role in diagnosis and management. Conventional external beam radiation therapy or stereotactic radiosurgery effectively treat the majority of patients with normal spinal alignment or minimal fracture subluxations. Surgery should be considered in patients with fracture subluxations greater than 5 mm, or 3.5 mm subluxation with 11-degree angulation. The palliative goals for surgery favor posterior approaches only including laminectomy for decompression, without the need for anterior approaches with the associated morbidity. Occipitocervical instrumentation using screw-rod systems are effective for irreducible subluxations, but posterior strategies using C1–C2 or C1–C3 can be used for patients with reducible subluxations. CONCLUSION Effective management of CVJ tumors using radiation and/or surgery results in significant pain and functional improvement in properly selected patients. Advanced surgical techniques and stereotactic radiation may improve outcomes with less morbidity.

Disparities in Patterns of Conventional Versus Stereotactic Body Radiotherapy in the Treatment of Spine Metastasis in the United States

2020 ◽  
pp. 082585972098220
Author(s):  
Ellen Kim ◽  
Shearwood McClelland ◽  
Jerry J. Jaboin ◽  
Albert Attia
Keyword(s):  
United States ◽  
Radiation Therapy ◽  
Private Insurance ◽  
Spinal Metastases ◽  
The United States ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Cancer Data ◽  
Spine Metastases ◽  
Population Type

Introduction: The improved survival of patients even with metastatic cancer has led to an increase in the incidence of spine metastases, suggesting the need for a more aggressive palliative treatment than conventional external beam radiation therapy (cEBRT). Consequently, spinal stereotactic body radiation therapy (SBRT) has increased in popularity over the past decade. However, there has been no comparison of patterns of usage of cEBRT versus SBRT in the treatment of spinal metastases in the US. Methods: The National Cancer Data Base (NCDB) from 2004-2013 was used for analysis. cEBRT was defined as 30 Gy in 10 fractions, 20 Gy in 5 fractions, or 8 Gy in 1 fraction. SBRT was defined as 25-32 Gy infive5 fractions, 24-32 Gy in 4 fractions, 20-32 Gy in three fractions, 14-32 Gy in 2 fractions, or 14-24 Gy in 1 fraction. Single and multivariable associations between patient demographic and cancer characteristics and type of radiation were performed. Results: From 2004-2013, 23,181 patients with spinal metastases in the United States received cEBRT, while 1,030 received SBRT as part of their first course of treatment. Most patients (88%) received 10 fractions of radiation. Multivariable analysis suggested that non-Medicare or private insurance (adjusted OR 0.4-0.7), African-American race (adjusted OR = 0.8, 95%CI = 0.7-1.0), age 65+ (adjusted OR = 0.8), living in a region with lower population (adjusted OR 0.7), earlier year of diagnosis (OR = 0.9), and receiving treatment in a non-academic/research facility (adjusted OR 0.6) were associated with cEBRT. After controlling for other variables, regional education level was no longer significantly associated with cEBRT. Conclusions: Most patients with spine metastases were treated with cEBRT, usually with 10 fractions. Receipt of SBRT was significantly associated with race, insurance, geography, population, type of treatment facility, and year of diagnosis, even after controlling for other factors. These findings raise questions about disparities in access to and delivery of care that deserve further investigation.

scholarly journals The application of C2 transpedicular screw, C1 laminar hook fixation and bone graft in the atlantoaxial instability

2021 ◽  
Vol 38 (2) ◽  
pp. 94-98
Author(s):  
Şükrü ORAL
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Surgical Techniques ◽  
Atlantoaxial Instability ◽  
Posterior Arch ◽  
X Rays ◽  
Advantages And Disadvantages ◽  
Transpedicular Screw ◽  
Flexion Extension ◽  
Laminar Hooks

Traumatic atlantoaxial instability usually results from a motor vehicle accident, falls and motorcycle accidents. Atlantoaxial instability can lead to spinal cord compression and neck pain, but, spasticity and radicular symptoms as well. The purpose of surgery is to remove the compression and stabilize the joint permanently. To date, several surgical techniques have been described to remedy C1-C2 instability. In this study, the clinical and radiological outcomes of patients who operated with the C1 (Atlas bone) laminar hooks fixation and bilateral C2 (Axis bone) trans-pedicular screw technique were shown. Also, the advantages and disadvantages of this technique are discussed. From March 2010 to December 2017, 12 patients who have atlantoaxial instability were surgically treated by modified fixation technique which consists C1 laminar hooks fixation and bilateral C2 transpedicular screw. Twelve patients were operated with this procedure from March 2010 to December 2017. All the patients were checked with flexion-extension x-rays at the end of the twelfth week. The posterior bony fusion formation was observed on imaging in all patients. C2 bilateral pedicle screw combined with C1 laminar hook system is a good method for atlantoaxial instability in the conditions which is not convenient for insertion of C1 lateral mass and C2 trans-articular screw. However, this method may not be available in some cases such as traumatic, infection, neoplastic or degenerative pathologies in which the posterior arch of the atlas is damaged.

scholarly journals An update in the management of spinal metastases

2015 ◽  
Vol 73 (9) ◽  
pp. 795-802 ◽  
Author(s):  
Andrei F. Joaquim ◽  
Ann Powers ◽  
Ilya Laufer ◽  
Mark H. Bilsky
Keyword(s):  
New Technologies ◽  
Systemic Disease ◽  
Spinal Metastases ◽  
Integrated Approach ◽  
External Beam Radiation ◽  
Tumor Control ◽  
Mechanical Instability ◽  
Beam Radiation ◽  
Definitive Therapy ◽  
Neurologic Function

The best clinical treatment for spinal metastases requires an integrated approach with input from an interdisciplinary cancer team. The principle goals of treatment are maintenance or improvement in neurologic function and ambulation, spinal stability, durable tumor control, and pain relief. The past decade has witnessed an explosion of new technologies that have impacted our ability to reach these goals, such as separation surgery and minimally invasive spinal procedures. The biggest advance, however, has been the evolution of stereotactic radiosurgery that has demonstrated durable tumor control both when delivered as definitive therapy and as a postoperative adjuvant even for tumors considered markedly resistant to conventional external beam radiation. In this paper, we perform an update on the management of spinal metastases demonstrating the integration of these new technologies into a decision framework NOMS that assesses four basic aspects of a patient’s spine disease: Neurologic, Oncologic, Mechanical Instability and Systemic disease.

The First Report of Extraosseous Ewing's Sarcoma in the Rectovaginal Septum

2002 ◽  
Vol 88 (4) ◽  
pp. 345-346 ◽  
Author(s):  
Marija Petković ◽  
Gordana Zamolo ◽  
Damir Muhvić ◽  
Miran Čoklo ◽  
Sanja Štifter ◽  
...  
Keyword(s):  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Malignant Neoplasm ◽  
External Beam Radiation ◽  
X Rays ◽  
Rectovaginal Septum ◽  
Beam Radiation ◽  
Palpable Mass ◽  
Residual Mass ◽  
Extraosseous Ewing’S Sarcoma

Aims and Background To report an extremely rare case of Ewing's sarcoma located in the rectovaginal septum. Ewing's sarcoma is a highly malignant neoplasm of bone, which usually occurs during childhood. Common extraosseous localizations of Ewing's sarcoma include the trunk, extremities, uterus, cervix and vagina. Methods A 45-year-old woman presented to us with a six-month history of pain in the lower abdomen during intercourse. Pelvic examination was performed and a palpable mass was found. The mass had a size of 9 × 6 cm, a soft tissue consistency, was partially movable and the patient felt the pain during palpation. Examination of the inguinal lymph nodes revealed no signs of inguinal adenopathy. The results of laboratory tests, rectoscopy, chest X-rays, barium enema and bone scan were normal. Computed tomography (CT) showed an inhomogeneous expansive mass in the rectovaginal septum measuring 8.7 × 6.1 cm, without any signs of rectum or bladder invasion. The vascular structures of the pelvis were normal. At laparotomy the process was judged inoperable and only biopsy of the tumor mass was carried out. Histology showed a neoplasm with small, round to oval cells with scarce cytoplasm. Immunohistology with the monoclonal antibody CD99 (MIC-2 gene product, Ewing's sarcoma marker, clone 12E7, DAKO A/S, Glostrup, Denmark) revealed an extraosseous Ewing's sarcoma. The patient was treated with chemotherapy followed by whole-pelvis external beam radiation and intracavitary brachytherapy. Results A residual mass measuring 3.5 × 2.5 cm was visible on a control CT scan 18 months after treatment; however, the patient was feeling well and refused surgery to remove the residual mass. Conclusions To our knowledge this is the first reported case of extraosseous Ewing's sarcoma in the rectovaginal septum.

Cervical Spine Movement Sequencing During Flexion-Extension

2011 ◽  
Author(s):  
William J. Anderst ◽  
Michelle Schafman ◽  
William F. Donaldson ◽  
Joon Y. Lee ◽  
James D. Kang
Keyword(s):  
Cervical Spine ◽  
Range Of Motion ◽  
Daily Living ◽  
X Rays ◽  
Clinical Tool ◽  
Normal Range ◽  
Kinematic Data ◽  
Flexion Extension ◽  
Functional Movements ◽  
Spine Movement

Static flexion-extension x-rays are the most common clinical tool used to assess abnormal motion of the cervical spine. Despite their widespread use (over 168,000 cases per year), the clinical efficacy of flexion-extension radiographs of the cervical spine has yet to be proven1. Limitations of static flexion-extension x-rays include data collection during static positions that may not accurately represent dynamic behavior, and the fact that data is collected at end range of motion positions, not in more frequently encountered mid-range positions. Consequently, static x-rays may not reveal movement abnormalities that occur during activities of daily living and lead to pain and degeneration. Therefore, it may be advantageous to analyze cervical spine kinematic data collected during dynamic, functional movements performed through an entire range of motion (not just the endpoints). Furthermore, the literature confirms there is substantial variability in “normal” range of motion and translation during flexion-extension1, making it difficult to reliably identify abnormal motion. Therefore, it may also be beneficial to evaluate alternative motion parameters that may reliably identify abnormal motion.

The role of radiosurgery in the management of WHO Grade II and III intracranial meningiomas

2013 ◽  
Vol 35 (6) ◽  
pp. E16 ◽  
Author(s):  
Dale Ding ◽  
Robert M. Starke ◽  
John Hantzmon ◽  
Chun-Po Yen ◽  
Brian J. Williams ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Stereotactic Radiosurgery ◽  
Case Reports ◽  
Case Series ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Who Grade ◽  
Intracranial Meningiomas ◽  
Grade Ii ◽  
Grade Iii

Object WHO Grade II and III intracranial meningiomas are uncommon, but they portend a significantly worse prognosis than their benign Grade I counterparts. The mainstay of current management is resection to obtain cytoreduction and histological tissue diagnosis. The timing and benefit of postoperative fractionated external beam radiation therapy and stereotactic radiosurgery remain controversial. The authors review the stereotactic radiosurgery outcomes for Grade II and III meningiomas. Methods A comprehensive literature search was performed using PubMed to identify all radiosurgery series reporting the treatment outcomes for Grade II and III meningiomas. Case reports and case series involving fewer than 10 patients were excluded. Results From 1998 to 2013, 19 radiosurgery series were published in which 647 Grade II and III meningiomas were treated. Median tumor volumes were 2.2–14.6 cm3. The median margin doses were 14–21 Gy, although generally the margin doses for Grade II meningiomas were 16–20 Gy and the margin doses for Grade III meningiomas were 18–22 Gy. The median 5-year PFS was 59% for Grade II tumors and 13% for Grade III tumors, which may have been affected by patient age, prior radiation therapy, tumor volume, and radiosurgical dose and timing. The median complication rate following radiosurgery was 8%. Conclusions The current data for radiosurgery suggest that it has a role in the management of residual or recurrent Grade II and III meningiomas. However, better studies are needed to fully define this role. Due to the relatively low prevalence of these tumors, it is unlikely that prospective studies will be feasible. As such, well-designed retrospective analyses may improve our understanding of the effect of radiosurgery on tumor recurrence and patient survival and the incidence and impact of treatment-induced complications.

External beam radiation for localized periocular amyloidosis: a case series

Orbit ◽  
2018 ◽  
Vol 38 (3) ◽  
pp. 210-216 ◽  
Author(s):  
Thomas S. Copperman ◽  
Minh Tam Truong ◽  
John L. Berk ◽  
Rachel K. Sobel
Keyword(s):  
Case Series ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation

Ultrasound-Guided Hyaluronic Acid Injection for the Management of Morton’s Neuroma

2017 ◽  
Vol 39 (2) ◽  
pp. 201-204 ◽  
Author(s):  
Kang Lee ◽  
Il-Yeong Hwang ◽  
Chang Hyun Ryu ◽  
Jae Woo Lee ◽  
Seung Woo Kang
Keyword(s):  
Hyaluronic Acid ◽  
Case Series ◽  
Functional Improvement ◽  
X Rays ◽  
Ultrasound Guided ◽  
Morton’S Neuroma ◽  
Level Of Evidence ◽  
Hyaluronic Acid Injection ◽  
Acid Injection ◽  
Morton's Neuroma

Background: Morton’s neuroma is one of the common causes of forefoot pain. In the present study, hyaluronic acid injection was performed on patients to determine the efficacy and adverse effects of hyaluronic acid in management of Morton’s neuroma. Methods: Eighty-three patients with Morton’s neuroma in their third intermetatarsal space with definite Mulder’s click were included in the study. Those with severe forefoot deformities such as forefoot cavus or hallux valgus on plain X-rays were excluded. Ultrasound-guided hyaluronic acid injections were performed on all patients weekly for 3 weeks. Pain during walking using visual analogue scale (VAS) and AOFAS Forefoot Scale were prospectively evaluated preinjection, and at 2, 4, 6, 12 months postinjection. Results: Significant improvement in VAS and AOFAS Forefoot Scale were seen overall at 2 months after hyaluronic acid injections ( P < .05). Then, there were almost no changes after 4 months, continuing until 12 months. The mean VAS was decreased from 73.1 initially to 23.0 at 12 months and AOFAS Forefoot Scale was increased from 32.2 to 86.5. There were no complications which occurred. Conclusion: In the present study, ultrasound-guided hyaluronic injection was clinically effective for pain relief and functional improvement for at least 12 months in patients with Morton’s neuroma. However, numbness associated with Morton’s neuroma should be addressed more cautiously since it may persist without much improvement. Level of Evidence: Level IV, retrospective case series.

DETECTION OF PEDIATRIC CERVICAL SPINE INJURY

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 700-708 ◽  
Author(s):  
Hugh J.L. Garton ◽  
Matthew R. Hammer
Keyword(s):  
Cervical Spine ◽  
Young Children ◽  
Cervical Spine Injury ◽  
Diagnostic Yield ◽  
Plain Film ◽  
Spine Injury ◽  
Lower Sensitivity ◽  
X Rays ◽  
Flexion Extension ◽  
National Emergency

Abstract OBJECTIVE In evaluating the pediatric cervical spine for injury, the use of adult protocols without sufficient sensitivity to pediatric injury patterns may lead to excessive radiation doses. Data on injury location and means of detection can inform pediatric-specific guideline development. METHODS We retrospectively identified pediatric patients with codes from the International Classification of Diseases, 9th Revision, for cervical spine injury treated between 1980 and 2000. Collected data included physical findings, radiographic means of detection, and location of injury. Sensitivity of plain x-rays and diagnostic yield from additional radiographic studies were calculated. RESULTS Of 239 patients, 190 had true injuries and adequate medical records; of these, 187 had adequate radiology records. Patients without radiographic abnormality were excluded. In 34 children younger than 8 years, National Emergency X-Radiography Utilization Study criteria missed two injuries (sensitivity, 94%), with 76% of injuries occurring from occiput–C2. In 158 children older than 8 years, National Emergency X-Radiography Utilization Study criteria identified all injured patients (sensitivity, 100%), with 25% of injuries occurring from occiput–C2. For children younger than 8 years, plain-film sensitivity was 75% and combination plain-film/occiput–C3 computed tomographic scan had a sensitivity of 94%, whereas combination plain-film and flexion-extension views had 81% sensitivity. In patients older than 8 years, the sensitivities were 93%, 97%, and 94%, respectively. CONCLUSION Younger children tend to have more rostral (occiput–C2) injuries compared with older children. The National Emergency X-Radiography Utilization Study protocol may have lower sensitivity in young children than in adults. Limited computed tomography from occiput–C3 may increase diagnostic yield appreciably in young children compared with flexion-extension views. Further prospective studies, especially of young children, are needed to develop reliable pediatric protocols.

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