A Case of a Spinal Epidural Capillary Hemangioma: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 68 (3) ◽  
pp. E850-E853 ◽  
Author(s):  
Alya Hasan ◽  
Marie-Christine Guiot ◽  
Carlos Torres ◽  
Judith Marcoux
Keyword(s):  
Thoracic Spine ◽  
Thoracolumbar Spine ◽  
Vascular Tumor ◽  
Capillary Hemangioma ◽  
Neurological Deficits ◽  
Thoracic Epidural ◽  
Spine Pain ◽  
Appropriate Treatment ◽  
The Right ◽  
Spinal Epidural

Abstract BACKGROUND AND IMPORTANCE: Spinal hemangiomas usually arise from the vertebral body. Epidural hemangiomas are rare lesions, and most reported cases are cavernous. We report a case of a capillary hemangioma in the thoracic epidural space. CLINICAL PRESENTATION: The 57-year-old male patient initially presented with low thoracic spine pain. A magnetic resonance image of the thoracolumbar spine demonstrated an avidly enhancing epidural mass lesion in the lower thoracic spine with extension into the adjacent foramina at 2 levels on the right side. The patient developed progressive myelopathy over the course of 2.5 years despite minimal radiological changes. Surgical treatment resulted in good recovery. Histopathologically, the lesion corresponded to a vascular tumor composed of vessels of various calibers with fibrous septa between them. CONCLUSION: Early treatment of this type of lesion should be advocated to prevent deterioration and permanent neurological deficits. Appropriate treatment appears to be gross total resection.

scholarly journals Thoracic Epidural Abscesses: A Systematic Review

2018 ◽  
Vol 8 (4_suppl) ◽  
pp. 68S-84S ◽  
Author(s):  
Benjamin A. Howie ◽  
Iyooh U. Davidson ◽  
Joseph E. Tanenbaum ◽  
Markian A. Pahuta ◽  
Avery L. Buchholz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Complete Blood Count ◽  
Significant Risk ◽  
Past Research ◽  
Neurological Deficits ◽  
Thoracic Epidural ◽  
Reactive Protein ◽  
Thoracic Level ◽  
Ovid Medline ◽  
Spinal Epidural

Study Design: Systematic review. Objectives: Past research has demonstrated increased speed and severity of progression for spinal epidural abscesses (SEAs) of the thoracic level, specifically, when compared with SEAs of other spinal cord levels. Untreated, this infection can result in permanent neurological sequelae with eventual progression to death if inadequately managed. Despite the seriousness of this disease, no articles have focused on the presentation, diagnosis, and treatment of SEAs of the thoracic level. For this reason, specific focus on SEAs of the thoracic level occurred when researchers designed and implemented the following systematic review. Methods: A query of Ovid-Medline and EMBASE, Cochrane Central, and additional review sources was conducted. Search criteria focused on articles specific to thoracic epidural abscesses. Results: Twenty-five articles met inclusion criteria. The most commonly reported symptoms present on admission included back pain, paraparesis/paraplegia, fever, and loss of bowel/bladder control. Significant risk factors included diabetes, intravenous drug use, and advanced age ( P = .001). Patients were most often treated surgically with either laminectomy, hemilaminectomy, or radical decompression with debridement. Patients who presented with neurological deficits and had delayed surgical intervention following a failed antibiotic course tended to do worse compared with their immediate surgical management counterparts ( P < .005). Conclusions: For the first time researchers have focused specifically on SEAs of the thoracic level, as opposed to previously published general analysis of SEAs as a whole. Based on the results, investigators recommend early magnetic resonance imaging of the spine, laboratory workup (sedimentation rate/C-reactive protein, complete blood count), abscess culture followed by empiric antibiotics, and immediate surgical decompression when neurological deficits are present.

Giant intracranial capillary hemangioma associated with enlarged head circumference in a newborn

2008 ◽  
Vol 1 (6) ◽  
pp. 488-492 ◽  
Author(s):  
Thomas Daenekindt ◽  
Frank Weyns ◽  
Kuan Hua Kho ◽  
Dieter Peuskens ◽  
Koen Engelborghs ◽  
...  
Keyword(s):  
Recent Literature ◽  
Endovascular Embolization ◽  
Capillary Hemangioma ◽  
Neurological Deficits ◽  
Conservative Approach ◽  
Temporal Fossa ◽  
Natural Behavior ◽  
Intracranial Lesion ◽  
The Right

✓ The authors describe the case of a patient with an intracranial capillary hemangioma, and they review the recent literature on intracranial capillary hemangiomas with special attention to their differential diagnosis and management. The only sign in this 7-week-old boy was head enlargement. There were no neurological deficits, and imaging revealed a large intracranial lesion in the right temporal fossa. The results of biopsy confirmed the diagnosis, and, after endovascular embolization, the entire lesion was resected. The incidence of intracranial capillary hemangioma is very low but may be underestimated. In the present case, the size of the tumor prompted surgical treatment. The natural behavior of extracranial capillary hemangiomas, however, suggests that a conservative approach with follow-up and steroid therapy may also be considered.

Spontaneous Ventral Spinal Epidural Hematoma with Anterior Cord Syndrome

Neurosurgery ◽  
1981 ◽  
Vol 9 (4) ◽  
pp. 440-443 ◽  
Author(s):  
Timothy W. Phillips ◽  
Thomas F. Kling ◽  
John E. McGillicuddy
Keyword(s):  
Spinal Canal ◽  
Epidural Hematoma ◽  
Neurological Deficits ◽  
Posterolateral Approach ◽  
Spinal Epidural Hematoma ◽  
Disseminated Intravascular Coagulopathy ◽  
Thoracic Epidural ◽  
Intravascular Coagulopathy ◽  
Spinal Epidural

Abstract The authors report a case of spontaneous ventral thoracic epidural hematoma presenting as an anterior cord syndrome. The epidural hematoma ws evacuated through a posterolateral approach to the spinal canal. A disseminated intravascular coagulopathy appeared intraoperatively. By 3 months after operation the neurological deficits had cleared.

scholarly journals An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

2014 ◽  
Vol 37 (2) ◽  
pp. E9 ◽  
Author(s):  
Faris Shweikeh ◽  
Kashif Saeed ◽  
Laura Bukavina ◽  
Stephanie Zyck ◽  
Doniel Drazin ◽  
...  
Keyword(s):  
Literature Search ◽  
Epidural Abscess ◽  
Early Recognition ◽  
Thoracolumbar Spine ◽  
Signs And Symptoms ◽  
Neurological Deficits ◽  
Current Status ◽  
Spinal Epidural Abscess ◽  
Presenting Symptoms ◽  
Spinal Epidural

Object Over the past decade, the incidence of bacterial spinal epidural abscess (SEA) has been increasing. In recent years, studies on this condition have been rampant in the literature. The authors present an 11-year institutional experience with SEA patients. Additionally, through an analysis of the contemporary literature, they provide an update on the challenging and controversial nature of this increasingly encountered condition. Methods An electronic medical record database was used to retrospectively analyze patients admitted with SEA from January 2001 through February 2012. Presenting symptoms, concurrent conditions, microorganisms, diagnostic modalities, treatments, and outcomes were examined. For the literature search, PubMed was used as the search engine. Studies published from January 1, 2000, through December 31, 2013, were critically reviewed. Data from articles on methodology, demographics, treatments, and outcomes were recorded. Results A total of 106 patients with bacterial SEA were identified. The mean ± SD age of patients was 63.3 ± 13.7 years, and 65.1% of patients were male. Common presenting signs and symptoms were back pain (47.1%) and focal neurological deficits (47.1%). Over 75% of SEAs were in the thoracolumbar spine, and over 50% were ventral. Approximately 34% had an infectious origin. Concurrent conditions included diabetes mellitus (35.8%), vascular conditions (31.3%), and renal insufficiency/dialysis (30.2%). The most commonly isolated organism was Staphylococcus aureus (70.7%), followed by Streptococcus spp. (6.6%). Surgery along with antibiotics was the treatment for 63 (59.4%) patients. Surgery involved spinal fusion for 19 (30.2%), discectomy for 14 (22.2%), and corpectomy for 9 (14.3%). Outcomes were reported objectively; at a mean ± SD follow-up time of 8.4 ± 26 weeks (range 0–192 weeks), outcome was good for 60.7% of patients and poor for 39.3%. The literature search yielded 40 articles, and the authors discuss the result of these studies. Conclusions Bacterial SEA is an ominous condition that calls for early recognition. Neurological status at the time of presentation is a key factor in decision making and patient outcome. In recent years, surgical treatment has been advocated for patients with neurological deficits and failed response to medical therapy. Surgery should be performed immediately and before 36–72 hours from onset of neurological sequelae. However, the decision between medical or surgical intervention entails individual patient considerations including age, concurrent conditions, and objective findings. An evidence-based algorithm for diagnosis and treatment is suggested.

scholarly journals Diagnosis and Management of Spinal Epidural Abscess

1992 ◽  
Vol 19 (2) ◽  
pp. 180-187 ◽  
Author(s):  
Gary J. Redekop ◽  
Rolando F. Del Maestro
Keyword(s):  
Thoracic Spine ◽  
Epidural Abscess ◽  
Radicular Pain ◽  
Neurological Deficits ◽  
Lumbosacral Spine ◽  
Spinal Epidural Abscess ◽  
Radiological Investigation ◽  
Limb Weakness ◽  
Delay In Diagnosis ◽  
Spinal Epidural

ABSTRACT:Twenty-five patients with spinal epidural abscess were treated at the University of Western Ontario hospitals between July 1980 and July 1990. There were eighteen males (72%) and seven females (28%), with a median age of 60 years. Concurrent illness resulting in immunocompromise was present in 60%. Eleven presented with complete myelopathy, thirteen had limb weakness, and one had no neurological deficit. In twenty cases the abscess consisted of frankly purulent material, while in five the epidural collection consisted of chronic granulation tissue. Staphylococcus aureus was isolated in 64% of the abscesses. Twenty-seven surgical procedures were performed on 21 patients. Ten cases occurred in the cervical spine (40%), seven in the thoracic spine (28%), three in both the cervical and thoracic spine (12%) and five in the lumbosacral spine (20%). Fourteen patients (56%) retained or recovered ambulation and there were five deaths (20%). The progression from back and radicular pain to weakness and eventual paralysis continues to be characteristic of spinal epidural infection. Morbidity and mortality remain unacceptably high because of delay in diagnosis and treatment. Magnetic resonance imaging is the radiological investigation of choice for the diagnosis of spinal epidural abscess. Prompt intervention, before the development of severe neurological deficits, can improve outcome. Immediate surgical drainage combined with antibiotics remains the treatment of choice.

scholarly journals Gasperini Syndrome: A Case Report and Systematic Review and Proposing a New Definition

2020 ◽  
Vol 12 (3) ◽  
pp. 433-439
Author(s):  
Riwaj Bhagat ◽  
Siddharth Narayanan ◽  
Marwa Elnazeir ◽  
Thong Diep Pham ◽  
Robert Paul Friedland ◽  
...  
Keyword(s):  
Systematic Review ◽  
Brain Mri ◽  
Cranial Nerves ◽  
Clinical Manifestations ◽  
The Other ◽  
Neurological Deficits ◽  
Brainstem Stroke ◽  
Neurological Features ◽  
The Right ◽  
Core Features

Gasperini syndrome (GS), a rare brainstem syndrome, is featured by ipsilateral cranial nerves (CN) V–VIII dysfunction with contralateral hemibody hypoesthesia. While there have been 18 reported cases, the GS definition remains ambiguous. We report a new case and reviewed the clinical features of this syndrome from all published reports to propose a new definition. A 57-year-old man with acute brainstem stroke had right CN V–VIII and XII palsies, left body hypoesthesia and ataxia. Brain MRI showed an acute stroke in the right caudal pons and bilateral cerebellum. After a systematic review, we classified the clinical manifestations into core and associate features based on the frequencies of occurring neurological deficits. We propose that a definitive GS requires the presence of ipsilateral CN VI and VII palsies, plus one or more of the other three core features (ipsilateral CN V, VIII palsies and contralateral hemibody hemihypalgesia). Additionally, GS, similar to Wallenberg’s syndrome, represents a spectrum that can have other associated neurological features. The revised definition presented in this study may enlighten physicians with the immediate recognition of the syndrome and help improve clinical localization of the lesions and its management.

scholarly journals Granulomatous orchitis: case report and review of the literature

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110037
Author(s):  
Liu Liang ◽  
Wang Jiajia ◽  
Li Shoubin ◽  
Qi Yufeng ◽  
Wang Gang ◽  
...  
Keyword(s):  
Color Doppler ◽  
Radical Resection ◽  
Blood Flow Imaging ◽  
Low Intensity ◽  
Disease Characteristics ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

We report the disease characteristics, diagnosis, and treatment of granulomatous orchitis. A 38-year-old man presented with a history of intermittent swelling, pain, and discomfort in the right testicle of 3 days’ duration. Unenhanced magnetic resonance imaging (MRI) of the testis and scrotum revealed an oval mass in the right testis measuring approximately 17 mm in diameter, with clear borders and a target ring-like appearance from periphery to center. T1-weighted imaging (T1WI) showed uniform low-intensity signals, and T2WI showed mixed high- and low-intensity signals. Diffusion-weighted imaging (DWI) signals were iso-intense, and the outer ring on enhanced scans showed progressive enhancement. We performed radical resection of the right testis under combined spinal–epidural anesthesia. The pathological diagnosis was granulomatous right orchitis. Two months postoperatively, ultrasonography showed no testis and epididymal echo signals in the right scrotum, and no obvious abnormalities; color Doppler blood flow imaging (CDFI) findings were normal. Granulomatous orchitis is rare in clinical practice, and the cause is unknown. The disease involves non-specific inflammation; however, it is currently believed that antibiotics and steroids are ineffective for conservative treatment, and orchiectomy should be actively performed.

Anatomical investigation of the segmental vessels for the right-sided anterior surgical approach to the thoracic spine: a human cadaver study

2020 ◽  
Vol 42 (8) ◽  
pp. 961-968
Author(s):  
Stavros Oikonomidis ◽  
Martin Scaal ◽  
Peer Eysel ◽  
Jan Bredow ◽  
Max Joseph Scheyerer
Keyword(s):  
Thoracic Spine ◽  
Surgical Approach ◽  
Cadaver Study ◽  
Human Cadaver ◽  
The Right ◽  
Human Cadaver Study

scholarly journals Novel free-hand T1 pedicle screw method: Review of 44 consecutive cases

2014 ◽  
Vol 05 (04) ◽  
pp. 349-354 ◽  
Author(s):  
Mark A. Rivkin ◽  
Jessica F. Okun ◽  
Steven S. Yocom
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Pedicle Screws ◽  
High Rate ◽  
Imaging Modalities ◽  
Neurological Deficits ◽  
Upper Thoracic Spine ◽  
Starting Point ◽  
Grade 3 ◽  
Upper Thoracic

ABSTRACT Summary of Background Data: Multilevel posterior cervical instrumented fusions are becoming more prevalent in current practice. Biomechanical characteristics of the cervicothoracic junction may necessitate extending the construct to upper thoracic segments. However, fixation in upper thoracic spine can be technically demanding owing to transitional anatomy while suboptimal placement facilitates vascular and neurologic complications. Thoracic instrumentation methods include free-hand, fluoroscopic guidance, and CT-based image guidance. However, fluoroscopy of upper thoracic spine is challenging secondary to vertebral geometry and patient positioning, while image-guided systems present substantial financial commitment and are not readily available at most centers. Additionally, imaging modalities increase radiation exposure to the patient and surgeon while potentially lengthening surgical time. Materials and Methods: Retrospective review of 44 consecutive patients undergoing a cervicothoracic fusion by a single surgeon using the novel free-hand T1 pedicle screw technique between June 2009 and November 2012. A starting point medial and cephalad to classic entry as well as new trajectory were utilized. No imaging modalities were employed during screw insertion. Postoperative CT scans were obtained on day 1. Screw accuracy was independently evaluated according to the Heary classification. Results: In total, 87 pedicle screws placed were at T1. Grade 1 placement occurred in 72 (82.8%) screws, Grade 2 in 4 (4.6%) screws and Grade 3 in 9 (10.3%) screws. All Grade 2 and 3 breaches were <2 mm except one Grade 3 screw breaching 2-4 mm laterally. Only two screws (2.3%) were noted to be Grade 4, both breaching medially by less than 2 mm. No new neurological deficits or returns to operating room took place postoperatively. Conclusions: This modification of the traditional starting point and trajectory at T1 is safe and effective. It attenuates additional bone removal or imaging modalities while maintaining a high rate of successful screw placement compared to historical controls.

scholarly journals Rapidly Progressive Spontaneous Spinal Epidural Abscess

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Abdurrahman Aycan ◽  
Ozgür Yusuf Aktas ◽  
Feyza Karagoz Guzey ◽  
Azmi Tufan ◽  
Cihan Isler ◽  
...  
Keyword(s):  
Epidural Abscess ◽  
Delayed Diagnosis ◽  
Clinical Findings ◽  
Neurological Deficits ◽  
Spinal Epidural Abscess ◽  
Low Back ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Paraspinal Abscess ◽  
Spinal Epidural

Spinal epidural abscess (SEA) is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI) remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

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