scholarly journals Intramedullary clear cell ependymoma of the lower thoracic spinal cord: report of a new case

2020 ◽  
Vol 11 ◽  
pp. 423
Author(s):  
Jesus Rocha-Maguey ◽  
Jesus Salvador Velarde-Felix ◽  
Myriam Cabrera-Lopez ◽  
Jaime Moya-Nuñez ◽  
Edgar Fragosa-Sanchez
Keyword(s):  
Differential Diagnosis ◽  
Clear Cell ◽  
Case Reports ◽  
Immunohistochemical Analysis ◽  
Gross Total Resection ◽  
Neurophysiological Monitoring ◽  
Total Resection ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Immunohistochemical Techniques

Background: Clear cell ependymomas (CCEs) are a rare variant of tumors of the nervous system, the main location is the intracranial compartment. Special differential diagnosis should be done with oligodendrogliomas, neurocytoma, glioneurocytoma, astrocytoma, or metastatic renal cell carcinoma, lesions that somehow share cells with clear cytoplasm. Most of these lesions are benign but differential diagnosis is essential to decide further treatment. Few case reports of intramedullary CCEs have being published and there is no strict consensus on the diagnostic criteria. Case Description: We hereby describe a new case of an intramedullary clear CCE with very few neurological symptoms, surgical treatment is satisfactory, histological and immunohistochemical analysis was confirmatory. After gross total resection and 3-year follow-up no recurrence of the lesion is evident. Conclusion: After this case presentation and review of the limited literature, it is evident that methodical clinical suspicion, radiological imaging combined with histological, and modern immunohistochemical techniques are essential for the diagnosis. Surgical options with gross total resection remain the cornerstone of its treatment. Neurophysiological monitoring is extremely useful to avoid postoperative morbidity.

Primary Melanocytoma of the Lower Thoracic Spinal Cord: Case report and review of the literature

2019 ◽  
Vol 8 (1) ◽  
pp. 5
Author(s):  
Dimitrios Panagopoulos
Keyword(s):  
Total Resection ◽  
Thoracic Spinal Cord ◽  
Meningeal Melanocytoma ◽  
Melanocytic Tumors ◽  
Thoracic Spinal ◽  
Thoracolumbar Region ◽  
Rare Benign Tumor ◽  
Mri Scans ◽  
History Of ◽  
The Central Nervous System

Background: Meningeal melanocytoma is a rare benign tumor, most frequently located in the posterior fossa and spinal canal. Our objective is to illustrate a case of this tumor that originated in the thoracolumbar area of the spine and had an uneventful clinical course after total resection. Case description: We present the case of a 59 years old woman who presented with a medical history of ongoing neurological deterioration due to spastic paresis of the lower extremities. MRI of the thoracolumbar region identified a melanocytic melanoma as the underlying cause. Conclusions: Melanocytic tumors of the central nervous system have a typical appearance on MRI scans, varying with the content and distribution of melanin. However, the differential diagnosis between malignant melanoma and melanocytoma still depends on pathological criteria. Spinal meningeal melanocytoma has a benign course, and it is amenable for gross total resection. The outcome is favorable following complete resection.

Factors for a Good Surgical Outcome in Posterior Decompression and Dekyphotic Corrective Fusion with Instrumentation for Thoracic Ossification of the Posterior Longitudinal Ligament: Prospective Single-Center Study

2017 ◽  
Vol 13 (6) ◽  
pp. 661-669 ◽  
Author(s):  
Shiro Imagama ◽  
Kei Ando ◽  
Kazuyoshi Kobayashi ◽  
Tetsuro Hida ◽  
Kenyu Ito ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Outcomes ◽  
Ligamentum Flavum ◽  
Posterior Longitudinal Ligament ◽  
Neurophysiological Monitoring ◽  
Posterior Decompression ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Estimated Blood Loss ◽  
Significant Factors

Abstract BACKGROUND Surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL) is still challenging, and factors for good surgical outcomes are unknown. OBJECTIVE To identify factors for good surgical outcomes with prospective and comparative study. METHODS Seventy-one consecutive patients who underwent posterior decompression and instrumented fusion were divided into good or poor outcome groups based on ≥50% and <50% recovery rates for the Japanese Orthopaedic Association score. Preoperative, intraoperative, and postoperative findings were compared in the 2 groups, and significant factors for a good outcome were analyzed. RESULTS Patients with a good outcome (76%) had significantly lower nonambulatory rate and positive prone and supine position tests preoperatively; lower rates of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level, thoracic spinal cord alignment difference, and spinal canal stenosis on preoperative magnetic resonance imaging; lower estimated blood loss; higher rates of intraoperative spinal cord floating and absence of deterioration of intraoperative neurophysiological monitoring; and lower rates of postoperative complications (P < .0005). In multivariate logistic regression analysis, negative prone and supine position test (odds ratio [OR]: 17.00), preoperative ambulatory status (OR: 6.05), absence of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level (OR: 5.84), intraoperative spinal cord floating (OR: 4.98), and lower estimated blood loss (OR: 1.01) were significant factors for a good surgical outcome. CONCLUSION This study demonstrated that early surgery is recommended during these positive factors. Appropriate surgical planning based on preoperative thoracic spinal cord alignment difference, as well as sufficient spinal cord decompression and reduction of complications using intraoperative ultrasonography and intraoperative neurophysiological monitoring, may improve surgical outcomes.

Clear cell ependymoma with a lipidized component that developed in the thoracic spinal cord

2003 ◽  
Vol 25 (4) ◽  
pp. 324-328 ◽  
Author(s):  
Yeong-Jin Kim ◽  
Shigeru Tsunoda ◽  
Kazuhiro Yokoyama ◽  
Kazunori Miyamoto ◽  
Masamitsu Tamai ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Clear Cell ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Clear Cell Ependymoma

scholarly journals Rare intraspinal clear cell meningioma in children: a case report and literature review

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052095226
Author(s):  
Zheng Hao ◽  
Si Hu ◽  
Nian-Zu Yu
Keyword(s):  
Recurrence Rate ◽  
English Language ◽  
Clear Cell ◽  
Extent Of Resection ◽  
Gross Total Resection ◽  
Total Resection ◽  
Current Case ◽  
Clear Cell Meningioma ◽  
Complete Surgical Resection ◽  
Significant Difference

Meningioma of the spinal canal is very rare. Clear cell meningioma (CCM) with special histological features occurs more commonly in the spinal cord. A review of the published English-language literature identified 40 reported cases of children with intraspinal CCM and this current report presents an additional case of a 3-year-old child with confirmed lumbar CCM. The current case underwent gross total resection of the CCM. At 9 months after the operation, lumbar magnetic resonance imaging was undertaken and confirmed the absence of tumour recurrence. The child was able to walk normally again. During this period, the child did not receive adjuvant treatments such as radiotherapy and chemotherapy. An evaluation of the 41 cases demonstrated the following: (i) there was no significant difference between the recurrence rate of females and males; (ii) there was a significant difference in the recurrence rate based on the extent of resection (gross total resection versus partial resection); (iii) the recurrence rate in patients where the number of involved segments ≥3 levels was significantly higher than that in patients where the number of involved segments was 1–2 levels. For children with CCM, complete surgical resection might be an important characteristic for predicting the risk of the recurrence of CCM.

scholarly journals Acute Polyradiculomyelitis With Spinal Cord Gray Matter Lesions: A Report of Two Cases

2021 ◽  
Vol 12 ◽  
Author(s):  
Charidimos Tsagkas ◽  
Maria Janina Wendebourg ◽  
Matthias Mehling ◽  
Johannes Lorscheider ◽  
Philippe Lyrer ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Gray Matter ◽  
Case Reports ◽  
Motor Impairment ◽  
Bowel Dysfunction ◽  
Motor Deficits ◽  
Spinal Cord Lesions ◽  
Rare Presentation ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal

Objective: Inflammatory polyradiculomyelitis belongs to a rare group of immune-mediated diseases affecting both the central and peripheral nervous system. We aimed to describe an unusual presentation of acute polyradiculomyelitis with marked spinal cord lesions restricted to the gray matter.Methods: Thorough examination of two case reports including clinical, MRI, serologic, electrophysiologic and CSF examinations as well as short-term follow-up.Results: We present two adult patients with acute polyradiculomyelitis and unusual spinal cord lesions restricted to the gray matter on MRI. The clinical presentation, serologic, electrophysiologic and CSF features of the two patients varied, whereas both patients demonstrated severe, asymmetrical, predominantly distal, motor deficits of the lower extremities as well as bladder and bowel dysfunction. Both patients only partially responded to anti-inflammatory treatment. Severe motor impairment and bladder dysfunction persisted even months after symptom onset.Conclusions: To our best of knowledge, these are the first reports of acute polyradiculomyelitis with distinct involvement of the lower thoracic spinal cord gray matter. Currently, it remains unclear whether gray matter lesions reflect a separate pathophysiologic mechanism or an exceedingly rare presentation of spinal cord involvement in acute polyradiculomyelitis.

Pediatric spinal pilomyxoid astrocytoma

2013 ◽  
Vol 12 (5) ◽  
pp. 511-516 ◽  
Author(s):  
Sarah T. Garber ◽  
Robert J. Bollo ◽  
Jay K. Riva-Cambrin
Keyword(s):  
Treatment Guidelines ◽  
Alkylating Agents ◽  
Malignant Gliomas ◽  
Spinal Tumor ◽  
Total Resection ◽  
Who Grade ◽  
Thoracic Spinal Cord ◽  
Pilomyxoid Astrocytoma ◽  
Treatment Regimens ◽  
Thoracic Spinal

Pediatric spinal pilomyxoid astrocytoma (PMA) is an extremely rare tumor that merits recognition as a specific, unique entity. The authors present the case of an intramedullary PMA in the thoracic spinal cord of an 11-year-old boy who presented with back pain, scoliosis, and multiple lung nodules. The patient underwent T5–11 laminoplasty and near-total resection of the spinal tumor. The final pathological diagnosis was WHO Grade II PMA. The patient did well for 14 months until the tumor progressed both clinically and radiographically. A literature review focusing on the clinical characteristics, histology, and treatment of PMAs provides a better understanding of these rare lesions. Because of the small number of cases optimal treatment guidelines have not been established, but gross-total resection and adjuvant chemotherapy with alkylating agents appear to confer a better long-term prognosis. Pediatric patients with PMAs can remain recurrence free at least 5 years after surgery, although these tumors may disseminate or dedifferentiate into more malignant gliomas. Recognition of intramedullary PMA as a unique entity in children is vital to the development of specific surgical and adjuvant treatment regimens.

scholarly journals Role of Multimodality Intraoperative Neurophysiological Monitoring during Embolisation of a Spinal Cord Arteriovenous Malformation

2000 ◽  
Vol 6 (3) ◽  
pp. 223-234 ◽  
Author(s):  
F. Sala ◽  
Y. Niimi ◽  
A. Berenstein ◽  
V. Deletis
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
General Anesthesia ◽  
Endovascular Procedures ◽  
Motor Evoked Potentials ◽  
Neurological Deficits ◽  
Neurophysiological Monitoring ◽  
Thoracic Spinal Cord ◽  
Lower Extremity Weakness ◽  
Thoracic Spinal

The decision whether or not to embolise during endovascular procedures for arteriovenous malformations (AVMs) of the spinal cord under general anesthesia, relies primarily on neurophysiological results of provocative tests with Lidocaine and short-acting barbiturates. Because of the complex haemodynamics of spinal AVMs, when either sensory (CSEPs) or muscle motor evoked potentials (mMEPs) are used independently, they can mislead the interpretation of provocative tests. This report illustrates the specific but complementary role played by provocative tests using CSEPs and mMEPs during embolisation of a low thoracic spinal cord AVM. We present the case of a 46 year old male with six year history of right lower extremity weakness. At that time, Magnetic Resonance (MR) imaging of the spine disclosed an intramedullary AVM at T11. He remained neurologically stable up to seven months before admission, when he developed sudden onset of low back pain, followed by progressive paraparesis, numbness in lower extremities, urinary retention and fecal incontinence. A new MR imaging study indicated venous thrombosis of the AVM. A two-stage embolisation was performed. During the first procedure, after provocative tests did not affect either CSEPs or mMEPs, an embolisation was performed through a sulco-commisure feeder from the anterior spinal artery (ASA) at T9. Conversely, provocative tests with Lidocaine performed from a right posterior spinal artery (PSA) feeder to the AVM nidus resulted in a significant (>50%) decrease of CSEPs, while mMEPs remained unchanged. The repeatedly positive tests warranted further investigation of the vascular anatomy which disclosed a normal right PSA distal to the nidus; the distal normal PSA was protected with coils. A repeated Lidocaine test was negative and the posterior feeder was embolised with no subsequent changes in CSEPs or mMEPs. After the procedure, the patient experienced only a mild transitory increase in right leg numbness, but no additional motor deficits. Five days later, the embolisation through the ASA feeder at T9 was completed on the basis of negative provocative tests. No additional neurological deficits were observed. Favoring either CSEPs or MEPs during endovascular procedures in the spinal cord is not justified by a solid scientific background. This case report illustrates that monitoring both CSEPs and mMEPs combined with provocative tests allows the safest and most effective embolisation of spinal cord AVMs under general anesthesia.

Regression of Recurrent Spinal Cord High-Grade Glioma After Convection-Enhanced Delivery of Nimustine Hydrochloride: Case Reports and Literature Review

2019 ◽  
Author(s):  
Toshiki Endo ◽  
Tomoo Inoue ◽  
Shinichiro Sugiyama ◽  
Ryuta Saito ◽  
Teiji Tominaga
Keyword(s):  
Spinal Cord ◽  
Case Reports ◽  
High Grade Glioma ◽  
Chemotherapeutic Agents ◽  
High Grade ◽  
Convection Enhanced Delivery ◽  
Thoracic Spinal Cord ◽  
Lower Extremity Weakness ◽  
Thoracic Spinal ◽  
Nimustine Hydrochloride

Abstract BACKGROUND Spinal cord high-grade glioma has poor prognosis. Especially, no treatment protocols have been established for recurrent cases. OBJECTIVE To apply a novel treatment method, convection-enhanced delivery (CED), for recurrent high-grade glioma. CED can deliver chemotherapeutic agents directly into the intramedullary lesion and possibly lead to remarkable regression of enlarging tumors that are, otherwise, difficult to control. METHODS Two patients developed high-grade glioma in the thoracic spinal cord. Partial resection and chemotherapy and radiotherapy induced remission of the disease. However, following the initial treatment, recurrence was noted in the spinal cord at 6 and 12 mo, respectively. No effective treatment was available for these recurrent lesions. Therefore, the authors decided to use CED to infuse nimustine hydrochloride (ACNU) directly into the spinal cord. During the procedure, the infusion cannula was inserted into the spinal cord lesion under intraoperative computed tomography scan. RESULTS After ACNU CED, successive magnetic resonance imaging confirmed remarkable shrinkages of the tumors in both cases. However, the patient's preinfusion symptoms, including bilateral lower extremity weakness, did not change after the treatment. Importantly, overall survivals of the 2 patients were as long as 67 and 33 mo. CONCLUSION The authors report the first 2 cases of recurrent spinal cord high-grade glioma. ACNU CED dramatically regressed enhanced mass lesions and provided local tumor controls in the spinal cord.

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