Intraoperative MR imaging in a case of a cervical spinal cord lesion

The aim of this article is to describe the feasibility of performing intraoperative MR imaging in patients with spinal cord lesions and the potential value of this technique. The authors report a case involving a 28-year-old man who presented with chronic cervical pain and pain along the ulnar side of the forearms during neck flexion. Findings on clinical examination were normal, but MR imaging revealed a multicystic cervical spinal cord lesion. Surgery was undertaken to open the cysts, evacuate old blood, and search for pathological tissue. Intraoperative MR imaging showed that the caudal cyst was not opened, and surgery was therefore continued. The caudal cyst was fenestrated and a suspected small cavernous malformation was removed. Electrophysiological monitoring was performed both before and after the intraoperative MR imaging. The use of intraoperative MR imaging changed the strategy of the procedure and helped the surgeon to safely enter all the cysts in the cervical cord.

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Grey matter involvement by focal cervical spinal cord lesions is associated with progressive multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458515604905 ◽

2015 ◽

Vol 22 (7) ◽

pp. 910-920 ◽

Cited By ~ 20

Author(s):

Hugh Kearney ◽

Katherine A Miszkiel ◽

Marios C Yiannakas ◽

Daniel R Altmann ◽

Olga Ciccarelli ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Grey Matter ◽

Cervical Spinal Cord ◽

Spinal Cord Lesion ◽

Cervical Cord ◽

Focal Lesions ◽

Lateral Column ◽

Cord Lesion

Background: The in vivo relationship of spinal cord lesion features with clinical course and function in multiple sclerosis (MS) is poorly defined. Objective: The objective of this paper is to investigate the associations of spinal cord lesion features on MRI with MS subgroup and disability. Methods: We recruited 120 people: 25 clinically isolated syndrome, 35 relapsing–remitting (RR), 30 secondary progressive (SP), and 30 primary progressive (PP) MS. Disability was measured using the Expanded Disability Status Scale. We performed 3T axial cervical cord MRI, using 3D-fast-field-echo and phase-sensitive-inversion-recovery sequences. Both focal lesions and diffuse abnormalities were recorded. Focal lesions were classified according to the number of white matter (WM) columns involved and whether they extended to grey matter (GM). Results: The proportion of patients with focal lesions involving at least two WM columns and extending to GM was higher in SPMS than in RRMS ( p = 0.03) and PPMS ( p = 0.015). Diffuse abnormalities were more common in both PPMS and SPMS, compared with RRMS (OR 6.1 ( p = 0.002) and 5.7 ( p = 0.003), respectively). The number of lesions per patient involving both the lateral column and extending to GM was independently associated with disability ( p < 0.001). Conclusions: More extensive focal cord lesions, extension of lesions to GM, and diffuse abnormalities are associated with progressive MS and disability.

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BLADE Sequences in Sagittal T2-Weighted MR Imaging of the Cervical Spine and Spinal Cord – Lesion Detection and Clinical Value

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren ◽

10.1055/s-0033-1350346 ◽

2013 ◽

Vol 186 (01) ◽

pp. 47-53 ◽

Cited By ~ 1

Author(s):

T. Finkenzeller ◽

C. Menzel ◽

F. Fellner ◽

C. Fellner ◽

C. Stroszczynski ◽

...

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Mr Imaging ◽

Spinal Cord Lesion ◽

Lesion Detection ◽

Clinical Value ◽

Cord Lesion

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Intramedullary Cavernous Malformation of the Spinal Cord in Two Dogs

Veterinary Pathology ◽

10.1354/vp.44-4-528 ◽

2007 ◽

Vol 44 (4) ◽

pp. 528-532 ◽

Cited By ~ 6

Author(s):

E. MacKillop ◽

N. J. Olby ◽

K. E. Linder ◽

T. T. Brown

Keyword(s):

Spinal Cord ◽

Cavernous Malformation ◽

Postmortem Examination ◽

Spinal Cord Lesion ◽

Intraparenchymal Hemorrhage ◽

Intramedullary Spinal Cord ◽

Cavernous Malformations ◽

Vascular Channels ◽

Thin Walled ◽

Cord Lesion

Intramedullary cavernous malformations (CVMs) of the spinal cord were diagnosed in 2 adult dogs that presented for paraparesis. An intramedullary spinal cord lesion was identified on a myelogram in the first dog, and expansion of the vertebral canal was evident on radiographs in the second. Extensive intraparenchymal hemorrhage was found on gross postmortem examination in both dogs, and a distinct lobulated intramedullary mass was evident in the second dog. Microscopically, both lesions were composed of dilated, thin-walled vascular channels with little-to-no intervening neural parenchyma. Both dogs had evidence of channel thrombosis along with perilesional hemorrhage and hemosiderin accumulation. The second dog had additional degenerative changes, including thickened fibrous channel walls with hyalinization, foci of mineralization, and occasional tongues of entrapped gliotic neuropil. CVMs appear to be an uncommon cause of both acute and chronic spinal cord disease in the dog.

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Spinal cord oligodendroglioma with 1p and 19q deletions presenting with cerebral oligodendrogliomatosis

Journal of Neurosurgery Spine ◽

10.3171/2009.2.spine08853 ◽

2009 ◽

Vol 10 (6) ◽

pp. 557-563 ◽

Cited By ~ 16

Author(s):

Kern H. Guppy ◽

Paul T. Akins ◽

Gregory S. Moes ◽

Michael D. Prados

Keyword(s):

Spinal Cord ◽

Tumor Cells ◽

Cervical Spinal Cord ◽

Cervical Cord ◽

Meningeal Enhancement ◽

Who Grade ◽

Term Survival ◽

Radiographic Findings ◽

Grade Ii ◽

Cord Lesion

Oligodendroglioma of the spinal cord is a rare tumor that most often presents with spinal cord symptoms. The authors present a case of spinal cord oligodendroglioma that was associated with cerebral rather than spinal cord symptoms. A 30-year-old woman developed nausea, vomiting, and severe headaches. Magnetic resonance imaging of the brain showed meningeal enhancement. The patient underwent a craniotomy with biopsies of the meninges and brain. The biopsy findings revealed an abnormal arachnoid thickening without tumor cells. The patient later developed hydrocephalus and underwent shunt placement. Cerebrospinal fluid cytological findings were negative for tumor cells or infection. She was found to have a cervical cord lesion at C3–4 that was initially nonenhancing but later enhanced after Gd administration. Biopsy of the cord lesion with partial resection showed a WHO Grade II oligodendroglioma with 1p and 19q deletions determined by fluorescence in situ hybridization. Neurooncological treatment with tumor radiation and temozolomide (Temodor) resulted in improvement in radiographic findings, symptoms, and long-term survival. This paper presents an extensive review of the literature, which revealed only 2 other reported cases of cerebral symptoms in adults that preceded spinal cord symptoms in a patient with oligodendroglioma of the spinal cord. It is also the first reported case of oligodendrogliomatosis due to a cervical spinal cord oligodendroglioma with 1p and 19q deletions.

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Presence of Occipital Neuralgia Predicts High Cervical Spinal Cord Lesion in Multiple Sclerosis

10.26226/morressier.59a3e8b4d462b8028d8944b1 ◽

2017 ◽

Author(s):

Narayan R. Kissoon

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Cervical Spinal Cord ◽

Spinal Cord Lesion ◽

Occipital Neuralgia ◽

High Cervical ◽

Cord Lesion

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Expansile, enhancing cervical cord lesion with an associated syrinx secondary to demyelination

Journal of Neurosurgery Spine ◽

10.3171/spi.2007.6.1.52 ◽

2007 ◽

Vol 6 (1) ◽

pp. 52-56 ◽

Cited By ~ 11

Author(s):

Allen Waziri ◽

Jean-Paul Vonsattel ◽

Michael G. Kaiser ◽

Richard C. E. Anderson

Keyword(s):

Spinal Cord ◽

Demyelinating Disease ◽

Cervical Spinal Cord ◽

Inpatient Rehabilitation ◽

Tissue Loss ◽

Cervical Cord ◽

High Dose ◽

Histopathological Analysis ◽

Dural Graft ◽

Cord Lesion

✓The authors describe the case of a patient with an enhancing, intramedullary cervical spinal cord lesion and associated syrinx. Biopsy sampling of the cervical lesion was performed, and the histological findings were consistent with a demyelinating process supporting the diagnosis of multiple sclerosis (MS). Syrinx formation associated with demyelinating disease has only been described in isolated cases, almost exclusively in Japanese patients with MS. A 22-year-old woman of Caribbean descent presented with a subacute, progressive myelopathy including symptoms of pain and weakness in all extremities, bladder incontinence, and the inability to ambulate. Magnetic resonance imaging of the brain and spinal cord demonstrated an enlarged cervical cord with enhancement and central cavitation consistent with a syrinx. The patient underwent a C3–7 laminoplasty and placement of a dural graft for cord decompression as well as fenestration of the central syrinx. Biopsy sampling of the lesion was performed, and the histopathological analysis, in conjunction with subsequent laboratory and diagnostic testing, supported the diagnosis of demyelinating disease. After treatment with a course of high-dose dexamethasone and inpatient rehabilitation therapy, the patient demonstrated significant clinical improvement. Spinal cord involvement is not uncommon in patients with demyelinating disease; however, enhancing lesions associated with extensive tissue loss and syrinx formation have rarely been reported. For the consulting neurological surgeon, demyelinating disease should be included in the differential diagnosis of such lesions given the level of complexity and risk to the patient associated with open biopsy of the spinal cord.

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The “presyrinx” state: is there a reversible myelopathic condition that may precede syringomyelia?

Neurosurgical FOCUS ◽

10.3171/foc.2000.8.3.4 ◽

2000 ◽

Vol 8 (3) ◽

pp. 1-13 ◽

Cited By ~ 23

Author(s):

Nancy J. Fischbein ◽

William P. Dillon ◽

Charles Cobbs ◽

Philip R. Weinstein

Keyword(s):

Spinal Cord ◽

Mr Imaging ◽

Clinical Evidence ◽

Cervical Spinal Cord ◽

Central Canal ◽

Intramedullary Tumor ◽

Csf Flow ◽

Before And After ◽

Late Evolution ◽

History Of

Object Alteration of cerebrospinal fluid (CSF) flow has been proposed as an important mechanism leading to the development of syringomyelia. We hypothesize that a “presyrinx” condition due to potentially reversible alteration in normal CSF flow exists and that its appearance may be due to variations in the competence of the central canal of the spinal cord. Methods Five patients with clinical evidence of myelopathy, no history of spinal cord trauma, enlargement of the cervical spinal cord with T1 and T2 prolongation but no cavitation, evidence for altered or obstructed CSF flow, and no evidence of intramedullary tumor or a spinal vascular event underwent MR imaging before and after intervention that alleviated obstruction to CSF flow. Results Preoperatively, all patients demonstrated enlarged spinal cords and parenchymal T1 and T2 prolongation without cavitation. Results of magnetic resonance (MR) imaging examinations following intervention in all patients showed resolution of cord enlargement and normalization or improvement of cord signal abnormalities. In one patient with severe arachnoid adhesions who initially improved following decompression, late evolution into syringomyelia occurred in association with continued CSF obstruction. Conclusion Nontraumatic obstruction of the CSF pathways in the spine may result in spinal cord parenchymal T2 prolongation that is reversible following restoration of patency of CSF pathways. We refer to this MR appearance as the “presyrinx” state and stress the importance of timely intervention to limit progression to syringomyelia.

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