Cervical corpectomy for resection of ventral intramedullary capillary hemangioma with circumferential involvement of the anterior spinal artery: case report

There is limited evidence to suggest that anterior approaches for the resection of ventral intramedullary lesions of the cervical spinal cord may result in superior neurological outcomes compared with those following more traditional posterior approaches. To the authors’ knowledge, no report of an anterior approach to resect a ventral intramedullary capillary hemangioma exists in the literature. In the following paper, the case of a 75-year-old male who presented with progressive neck and left shoulder pain, weakness of the left hand, myelopathy, and gait imbalance is reported. Postcontrast T1-weighted MRI demonstrated a homogeneously enhancing intramedullary lesion with associated severe impingement of the cervical spinal cord at C-4. Following a C-4 corpectomy, intradural exposure revealed a vascular lesion that circumferentially enveloped the anterior spinal artery. Gross-total resection of the lesion was performed, followed by reconstruction of the corpectomy defect, without neurological deterioration. Pathology was consistent with capillary hemangioma. In this instance, the anterior approach helped to avoid unnecessary neural manipulation and allowed for early identification of normal proximal and distal segments of the anterior spinal artery, which facilitated safe dissection and gross-total removal.

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Autonomic dysreflexia associated with cervical spinal cord gliofibroma: case report

BMC Neurology ◽

10.1186/s12883-021-02271-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hiroyuki Mizuno ◽

Fumiaki Honda ◽

Hayato Ikota ◽

Yuhei Yoshimoto

Keyword(s):

Spinal Cord ◽

Cervical Spinal Cord ◽

Spinal Cord Tumor ◽

Autonomic Dysreflexia ◽

Tumor Biopsy ◽

Intramedullary Lesion ◽

First Case ◽

Cord Injury ◽

Paroxysmal Hypertension ◽

Upper And Lower Extremities

Abstract Background Autonomic dysreflexia (AD) is an abnormal reflex of the autonomic nervous system normally observed in patients with spinal cord injury from the sixth thoracic vertebra and above. AD causes various symptoms including paroxysmal hypertension due to stimulus. Here, we report a case of recurrent AD associated with cervical spinal cord tumor. Case presentation The patient was a 57-year-old man. Magnetic resonance imaging revealed an intramedullary lesion in the C2, C6, and high Th12 levels. During the course of treatment, sudden loss of consciousness occurred together with abnormal paroxysmal hypertension, marked facial sweating, left upward conjugate gaze deviation, ankylosis of both upper and lower extremities, and mydriasis. Seizures repeatedly occurred, with symptoms disappearing after approximately 30 min. AD associated with cervical spinal cord tumor was diagnosed. Histological examination by tumor biopsy confirmed the diagnosis of gliofibroma. Radiotherapy was performed targeting the entire brain and spinal cord. The patient died approximately 3 months after treatment was started. Conclusions AD is rarely associated with spinal cord tumor, and this is the first case associated with cervical spinal cord gliofibroma. AD is important to recognize, since immediate and appropriate response is required.

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The Effects of Gender on Clinical and Neurological Outcomes after Acute Cervical Spinal Cord Injury

Journal of Neurotrauma ◽

10.1089/neu.2005.22.368 ◽

2005 ◽

Vol 22 (3) ◽

pp. 368-381 ◽

Cited By ~ 41

Author(s):

Julio C. Furlan ◽

Andrei V. Krassioukov ◽

Michael G. Fehlings

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spinal Cord ◽

Cervical Spinal Cord Injury ◽

Neurological Outcomes ◽

Cord Injury

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Resection of a ventral intramedullary cervical spinal cord cavernous malformation through an anterior approach

Neurosurgical FOCUS ◽

10.3171/2014.v3.focus14401 ◽

2014 ◽

Vol 37 (v2supplement) ◽

pp. Video18 ◽

Cited By ~ 4

Author(s):

Alexander G. Weil ◽

Sanjiv Bhatia

Keyword(s):

Spinal Cord ◽

Surgical Approach ◽

Anterior Approach ◽

Posterior Approach ◽

Cavernous Malformation ◽

Cervical Spinal Cord ◽

Pediatric Population ◽

Complete Resection ◽

Surgical Access ◽

Partial Corpectomy

Ventrally-located intramedullary cervical spinal cord cavernomas are rare entities in the pediatric population. Surgical access to these lesions is challenging. The authors present the complete resection of a symptomatic ventral cervical intramedullary cavernoma through an anterior approach in a 15-year-old boy. The lesion was accessed following left anterolateral dissection, C3–4 discectomy and C3/C4 partial corpectomy. The authors will discuss the rationale for intervening in this patient and for selecting this anterior approach over other approaches, such as the anterolateral, posterolateral or posterior approach. The steps, pitfalls and pearls of this surgical approach will be demonstrated in a detailed video.The video can be found here: http://youtu.be/-ARTp6g13hgs.

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Intramedullary Spinal Capillary Hemangioma: Case Report

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0035-1570100 ◽

2015 ◽

Vol 36 (02) ◽

pp. 125-127

Author(s):

Leonardo Welling ◽

Mariana Welling ◽

Eberval Figueiredo

Keyword(s):

Spinal Cord ◽

Complete Removal ◽

Conus Medullaris ◽

Capillary Hemangioma ◽

The Body ◽

Accurate Information ◽

Histopathological Diagnosis ◽

Intramedullary Lesion ◽

History Of

AbstractCapillary hemangiomas involving the neuraxis are very uncommon. In the spinal cord, they are located mainly intradural and extramedullary. To our knowledge, only four cases in conus medullaris have been previously described. In our case, a 46-year-old man was admitted with back pain, sphincter disturbances, as well as progressive weakness and numbness on the lower extremities. Magnetic resonance imaging revealed an undefined intramedullary lesion on the conus medullaris. The patient underwent microsurgery, which achieved complete removal. Histopathological diagnosis was compatible with capillary hemangioma. His postoperative course was uneventful and all symptoms, including bladder dysfunction clearly regressed. The treatment of intramedullary capillary hemangiomas is very critical in preventing unnecessary morbidity, providing accurate information with respect to prognosis, and establishes a regular outpatient follow-up. The natural history of this lesion involving the spinal cord is not well described, although they are common elsewhere in the body.

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Computed tomographic angiography of anterior spinal artery in acute cervical spinal cord injury

Spinal Cord ◽

10.1038/sc.2012.179 ◽

2013 ◽

Vol 51 (6) ◽

pp. 442-447 ◽

Cited By ~ 11

Author(s):

Z Zhang ◽

H Wang ◽

Y Zhou ◽

J Wang

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spinal Cord ◽

Computed Tomographic Angiography ◽

Cervical Spinal Cord Injury ◽

Anterior Spinal Artery ◽

Computed Tomographic ◽

Cord Injury ◽

Tomographic Angiography

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Posterior approach for anteriorly located cervical spinal cord hemangioblastomas: technical note

Journal of Neurosurgery Spine ◽

10.3171/2018.1.spine171108 ◽

2018 ◽

Vol 29 (4) ◽

pp. 448-451 ◽

Cited By ~ 2

Author(s):

Jorn Van Der Veken ◽

Sven Gläsker ◽

Vassilis Vougioukas ◽

Vera Van Velthoven

Keyword(s):

Spinal Cord ◽

Surgical Management ◽

Anterior Approach ◽

Posterior Approach ◽

Cervical Spinal Cord ◽

Technical Note

The surgical management of anteriorly located spinal cord hemangioblastomas remains a challenge. Different approaches have been published, of which the anterior approach seems to be the most obvious and commonly used. A posterior approach might be more suitable in certain patients, especially in cases of cystic hemangioblastomas. The authors present 3 cases of anterior spinal hemangioblastomas, which were all resected via a posterior approach. The authors discuss the rationale for choosing this approach and explain the technique in detail.

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A Mobile Schwannoma of the Cervical Spinal Cord

Neurosurgery ◽

10.1227/neu.0000000000000975 ◽

2015 ◽

Vol 78 (1) ◽

pp. E156-E159 ◽

Cited By ~ 11

Author(s):

Yukinori Terada ◽

Hiroki Toda ◽

Akiyoshi Yokote ◽

Koichi Iwasaki

Keyword(s):

Spinal Cord ◽

Subarachnoid Space ◽

Magnetic Resonance Image ◽

Clinical Presentation ◽

Cervical Spinal Cord ◽

Intraoperative Ultrasonography ◽

Vertebral Level ◽

Left Hand ◽

Extramedullary Tumor ◽

Intradural Extramedullary

Abstract BACKGROUND AND IMPORTANCE: Mobile schwannomas have been reported in the lumbar spine and occasionally in the thoracic spine. However, to the best of our knowledge, this is the first known report of a cervical mobile schwannoma. Mobile schwannomas require careful preoperative and intraoperative evaluation of their localization because tumor mobility may result in surgery at the wrong level. CLINICAL PRESENTATION: A 68-year-old man had complained of clumsiness in his left hand for 10 years. An initial magnetic resonance image (MRI) showed an intradural extramedullary tumor at the C5 to C7 levels, deformation of the adjacent spinal cord, and unusual dilatation of the subarachnoid space from the C7 to T1 levels. A subsequent MRI revealed that the tumor had moved to the C6 to T1 levels. We diagnosed the lesion as a mobile tumor of the cervical spinal cord. The patient underwent a C6-C7 laminectomy with an additional partial laminectomy of C5 and T1. Intraoperative ultrasonography helped localize the tumor. Transdural ultrasonography and direct observation confirmed the tumor mobility. The tumor was completely removed. The histological diagnosis was schwannoma. CONCLUSION: We observed an extremely rare case of a mobile schwannoma of the cervical spine. Unusually dilated subarachnoid space adjacent to the tumor can be a diagnostic sign of tumor mobility, regardless of vertebral level. Repeated MRI studies are useful to preoperatively confirm tumor mobility. Intraoperative ultrasonography is valuable for the real-time localization of such mobile tumors to avoid potentially performing surgery at the wrong vertebral level.

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Lateral interscalenic multilevel oblique corpectomies to repair ventral root avulsions after brachial plexus injury in humans: anatomical study and first clinical experience

Journal of Neurosurgery Spine ◽

10.3171/spi.2001.95.2.0202 ◽

2001 ◽

Vol 95 (2) ◽

pp. 202-207 ◽

Cited By ~ 9

Author(s):

Henri-Dominique Fournier ◽

Philippe Mercier ◽

Philippe Menei

Keyword(s):

Spinal Cord ◽

White Matter ◽

Anterior Approach ◽

Cervical Spinal Cord ◽

Anatomical Study ◽

Ventral Root ◽

Anterolateral Approach ◽

Content Type ◽

Anterior Aspect ◽

Fine Print

Object. Because central nervous system white matter exerts a powerful inhibitory effect on axonal growth, implantation of nerve grafts or rootlets into the cervical spinal cord following ventral root avulsion injury should, ideally, be performed directly through the ventral root exit zone (VRExZ), which is located near the anteromedial aspect of the anterior horn; the grafts/rootlets should not be implanted into the white matter of the lateral cord. This is not possible when using a conservative posterior approach. Therefore, the authors have studied the anatomy encountered when using the anterolateral approach and evaluated the technique in the particular case of avulsed ventral nerve roots. They also present a case illustration of the procedure, which is used currently in their department. Methods. Anterior access to the rootlets is obtained using a lateral interscalenic approach; the vertebral artery is exposed and mobilized, and oblique drilling of the vertebral bodies (VBs) is performed. Because the articular processes and half of the VBs are preserved, fusion is not required. The approach allows the surgeon to expose the anterior aspect of the cervical dura and the entire length of the emerging spinal nerves. The anterior aspect of the dura is opened at the desired levels for VRExZ exposure, and the position is ideal for implantation of the graft/rootlets. The interscalenic dissection is mandatory so that the lesions of the supraclavicular plexus can be evaluated and repaired. If necessary, the anterior approach allows for exploration of the infraclavicular plexus during the same procedure. Conclusions. The use of a true anterior approach to the ventral rootlets appears to be a valuable and appropriate approach that avoids extensive laminectomy/facetectomy while reimplantation is performed through the anterolateral sulcus itself. In this approach, however, reimplantation of dorsal roots into the spinal cord remains impossible.

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