Rapid arteriovenous shunting in a spinal cord ependymoma

1976 ◽  
Vol 44 (6) ◽  
pp. 744-747 ◽  
Author(s):  
Eric T. Yuhl ◽  
John R. Bentson
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Spinal Angiography ◽  
Arteriovenous Shunting ◽  
Content Type ◽  
Spinal Cord Ependymoma ◽  
Fine Print

✓ A case of ependymoma of the conus medullaris and cauda equina is described in which spinal angiography demonstrated rapid arteriovenous shunting, an angiographic sign which is typical of arteriovenous malformations and which has not been previously reported to occur with ependymomas.

Dermoid tumors of the spinal cord

1970 ◽  
Vol 33 (6) ◽  
pp. 676-681 ◽  
Author(s):  
Ian C. Bailey
Keyword(s):  
Spinal Cord ◽  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina ◽  
Complete Removal ◽  
Cord Compression ◽  
Conus Medullaris ◽  
Low Back ◽  
Content Type ◽  
Fine Print

✓ This is an analysis of 10 cases of dermoid tumor occurring in the spinal canal (8 lumbar and 2 thoracic). Low-back pain was the commonest presenting symptom, especially if the tumor was adherent to the conus medullaris. Other complaints included urinary dysfunction and motor and sensory disturbances of the legs. Clinical and radiological evidence of spina bifida was found in about half of the cases and suggested the diagnosis of a developmental type of tumor when patients presented with progressive spinal cord compression. At operation, the tumors were often found embedded in the conus medullaris or firmly adherent to the cauda equina, thus precluding complete removal. Evacuation of the cystic contents, however, gave lasting relief of the low-back pain and did not cause any deterioration in neurological function. In a follow-up study, ranging from 1 to 15 years, virtually no improvement in the neurological signs was observed. On the other hand, only one case has deteriorated due to recurrence of tumor growth.

Rupture of spinal cord ependymoma

1973 ◽  
Vol 39 (5) ◽  
pp. 662-665 ◽  
Author(s):  
Nettleton S. Payne ◽  
Joseph V. McDonald
Keyword(s):  
Spinal Cord ◽  
Subarachnoid Hemorrhage ◽  
Clinical Course ◽  
Cauda Equina ◽  
Content Type ◽  
Spinal Cord Ependymoma ◽  
Fine Print

✓ The rupture of an ependymoma of the cauda equina associated with trauma and subarachnoid hemorrhage is described. The clinical course of the patient is discussed, and the mechanism and significance of the rupture postulated.

Spontaneous spinal subarachnoid hemorrhage and subdural hematoma

1984 ◽  
Vol 61 (5) ◽  
pp. 975-980 ◽  
Author(s):  
Karl W. Swann ◽  
Allan H. Ropper ◽  
Paul F. J. New ◽  
Charles E. Poletti
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Subdural Hematoma ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Spinal Angiography ◽  
Content Type ◽  
Radiological Features ◽  
Spinal Subarachnoid Hemorrhage ◽  
Severe Back Pain ◽  
Fine Print

✓ Two patients with spontaneous spinal subarachnoid hemorrhage are presented to emphasize the clinical and radiological features of this uncommon illness. Both had severe back pain at the onset. One patient had a subdural hematoma that compressed the conus medullaris and cauda equina, and was drained percutaneously; the other had clots in the subarachnoid space. The cerebrospinal fluid showed a polymorphonuclear pleocytosis that simulated septic meningitis. Complete spinal angiography failed to reveal a cause for the hemorrhages.

Multisession CyberKnife Radiosurgery for Intramedullary Spinal Cord Arteriovenous Malformations

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1081-1089 ◽  
Author(s):  
John Sinclair ◽  
Steven D. Chang ◽  
Iris C. Gibbs ◽  
John R. Adler
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Arteriovenous Malformations ◽  
Conus Medullaris ◽  
Spinal Angiography ◽  
Resonance Imaging ◽  
Intramedullary Spinal Cord ◽  
Cyberknife Radiosurgery

Abstract OBJECTIVE: Intramedullary spinal cord arteriovenous malformations (AVMs) have an unfavorable natural history that characteristically involves myelopathy secondary to progressive ischemia and/or recurrent hemorrhage. Although some lesions can be managed successfully with embolization and surgery, AVM size, location, and angioarchitecture precludes treatment in many circumstances. Given the poor outlook for such patients, and building on the successful experience with radiosurgical ablation of cerebral AVMs, our group at Stanford University has used CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) to treat selected spinal cord AVMs since 1997. In this article, we retrospectively analyze our preliminary experience with this technique. METHODS: Fifteen patients with intramedullary spinal cord AVMs (nine cervical, three thoracic, and three conus medullaris) were treated by image-guided SRS between 1997 and 2005. SRS was delivered in two to five sessions with an average marginal dose of 20.5 Gy. The biologically effective dose used in individual patients was escalated gradually over the course of this study. Clinical and magnetic resonance imaging follow-up were carried out annually, and spinal angiography was repeated at 3 years. RESULTS: After a mean follow-up period of 27.9 months (range, 3–59 mo), six of the seven patients who were more than 3 years from SRS had significant reductions in AVM volumes on interim magnetic resonance imaging examinations. In four of the five patients who underwent postoperative spinal angiography, persistent AVM was confirmed, albeit reduced in size. One patient demonstrated complete angiographic obliteration of a conus medullaris AVM 26 months after radiosurgery. There was no evidence of further hemorrhage after CyberKnife treatment or neurological deterioration attributable to SRS. CONCLUSION: This description of CyberKnife radiosurgical ablation demonstrates its feasibility and apparent safety for selected intramedullary spinal cord AVMs. Additional experience is necessary to ascertain the optimal radiosurgical dose and ultimate efficacy of this technique.

Primary intramedullary spinal cord germinoma

1996 ◽  
Vol 84 (6) ◽  
pp. 1060-1061 ◽  
Author(s):  
Akira Miyauchi ◽  
Katsumi Matsumoto ◽  
Eiji Kohmura ◽  
Teruo Doi ◽  
Kazuhiko Hashimoto ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Central Nervous System ◽  
Nervous System ◽  
Conus Medullaris ◽  
Rare Occurrence ◽  
Partial Removal ◽  
Intramedullary Spinal Cord ◽  
Content Type ◽  
Disease Free ◽  
Fine Print

✓ Primary central nervous system germinoma usually presents as an extraaxial intracerebral mass. The authors report the rare occurrence of an intramedullary spinal cord germinoma at the conus medullaris in a 24-year-old man, which was treated by partial removal and radiation therapy. The tumor was highly radiosensitive and the patient remains disease free 15 months posttreatment.

The cryoprobe retractor in the microsurgical dissection of tumors

1978 ◽  
Vol 49 (1) ◽  
pp. 143-145 ◽  
Author(s):  
John I. Moseley ◽  
Robert W. Rand
Keyword(s):  
Spinal Cord ◽  
Operating Microscope ◽  
Content Type ◽  
Spinal Cord Ependymoma ◽  
Fine Print

✓ A technique is outlined for retraction of tumors under the operating microscope using the microcryoprobe. The method depends on temperature settings in the −20° to −30° C range to produce a small ice bond uniting tumor and cryoprobe. No attempt is made to create a solid frozen tumor. The locally avascular field and retraction provided ideal circumstances for microdissection. Examples of this approach are outlined with case summaries for spinal cord ependymoma and hemangioblastoma.

Cavernous angioma of the cauda equina producing subarachnoid hemorrhage

1987 ◽  
Vol 66 (1) ◽  
pp. 134-136 ◽  
Author(s):  
Shinsuke Ueda ◽  
Akihito Saito ◽  
Shigeo Inomori ◽  
Ilu Kim
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cauda Equina ◽  
Cavernous Angioma ◽  
Low Back ◽  
Spinal Angiography ◽  
Resonance Imaging ◽  
Total Removal ◽  
Content Type ◽  
Similar Episode ◽  
Fine Print

✓ A case of a cavernous angioma of the cauda equina is presented. The patient was a 28-year-old man who experienced sudden low-back pain and headache without neurological symptoms. Lumbar puncture revealed subarachnoid hemorrhage. He had suffered a similar episode 3 years previously. Selective spinal angiography did not demonstrate any abnormal vascularity. Metrizamide myelography and magnetic resonance imaging were useful in demonstrating the presence of a tumor. Laminectomy at L1–3 and total removal of the tumor were performed without neurological deficit.

Multiple hemangiomas (hemangiomatosis) of the cauda equina and spinal cord

2000 ◽  
Vol 92 (2) ◽  
pp. 229-232 ◽  
Author(s):  
Federico Roncaroli ◽  
Bernd W. Scheithauer ◽  
H. Gordon Deen
Keyword(s):  
Spinal Cord ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Unique Case ◽  
Nerve Roots ◽  
Thoracic Spinal Cord ◽  
Content Type ◽  
Thoracic Spinal ◽  
History Of ◽  
Leg Weakness

✓ A case of multiple hemangiomas of the cauda equina nerve roots, conus medullaris, and lower spinal cord is described. The 74-year-old male patient presented with a 9-month history of progressive bilateral leg weakness. He had a history of lymphoma at the age of 39 years and renal cell carcinoma in his early 40s. Neither disease was evident at the time of this presentation. A magnetic resonance image revealed multiple enhancing nodules in the cauda equina region as well as on the pial surface of the lower thoracic spinal cord and conus medullaris. The patient underwent an L2–3 laminectomy. Cauda equina nerve roots were found to be studded with numerous purple nodules, the largest measuring 6 to 8 mm. The nodules were adherent to nerve roots from which they could not be resected. Two lesions were histologically examined and found to be capillary hemangiomas. Twelve months into an uneventful postoperative course, the patient is neurologically unchanged. This unique case might represent a distinct form of hemangiomatosis confined to the cauda equina nerve roots and spinal cord.

Clinical recording of pressure on the spinal cord and cauda equina

1982 ◽  
Vol 57 (1) ◽  
pp. 48-56 ◽  
Author(s):  
Bjørn Magnaes
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Arterial Blood Pressure ◽  
Cauda Equina ◽  
Surrounding Tissue ◽  
Spinal Block ◽  
Pressure Curve ◽  
Content Type ◽  
Arterial Blood ◽  
Fine Print

✓ When an intraspinal expanding lesion causes a spinal block, a segment of the spinal cord or cauda equina will be subjected to general pressure from the surrounding tissue. This spinal block pressure, the spinal equivalent to intracranial pressure, was measured by lumbar infusion of fluid and simultaneous recording of the volume-pressure curve caudal to the block. The point of deviation from or breakthrough of the exponential volume-pressure curve indicated the spinal block pressure. Spinal block pressure of about 500 mm H2O and more could be determined by this method, and, when it was combined with Queckenstedt's test, lower pressures could be assessed as well. In the static (thoracic) part of the spine, spinal block pressure up to the level of arterial blood pressure was recorded. In the dynamic part of the spine, however, spinal block pressure could exceed arterial blood pressure due to external compressive forces during extension of the spine. There was a general tendency for more severe neurological deficits in patients with high spinal block pressure; but the duration of the pressure, additional focal pressure, and spinal cord compared with nerve root compression seemed equally important factors. The recording has implications for diagnosis, positioning of patients for myelography and surgery, selection of high-risk patients for the most appropriate surgical procedure, and detection of postoperative hematoma. There were no complications associated with the recordings.

Modified classification of spinal cord vascular lesions

2002 ◽  
Vol 96 (2) ◽  
pp. 145-156 ◽  
Author(s):  
Robert F. Spetzler ◽  
Paul W. Detwiler ◽  
Howard A. Riina ◽  
Randall W. Porter
Keyword(s):  
Spinal Cord ◽  
Classification System ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Relevant Literature ◽  
Vascular Lesions ◽  
Cavernous Malformations ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Fine Print

The literature on spinal vascular malformations contains a great deal of confusing terminology. Some of the nomenclature is inconsistent with the lesions described. Based on the experience of the senior author (R.F.S.) in the treatment of more than 130 spinal cord vascular lesions and based on a thorough review of the relevant literature, the authors propose a modified classification system for spinal cord vascular lesions. Lesions are divided into three primary or broad categories: neoplasms, aneurysms, and arteriovenous lesions. Neoplastic vascular lesions include hemangioblastomas and cavernous malformations, both of which occur sporadically and familially. The second category consists of spinal aneurysms, which are rare. The third category, spinal cord arteriovenous lesions, is divided into arteriovenous fistulas and arteriovenous malformations (AVMs). Arteriovenous fistulas are subdivided into those that are extradural and those that are intradural, with intradural lesions categorized as either dorsal or ventral. Arteriovenous malformations are subdivided into extradural-intradural and intradural malformations. Intradural lesions are further divided into intramedullary, intramedullary-extramedullary, and conus medullaris, a new category of AVM. This modified classification system for vascular lesions of the spinal cord, based on pathophysiology, neuroimaging features, intraoperative observations, and neuroanatomy, offers several advantages. First, it includes all surgical vascular lesions that affect the spinal cord. Second, it guides treatment by classifying lesions based on location and pathophysiology. Finally, it eliminates the confusion produced by the multitude of unrelated nomenclatural terms found in the literature.

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