Surgical treatment of the retethered spinal cord after repair of lipomyelomeningocele

1991 ◽  
Vol 74 (5) ◽  
pp. 709-714 ◽  
Author(s):  
Hiroaki Sakamoto ◽  
Akira Hakuba ◽  
Ken Fujitani ◽  
Shuro Nishimura
Keyword(s):  
Spinal Cord ◽  
Dura Mater ◽  
Conus Medullaris ◽  
Posterior Arch ◽  
Pia Mater ◽  
Dense Adhesion ◽  
Content Type ◽  
Dural Sac ◽  
Long Term Observation

✓ In a series of 75 patients with surgically treated lipomyelomeningoceles, the neurological condition of six patients deteriorated 6 months to 14 years after the operation due to repeat tethering of the spinal cord. The tethering resulted from postoperative dense adhesion between the cord and the overlying dura mater. Two of the six patients underwent conventional repeat untethering procedures, and the remaining four were successfully treated with a new surgical technique developed by the authors to prevent such dural adhesion. For this procedure, after complete untethering of the spinal cord, the lumbosacral cord is retained in the center of the dural sac by fine stay sutures between the pia mater of the conus medullaris and the ventral dura mater. In addition, the dura mater is tacked to the posterior arch which is reconstructed with bone grafts at one or two bifid vertebral levels. During a postoperative follow-up period of 1 to 3 years, no further deterioration has been observed and magnetic resonance studies have demonstrated a space filled with cerebrospinal fluid (CSF) around the lumbosacral cord. The authors conclude that long-term observation, both neurological and radiological, is essential even after successful repair of a lipomyelomeningocele. This new surgical procedure can maintain a CSF bath around the lumbosacral cord, thus preventing dural adhesion. Application of this technique will hopefully be beneficial in lipomyelomeningocele patients with a high risk of cord retethering after initial repair.

Intraspinal mesenchymal chondrosarcoma

1994 ◽  
Vol 80 (5) ◽  
pp. 928-930 ◽  
Author(s):  
Alok Ranjan ◽  
Geeta Chacko ◽  
Thomas Joseph ◽  
Sushil M. Chandi
Keyword(s):  
Spinal Cord ◽  
Magnetic Resonance ◽  
Dura Mater ◽  
Microscopic Examination ◽  
Mesenchymal Chondrosarcoma ◽  
Pia Mater ◽  
Content Type ◽  
The Right ◽  
Fine Print

✓ A 52-year-old man presented with symptoms of progressive cervical radiculomyelopathy. A myelogram showed an intradural block at the C-6 level. Magnetic resonance T1-weighted imaging revealed a hypointense, sausage-shaped mass extending from C-3 to C-6, located posterolaterally on the right side and pushing the spinal cord to the left and anteriorly. At surgery, a mass was found attached solely to the pia mater, with a normal arachnoid and dura mater overlying it. The mass was excised completely and microscopic examination identified a mesenchymal chondrosarcoma. The patient was symptom-free 6 months after surgery.

Professor Betz's Method of Making Sections of Nervous Tissue

1873 ◽  
Vol 19 (87) ◽  
pp. 465-466
Author(s):  
Batty Tuke
Keyword(s):  
Spinal Cord ◽  
Dura Mater ◽  
Nervous Tissue ◽  
Cool Temperature ◽  
Cent Solution ◽  
Pia Mater ◽  
Thin Sections ◽  
Brown Colour ◽  
Ordinary Temperature

Professor Betz, of Kiew, has lately produced brain sections, which have attracted very considerable attention in Vienna. His specimens are of vast extent. He appears to be able to produce thin sections of an entire hemisphere. We append his method of hardening and cutting as it is stated in the “Correspondentze Blatt der deutschen Gesellschaft für Psychiatrie und Gerichtlich Psychologie, Jan., 1873.” The method of hardening which we wish to bring into notice is as follows:—observing that differences exist in the treatment of the spinal-cord, cerebrum and cerebellum. The spinal-cord—after tbe careful removal of the dura mater, it is placed in spirit of from 75 to 80 per cent., which is tinged a clear brown colour by the addition of Iodine. After from one to three days, during which the preparation must stand in a cool temperature, the Pia Mater and the Arachnoid are also removed; the specimen remaining in the spirit, to which a few drops of Iodine must be added daily for three days, maintaining an ordinary temperature. It is then transferred to a three per cent. solution of Chromate of Potass, and back again to the cool temperature. Here it hardens thoroughly, which is known by the fluid becoming turbid, and by the formation of a brown deposit upon the preparation. When this occurs, it must be immediately thoroughly washed with water, and immersed in a solution of Chromate of Potass, from a half to one per cent. strength, in which it will not become too hard or brittle.

Sacral rootlet rhizotomy at the conus medullaris for hypertonic neurogenic bladder

1978 ◽  
Vol 48 (2) ◽  
pp. 193-196 ◽  
Author(s):  
Stanislaw K. Toczek ◽  
David C. McCullough ◽  
John S. Boggs
Keyword(s):  
Neurogenic Bladder ◽  
Smooth Muscle Contraction ◽  
Conus Medullaris ◽  
Detrusor Muscle ◽  
Urinary Frequency ◽  
Content Type ◽  
Bladder Activity ◽  
Root Stimulation

✓ Three patients with spastic neurogenic bladder underwent sacral root stimulation and appropriate section of motor rootlets to the detrusor at the level of the conus medullaris. Compared to the results obtained with rhizotomies at the sacral levels in a previous series of patients, urinary frequency and infection were inhibited for longer periods of time, but some uninhibited bladder activity recurred in all three patients. Analysis of anatomical and electrophysiological data serves to emphasize the complexity and asymmetry of efferent supply to detrusor muscle. The authors conclude that the role of selective rhizotomy for inhibition of the spastic bladder is inconclusive, and perhaps a combination of surgery and medications that inhibit smooth-muscle contraction may be required for long-term protection of urinary collection systems.

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.

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 fine anatomy of the human spinal meninges

1988 ◽  
Vol 69 (2) ◽  
pp. 276-282 ◽  
Author(s):  
David S. Nicholas ◽  
Roy O. Weller
Keyword(s):  
Spinal Cord ◽  
Blood Vessels ◽  
Transverse Section ◽  
Human Cerebral Cortex ◽  
Pia Mater ◽  
Content Type ◽  
Inner Aspect ◽  
Dentate Ligament ◽  
Arachnoid Mater ◽  
Fine Print

✓ The fine anatomy of the human spinal meninges was examined in five postmortem spinal cords taken within 12 hours after death from patients aged 15 months to 46 years. Specimens of spinal cord were viewed in transverse section and from the dorsal and ventral aspects by scanning electron microscopy. Transverse sections of spinal cord and meninges were also examined by light microscopy. The arachnoid mater was seen to be closely applied to the inner aspect of the dura. An intermediate fenestrated leptomeningeal layer was observed attached to the inner aspect of the arachnoid mater and was reflected ventrally to form a series of dorsal septa. As it arborized laterally over the surface of the cord to surround nerves and blood vessels, the intermediate layer became highly fenestrated but remained distinct from the pia and arachnoid mater. The pia mater appeared to form a continuous layer which was reflected off the surface of the cord to coat blood vessels within the subarachnoid space in a manner similar to that described in the leptomeninges over the human cerebral cortex. Each dentate ligament consisted of a collagenous core which was continuous with the subpial connective tissue and was attached at intervals to the dura; pia-arachnoid cells coated the surface of the dentate ligaments. The present study suggests that the fine anatomy of the human spinal meninges differs significantly from that described in other mammals.

Recurrent transient quadriparesis after minor cervical trauma associated with bilateral partial agenesis of the posterior arch of the atlas

1996 ◽  
Vol 84 (4) ◽  
pp. 663-665 ◽  
Author(s):  
Martijn Torreman ◽  
Ivo T. H. J. Verhagen ◽  
Menno Sluzewski ◽  
Alexander J. M. Kok ◽  
Willem Jan van Rooij
Keyword(s):  
Spinal Cord ◽  
Posterior Arch ◽  
Review Of The Literature ◽  
Cervical Trauma ◽  
Content Type ◽  
Causative Mechanism ◽  
Type D ◽  
Aggressive Management ◽  
Type C ◽  
Fine Print

✓ The case of a 33-year-old woman with bilateral partial agenesis (type D) of the posterior arch of the atlas and recurrent transient quadriparesis due to contusion of the spinal cord after minor cervical trauma is described. At least some patients with type C or D congenital anomalies of the posterior arch of the atlas are prone to transient quadriparesis; thus a more aggressive management is advocated for them. Radiological and surgical findings showing the possible causative mechanism are presented and a review of the literature is given.

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.

Dorsal arachnoid web with spinal cord compression: variant of an arachnoid cyst?

2000 ◽  
Vol 93 (2) ◽  
pp. 287-290 ◽  
Author(s):  
Christopher G. Paramore
Keyword(s):  
Spinal Cord ◽  
Subarachnoid Space ◽  
Rare Variants ◽  
Mass Effect ◽  
Arachnoid Cysts ◽  
Thoracic Myelopathy ◽  
Pia Mater ◽  
Thoracic Spinal Cord ◽  
Content Type ◽  
Thoracic Spinal

✓ Spinal arachnoid cysts are diverticula of the subarachnoid space that may compress the spinal cord; these lesions are most commonly found in the thoracic spine. Two patients who presented with thoracic myelopathy were noted on magnetic resonance imaging to have focal indentation of the dorsal thoracic cord, with syringomyelia inferior to the site of compression. Both patients were found at operation to have discrete arachnoid “webs” tenaciously attached to the dura mater and pia mater. These webs were not true arachnoid cysts, yet they blocked the flow of cerebrospinal fluid (CSF) and caused focal compression of the spinal cord. The mass effect appeared to be the result of a pressure gradient created by the obstruction of CSF flow in the dorsal aspect of the subarachnoid space. Both patients responded well to resection of the arachnoid web. Arachnoid webs appear to be rare variants of arachnoid cysts and should be suspected in patients with focal compression of the thoracic spinal cord.

Long-term control of recurrent cyst of the conus medullaris

1977 ◽  
Vol 47 (6) ◽  
pp. 953-954 ◽  
Author(s):  
Harold J. Hoffman ◽  
Renn O. Holness ◽  
Norman R. Flett
Keyword(s):  
Epidermoid Cyst ◽  
Conus Medullaris ◽  
Ommaya Reservoir ◽  
Content Type ◽  
Recurrent Cyst ◽  
Intermittent Drainage ◽  
Fine Print

✓ The authors report a case in which decompression of an intramedullary epidermoid cyst was maintained by intermittent drainage via an implanted subcutaneous Ommaya reservoir.

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