The nature of congenital posterior cervical or cervicothoracic midline cutaneous mass lesions

1991 ◽  
Vol 75 (2) ◽  
pp. 206-212 ◽  
Author(s):  
Paul Steinbok ◽  
D. Douglas Cochrane
Keyword(s):  
Spinal Cord ◽  
Spinal Dysraphism ◽  
Large Body ◽  
Posterior Part ◽  
Cervical Region ◽  
Posterior Aspect ◽  
Content Type ◽  
Chiari Ii ◽  
Spina Bifida Cystica ◽  
Mass Lesions

✓ Between 4% and 8% of cases of spina bifida cystica occur in a cervical or cervicothoracic location. Despite a large body of literature concerning spinal dysraphism, there has been little written specifically about patients afflicted with this disorder in a cervical location. Eight children who presented at birth with posterior cervical or cervicothoracic lumps, all of which represented a dysraphic state, are discussed. Two types of abnormalities were noted. Three patients had hydromyelia with an associated myelocystocele herniating posteriorly into a meningocele sac. In these three patients there was an associated Chiari II malformation and hydrocephalus. The other five children had a meningocele in which a band of tissue extended from the posterior aspect of the spinal cord through a defect in the bone and fascia to the posterior part of the meningocele sac itself. No patient had a lesion that could be described as a meningomyelocele. The investigation and surgical management of these conditions are discussed and the need for intradural exploration to untether the spinal cord in the cervical region is stressed.

Isolated toxoplasmosis of the thoracic spinal cord in a patient with acquired immunodeficiency syndrome

1995 ◽  
Vol 82 (3) ◽  
pp. 493-496 ◽  
Author(s):  
Daniel K. Resnick ◽  
Christopher H. Comey ◽  
William C. Welch ◽  
A. Julio Martinez ◽  
William W. Hoover ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Acquired Immunodeficiency Syndrome ◽  
Treatment Algorithm ◽  
Thoracic Spinal Cord ◽  
Similar Treatment ◽  
Content Type ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome ◽  
Mass Lesions ◽  
Fine Print

✓ Toxoplasmosis and lymphoma are the two most common causes of intraparenchymal cerebral mass lesions in patients with acquired immunodeficiency syndrome (AIDS). The clinical and radiographic features of the intracranial lesions have been well described. Because of the high frequency of toxoplasmosis in the AIDS population, common therapy for patients presenting with intracranial mass lesions consists of an empirical trial of anti-Toxoplasma chemotherapy, with biopsy reserved for cases demonstrating features considered to be more consistent with lymphoma, or for lesions that do not improve despite adequate anti-Toxoplasma treatment. A similar treatment algorithm does not exist for intramedullary lesions of the spinal cord. The authors describe a patient who presented with paraparesis resulting from an isolated thoracic intramedullary lesion. An open biopsy of the lesion revealed characteristic structures containing Toxoplasma tachyzoites. The clinical and radiographic presentation of the lesion is discussed, the available literature is reviewed, and a treatment strategy for spinal cord lesions in AIDS patients is proposed.

The denticulate ligament: anatomy and functional significance

2001 ◽  
Vol 94 (2) ◽  
pp. 271-275 ◽  
Author(s):  
R. Shane Tubbs ◽  
George Salter ◽  
Paul A. Grabb ◽  
W. Jerry Oakes
Keyword(s):  
Spinal Cord ◽  
Functional Significance ◽  
Spinal Canal ◽  
Cervical Region ◽  
Content Type ◽  
Functional Studies ◽  
Applied Tension ◽  
Limited Degree ◽  
Formalin Fixed ◽  
Fine Print

Object. The authors conducted a study to examine the detailed anatomy of the denticulate ligaments and to assess their classic role in spinal cord stability within the spinal canal. Methods. Detailed observation of the denticulate ligaments in 12 adult cadavers was performed. Stress was applied in all major planes to discern when the ligaments would become taut, and at the same time, gross motion of the cord was observed at sites distal to the stresses applied. Tension necessary for avulsion of the ligaments in various areas of the spinal cord was also measured. Conclusions. These results show that the denticulate ligaments do not inhibit cord motion to such discrete areas of the cord as was once thought. The authors have determined that the ligaments are stronger in the cervical region and that they decrease in strength as the spinal cord descends. These findings are demonstrative of the denticulate ligaments being more resistant to caudal compared with cephalad stresses in the cord. Anterior and posterior motion is constrained by these ligaments but to a limited degree, especially as one descends inferiorly along the cord. Further embryological and functional studies of these ligaments is needed in non—formalin fixed tissues.

scholarly journals Intraspinal Neurenteric Cysts in Children

2008 ◽  
Vol 35 (5) ◽  
pp. 609-615 ◽  
Author(s):  
Chunquan Cai ◽  
Changhong Shen ◽  
Weidong Yang ◽  
Qingjiang Zhang ◽  
Xiaoli Hu
Keyword(s):  
Spinal Cord ◽  
Imaging Modality ◽  
Spinal Dysraphism ◽  
Clinical Manifestations ◽  
The Other ◽  
Cervical Region ◽  
Neurological Involvement ◽  
Neurenteric Cyst ◽  
Lumbar Region ◽  
Magnetic Resonance Imaging Mri

Background:Neurenteric cysts are rare congenital epithelium-lined cysts of the central nervous system. They are found predominantly in the spinal cord, with lower incidence in the intracranial compartment, and may be associated with various other congenital spinal anomalies. Seven patients with symptomatic intraspinal neurenteric cysts are presented.Materials and Methods:Seven patients with intraspinal neurenteric cysts aged from nine months to ten years treated at this hospital from May 2000 to July 2006 were reviewed. The clinical manifestations, imaging and surgical findings of patients were analyzed retrospectively. All patients underwent operation. One patient's cervical neurenteric cyst was resected using the lateral cervical approach, and the other six resections were performed with posterior approach.Results:All seven patients presented with neurological involvement. One patient had an intramedullary cyst, while the other six cysts were situated ventrally. Three patients' cysts occurred in the cervical region, two in the cervicothoracic region, one in the thoracic region and one in the lumbar region. One patient had bony anomalies, and one had a lumbar posterior occult spinal dysraphism. Five patients' symptoms improved rapidly after surgery.Conclusions:Intraspinal neurenteric cysts in children are rare and most occur ventral to the spinal cord. Magnetic resonance imaging (MRI) is the most effective imaging modality. Earlier diagnosis and surgical resection of spinal neurenteric cysts improves prognosis.

Terminal syringohydromyelia and occult spinal dysraphism

1994 ◽  
Vol 81 (4) ◽  
pp. 513-519 ◽  
Author(s):  
Bermans J. Iskandar ◽  
Jerry Oakes ◽  
Colleen McLaughlin ◽  
Alan K. Osumi ◽  
Robert D. Tien
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Medical Center ◽  
Spinal Dysraphism ◽  
Occult Spinal Dysraphism ◽  
Content Type ◽  
Bowel And Bladder Dysfunction ◽  
Duke University ◽  
Tight Filum Terminale ◽  
Fine Print

✓ Terminal syringohydromyelia is a cystic dilatation of the lower third of the spinal cord. The authors describe its incidence and characteristics, its frequent association with occult spinal dysraphism, and its clinical significance and need for surgical treatment. All 143 cases of occult spinal dysraphism treated at the Duke University Medical Center between 1972 and 1992 were reviewed. A terminal syrinx was found in 24 (27%) of the 90 cases that were evaluated by magnetic resonance (MR) imaging. In contrast, three (6.2%) of 48 cases evaluated by myelography and postmyelographic computerized tomography had a syrinx documented. The relative radiographic severity of the different syringes was estimated by using measurements of the syrinx and spinal cord on the MR images, classifying the cysts into large and small. Large syringes were frequently symptomatic, commonly presenting with pain, motor and sensory deficits of the lower extremities, scoliosis, and bowel and bladder dysfunction. Terminal syringohydromyelia with occult spinal dysraphic lesions was most often associated with tethered spinal cord from a tight filum terminale in the presence of an anorectal anomaly (67% of cases), meningocele manqué (54%), and diastematomyelia (38%). An infrequent association was seen with other spinal cord anomalies. The results of surgical management of terminal syringohydromyelia were analyzed, highlighting the necessity and effectiveness of shunting the large cysts, especially in the setting of a progressive symptomatology. Of the 11 patients with shunts who underwent MR imaging, 10 showed either complete or significant resolution of the syrinx; all five patients who had presented with pain (mainly back pain) showed complete resolution of the pain after shunting; finally, one-third of patients with shunt placement had significant postoperative improvement in their neurological examination, whereas none worsened. It is stressed that terminal syringohydromyelia is an important pathological entity that should be considered in patients with occult spinal dysraphism, and treated surgically when clinically or radiographically significant.

scholarly journals Infected congenital cervical dermal sinuses leading to spinal cord abscess: two case reports and a review of the literature

2020 ◽  
Vol 37 (1) ◽  
pp. 225-228
Author(s):  
Rhian Bevan ◽  
Paul Leach
Keyword(s):  
Spinal Cord ◽  
Case Reports ◽  
Spinal Dysraphism ◽  
Febrile Illness ◽  
Surgical Excision ◽  
Late Recurrence ◽  
Cervical Region ◽  
Developmental Defects ◽  
Complete Surgical Excision

Abstract Purpose Congenital dermal sinuses are a rare form of spinal dysraphism. The developmental defects are located along the midline neuroaxis, with sinuses in the cervical region being the least common. Congenital dermal sinuses can be associated with intraspinal infection as they act as a direct route from the skin and subcutaneous tissues into the spinal cord. Methods The authors present two cases of cervical dermal sinuses complicated by intramedullary abscess. Both children presented with neurological decline and febrile illness. MRI showed intraspinal abscess. Both underwent prompt surgical excision of the sinus tract, exploration of the cord and intravenous antibiotics. Results Both patients demonstrated excellent neurological recovery. Conclusions Complete surgical excision of the sinus and tract in addition to long-term antimicrobials can yield excellent neurological outcomes. At surgery, do not expect to find pus when exploring the intramedullary component. Long-term follow-up is advocated due to potential late recurrence.

Intramedullary mature teratoma of the cervical spinal cord at C1–2 associated with occult spinal dysraphism in an adult

2007 ◽  
Vol 6 (6) ◽  
pp. 579-584 ◽  
Author(s):  
Raafat Makary ◽  
David Wolfson ◽  
Victor Dasilva ◽  
Amir Mohammadi ◽  
Sania Shuja
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Spinal Dysraphism ◽  
Treatment Options ◽  
Mature Teratoma ◽  
Postoperative Outcome ◽  
Complete Removal ◽  
Cervical Region ◽  
Upper Cervical ◽  
Spinal Malformations

✓There is a well-recognized association between dysontogenetic tumors of the spinal cord (including teratomas and enterogenous cysts) and dysraphic congenital spinal malformations. The authors present a case of an adult with an intramedullary mature teratoma (IMMT) at the level of C1–2 of the cord associated with dysraphic congenital spinal malformations. Intramedullary mature teratomas of the cervical region of the spinal cord are very rare in adults; only four such lesions have been reported, two of which involved upper cervical segments. Despite the potentially critical location of the tumor, monitored microsurgery resulted in complete removal of the tumor with an intact surrounding capsule, associated fibrous tract, and ellipse of skin with a central dimple. There was an excellent postoperative neurological outcome. The clinical features, imaging studies, treatment options, postoperative outcome, and plausible pathological correlations of IMMTs are discussed.

A percutaneous technique for producing intraspinal mass lesions in experimental animals

1973 ◽  
Vol 38 (4) ◽  
pp. 438-447 ◽  
Author(s):  
John L. Doppman ◽  
Roy Ramsey ◽  
Raymond J. Thies
Keyword(s):  
Spinal Cord ◽  
Percutaneous Technique ◽  
Spinal Cord Blood Flow ◽  
Content Type ◽  
Experimental Animals ◽  
Balloon Catheters ◽  
Perfusion Studies ◽  
Fluoroscopic Control ◽  
Mass Lesions ◽  
Fine Print

✓ The authors describe a percutaneous technique for producing extra- and intramedullary mass lesions in the dog and monkey. Small balloon catheters introduced through needles into the spinal canal can be positioned under fluoroscopic control to simulate epidural masses or masses within the cord. Selective spinal cord arteriography and silicone perfusion studies demonstrate the effect of such masses on spinal cord blood flow.

Treatment and prevention of tethered and retethered spinal cord using a Gore-Tex surgical membrane

1994 ◽  
Vol 80 (4) ◽  
pp. 689-693 ◽  
Author(s):  
Hiroshi K. Inoue ◽  
Satoshi Kobayashi ◽  
Katsumi Ohbayashi ◽  
Hideaki Kohga ◽  
Masaru Nakamura
Keyword(s):  
Spinal Cord ◽  
Spinal Dysraphism ◽  
Tethered Cord ◽  
New Method ◽  
Resonance Imaging ◽  
Imaging Studies ◽  
Content Type ◽  
Follow Up Study ◽  
Treatment And Prevention

✓ The incidence of the tethered cord syndrome after repair of spinal dysraphism is not insignificant. A retethered spinal cord may also develop after an untethering operation. In order to treat and/or prevent the tethered and retethered spinal cord, the authors developed and successfully used a new method in 12 cases. After complete release and reconstruction of the spinal cord, a Gore-Tex surgical membrane was placed over the cord and fixed to the lateral dural surface with stay sutures. During a postoperative follow-up period ranging from 23 months to 7 years, no further neurological deterioration was observed in the 12 patients and magnetic resonance imaging studies showed no adhesion of the spinal cord to the operative site. It is concluded that this simple new method is effective for the treatment and prevention of tethering and/or retethering of the spinal cord, although a longer follow-up study is required.

Spinal intradural arachnoid cysts located anterior to the cervical spinal cord

1999 ◽  
Vol 91 (2) ◽  
pp. 211-215 ◽  
Author(s):  
Saim Kazan ◽  
Özgür Özdemir ◽  
Mahmut Akyüz ◽  
Recai Tuncer
Keyword(s):  
Spinal Cord ◽  
Arachnoid Cyst ◽  
Cervical Spinal Cord ◽  
Arachnoid Cysts ◽  
Cervical Region ◽  
Diagnostic Tools ◽  
Content Type ◽  
Contrast Enhanced Ct ◽  
Intradural Arachnoid Cysts ◽  
Fine Print

✓ The authors describe two rare occurrences of radiographically, surgically, and pathologically confirmed spinal intradural arachnoid cysts (not associated with additional pathological entities) that were located anterior to the cervical spinal cord. These lesions have been reported previously in only eight patients. The patients described in this report were young adults who presented with progressive spastic tetraparesis shortly after sustaining mild cervical trauma and in whom no neurological deficit or bone fracture was demonstrated. The presence of an intradural arachnoid cyst was detected on postcontrast computerized tomography (CT) myelography and on magnetic resonance imaging; both diagnostic tools correctly characterized the cystic nature of the lesion. Plain radiography, plain tomography, and contrast-enhanced CT scans were not diagnostic. In both cases a laminectomy was performed, and the wall of the cyst was excised and fenestrated with subarachnoid space. Postoperatively, the patients made complete neurological recoveries. Based on a review of the literature, arachnoid cysts of the spinal canal may be classified as either extra- or intradural. Intradural arachnoid cysts usually arise posterior to the spinal cord in the thoracic spine region; however, these cysts very rarely develop in the cervical region. The pathogenesis of arachnoid cysts is unclear, although congenital, traumatic and inflammatory causes have been postulated. The authors believe that the formation of an arachnoid cyst cannot be explained by simply one mechanism because, in some reported cases, there has been accidental or iatrogenic trauma in association with congenital lesions. They also note that an intradural arachnoid cyst located anterior to the cervical spinal cord is an extremely rare disorder that may cause progressive myelopathy; however, the postoperative prognosis is good.

Myelomeningocele before birth

1978 ◽  
Vol 49 (5) ◽  
pp. 711-724 ◽  
Author(s):  
Kunihiko Osaka ◽  
Takashi Tanimura ◽  
Akihiko Hirayama ◽  
Satoshi Matsumoto
Keyword(s):  
Spinal Cord ◽  
Chiari Malformation ◽  
Cervical Cord ◽  
Human Embryos ◽  
Content Type ◽  
Fetal Period ◽  
Arnold Chiari Malformation ◽  
Spina Bifida Cystica ◽  
Almost All ◽  
Fine Print

✓ The authors report a study of 92 human embryos and four fetuses with myeloschisis. The characteristics of embryonic myeloschisis compared with spina bifida cystica in infants are: 1) the lesion is often more diffuse, involving the whole spinal cord (12 embryos); 2) the cervical cord is more frequently affected (23 of the remaining 80 embryos); 3) holoprosencephaly is frequently associated (18 embryos); 4) meningocele is not found; and 5) hydrocephalus and Arnold-Chiari malformation are not yet developed. Hydrocephalus and Arnold-Chiari malformation are found in myeloschistic fetuses. Almost all embryos with diffuse and cervical myeloschisis or with holoprosencephaly are extruded before birth by spontaneous abortion. Absence of meningocele in the embryonic period implies that its appearance is deferred to the fetal period. The development of hydrocephalus and Arnold-Chiari malformation also seems to be delayed until the fetal period. Our observation implies that myelomeningocele is induced by non-closure of the neural tube, not by rupture once it was closed. “Neural overgrowth” and disturbed “recanalization process” are discussed in relation to the pathogenesis of myelomeningocele.

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