De novo development of a cavernous malformation of the spinal cord following spinal axis radiation

1999 ◽  
Vol 90 (2) ◽  
pp. 234-238 ◽  
Author(s):  
J. Nozipo Maraire ◽  
Saleem I. Abdulrauf ◽  
Scott Berger ◽  
Jonathan Knisely ◽  
Issam A. Awad
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
De Novo ◽  
Pathological Examination ◽  
High Dose ◽  
Mr Image ◽  
Lower Extremity Weakness ◽  
Cavernous Malformations ◽  
Content Type ◽  
Fine Print

✓ Analysis of recent reports has suggested that cavernous malformations (CMs) of the brain may have an acquired pathogenesis and a dynamic pathophysiological composition, with documented appearance of new lesions in familial cases and following radiotherapy. The authors report the first case of demonstrated de novo formation of an intramedullary CM following spinal radiation therapy. A 17 year-old boy presented with diabetes insipidus and delayed puberty. Evaluation of endocrine levels revealed hypopituitarism, and magnetic resonance (MR) imaging demonstrated an infundibular mass. The patient underwent a pterional craniotomy and removal of an infundibular germinoma. The MR image of the spine demonstrated normal results. The patient received craniospinal radiation therapy and did well. He presented 5 years later with acute onset of back pain, lower-extremity weakness and numbness, and difficulty with urination. An MR image obtained of the spine revealed an intramedullary T-7 lesion; its signal characteristics were consistent with a CM. The patient was initially managed conservatively but developed progressive myelopathy and partial Brown—Séquard syndrome. Although he received high-dose steroids and bed rest, his symptoms worsened. He underwent a costotransversectomy and excision of a hemorrhagic vascular lesion via an anterolateral myelotomy. Pathological examination confirmed features of a CM. The patient has done well and was walking without assistance within 4 weeks of surgery. De novo genesis of CMs may be associated with prior radiation therapy to the spinal cord.

Spinal cord astrocytoma: pathological and treatment considerations

1995 ◽  
Vol 83 (4) ◽  
pp. 590-595 ◽  
Author(s):  
Kern J. Minehan ◽  
Edward G. Shaw ◽  
Bernd W. Scheithauer ◽  
Dean L. Davis ◽  
Burton M. Onofrio
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Survival Rate ◽  
Pilocytic Astrocytoma ◽  
Histological Type ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Content Type ◽  
Fibrillary Astrocytoma ◽  
Fine Print

✓ Seventy-nine patients underwent surgery, with or without radiation therapy, for astrocytoma of the spinal cord. There were 43 tumors (54%) classified as pilocytic astrocytoma and 25 (32%) as diffuse fibrillary astrocytoma. Eleven tumors (14%) could not be classified other than as astrocytoma, “type not otherwise specified.” The 10-year overall survival rate for all 79 patients was 50% but significantly differed by histological type: 81% for patients with pilocytic astrocytoma compared to 15% for those with diffuse fibrillary astrocytoma. Tumor grade by the Kernohan, et al., or St. Anne—Mayo methods was also a significant predictor of survival in patients with diffuse fibrillary astrocytoma. The extent of surgical resection (biopsy vs. subtotal resection vs. gross total resection) did not significantly impact survival among patients with pilocytic or nonpilocytic astrocytomas of the spinal cord, although there was a trend toward poorer survival in patients undergoing some degree of resection as opposed to biopsy. Postoperative radiation therapy improved survival but did so more for diffuse fibrillary astrocytoma than pilocytic astrocytoma. In this series, histological type was the most significant predictor of survival in patients with astrocytoma of the spinal cord. The survival rate was highest in patients who underwent biopsy followed by postoperative radiation therapy.

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.

Spinal blood flow in 24-hour megadose glucocorticoid treatment in awake pigs

2003 ◽  
Vol 99 (3) ◽  
pp. 286-290
Author(s):  
Wolf R. Drescher ◽  
Karen P. Weigert ◽  
Mathias H. Bünger ◽  
Ebbe S. Hansen ◽  
Cody E. Bünger
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Blood Flow ◽  
Body Weight ◽  
High Dose ◽  
Content Type ◽  
Significant Difference ◽  
Cord Injury ◽  
Methylprednisolone Treatment ◽  
Fine Print

Object. Because of the controversy regarding the benefits of 24-hour administration of methylprednisolone in patients with spinal cord injury (SCI), it is important to investigate its mechanism of action and side effects. This study was conducted to determine if high-dose methylprednisolone modulates neural and vertebral blood flow in an awake large-sized animal model without SCI. Methods. From a group of 18 immature female domestic pigs born to nine different litters, nine animals were randomly allocated to receive methylprednisolone treatment, whereas their nine female siblings served as controls. Drug or placebo was applied in a blinded fashion by a third person not involved in the study. The following treatment for SCI, as suggested by the North American Spinal Cord Injury Study, was administered to the awake pig: methylprednisolone (30 mg/kg of body weight) was infused into the jugular vein during a 15-minute period, followed by a 45-minute pause, and the infusion was maintained over a 23-hour period at a dose of 5.4 mg/kg body weight/hour. By means of the radioactive tracer microsphere technique, spinal cord blood flow (SCBF) was measured in the awake standing pig in the cerebrum, and in spinal gray and white matter, nerve roots, endplates, cancellous bone, cortical shell, and T12—L2 discs. Blood flow was measured before, 1 hour after initiation of infusion, and 24 hours postinfusion. Examination of blood flow in the neural and vertebral tissue samples, as well as of central hemodynamics, revealed no significant difference between the experimental and control groups, and this parity was maintained throughout the experimental phases. Conclusions. In the awake pig model, 24-hour methylprednisolone treatment does not modulate cerebral or SCBF, nor does it increase the risk for vertebral osteonecrosis by producing vertebral ischemia.

Radiosurgery and radiotherapy: observations and clarifications

2004 ◽  
Vol 101 (4) ◽  
pp. 585-589 ◽  
Author(s):  
Douglas Kondziolka ◽  
L. Dade Lunsford ◽  
Jay S. Loeffler ◽  
William A. Friedman
Keyword(s):  
Radiation Therapy ◽  
Vascular Lesions ◽  
High Dose ◽  
Wide Field ◽  
Content Type ◽  
Stereotactic Radiation ◽  
Task Forces ◽  
National Organizations ◽  
Fractionated Radiation Therapy ◽  
Fine Print

Object. Radiosurgery and radiation therapy represent important but unique treatment paradigms for patients with certain neoplasms, vascular lesions, or functional disorders. The authors discuss their differences. Methods. Reviewing the authors' experiences shows how the roles of these approaches vary just as their techniques differ. The distinct differences include the method of target localization (intraoperative compared with pretreatment) and irradiation (focused compared with wide-field), their radiobiology (effects of a single high-dose compared with multiple fractions), the physicians and other health personnel involved in the conduct of these procedures (surgical team compared with radiation team), and the expectations that follow treatment. During the last decade, considerable confusion has grown regarding nomenclature, requisite physician training, and the roles of the physician and surgeon. Ten years ago, two task forces on radiosurgery were created by national organizations in neurosurgery and radiation oncology to address these issues of procedural conduct and quality-assurance requirements. At the present time these guidelines are widely ignored. Currently, many patients, payers, and regulatory agencies are bewildered. What are the differences among stereotactic radiosurgery, fractionated radiation therapy, and stereotactic radiation therapy? Radiosurgery is to radiation therapy as microsurgery is to “microtherapy.” Conclusions. In this report the authors discuss terminology, training, and physician roles in this expanding field.

Anterolateral decompression for metastatic epidural spinal cord tumors

1985 ◽  
Vol 62 (3) ◽  
pp. 344-348 ◽  
Author(s):  
M. Chris Overby ◽  
Allen S. Rothman
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Neurological Status ◽  
Cord Compression ◽  
Metastatic Carcinoma ◽  
Anterior Decompression ◽  
Spinal Cord Tumors ◽  
Posterior Stabilization ◽  
Content Type ◽  
Fine Print

✓ Since 1981, 12 patients with epidural spinal cord compression from metastatic carcinoma have been treated surgically by a modified costotransversectomy approach for anterolateral decompression. Before surgery, all patients had received dexamethasone, and had deteriorated neurologically despite radiation therapy, chemotherapy, or steroid therapy. Postoperatively, nine patients (75%) improved neurologically and were ambulatory, two (17%) had no change in neurological status, and one patient was unchanged initially but deteriorated and died 8 weeks later. Anterolateral decompression by a modified costotransversectomy approach should be considered for management of ventrally located tumors or when posterior stabilization is considered a possible requirement following a proposed anterior decompression.

Evaluation of time-dependent spread of tissue damage in experimental spinal cord injury by killed-end evoked potential: effect of high-dose methylprednisolone

2003 ◽  
Vol 98 (1) ◽  
pp. 56-62 ◽  
Author(s):  
Chikashi Fukaya ◽  
Yoichi Katayama ◽  
Masahiko Kasai ◽  
Jun Kurihara ◽  
Sadahiro Maejima ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Tissue Damage ◽  
Conduction Block ◽  
Time Dependent ◽  
High Dose ◽  
Injury Site ◽  
Content Type ◽  
Cord Injury ◽  
Fine Print

Object. Histopathological studies on spinal cord injury (SCI) have demonstrated time-dependent spread of tissue damage during the initial several hours postinjury. When the long tract within the spinal cord is stimulated, a large monophasic positivity occurs at the injury site. This type of potential, termed the killed-end evoked potential (KEEP), indicates that a nerve impulse approaches but does not pass beyond the injury site. The authors tested the hypothesis that the damage spread can be evaluated as a progressive shift of the KEEP on a real-time basis. The effect of high-dose methylprednisolone sodium succinate (MPSS) on the spread of tissue damage was also examined by this methodology. Methods. The KEEP was recorded using an electrode array placed on the spinal cord at the T-10 level in cats. This electrode array consisted of multiple 0.2-mm-diameter electrodes, each separated by 0.5 mm. Spinal cord injury was induced using a vascular clip (65 g pinching pressure for 30 seconds). The midline posterior surface of the spinal cord was stimulated bipolarly at the C-7 level by applying a single pulse at supramaximal intensity. During the initial period of 6 hours postinjury, the localization of the largest KEEP shifted progressively up to 2.5 mm rostral from the injury site. The amplitude of the KEEP recorded at the injury site decreased to 55 to 70% and became slightly shortened in latency as the localization of the largest KEEP shifted rostrally. These findings imply that the injury site KEEP represents the volume-conducted potential of the largest KEEP at the site of the conduction block. It moved away from the injury site in association with the damage spread, and this was confirmed histopathologically. A decrease in amplitude of KEEP at the injury site appeared to be the most sensitive measure of the damage spread, because the amplitude of the volume-conducted KEEP is inversely proportional to the square of the distance between the recording site and site of conduction block. Administered immediately after SCI, MPSS clearly inhibited these events, especially within 30 minutes postinjury. Conclusions. The KEEP enables sequential evaluation to be made of the time-dependent spread of tissue damage in SCI in the same animal. It is, therefore, useful for detecting the effect of therapeutic interventions and for determining the therapeutic time window. The efficiency of MPSS to inhibit the spread of damaged tissue appeared to be maximized when it was administered within the initial 30-minute period postinjury.

Formation of intracerebral cavernous malformations after brain radiation treatment for central nervous system neoplasia in children

1998 ◽  
Vol 88 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Jeffrey J. Larson ◽  
William S. Ball ◽  
Kevin E. Bove ◽  
Kerry R. Crone ◽  
John M. Tew
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Radiation Therapy ◽  
Radiation Treatment ◽  
Cavernous Malformation ◽  
Cerebral Cavernous Malformations ◽  
Cavernous Malformations ◽  
Content Type ◽  
Brain Radiation ◽  
Fine Print

Object. Radiation is a common treatment modality for pediatric brain tumors. The authors present a retrospective review of six children who developed cerebral cavernous malformations after they underwent radiation treatment for central nervous system (CNS) neoplasia and propose two possible models to explain the formation of cavernous malformations. Methods. Three boys, aged 13, 9, and 17 years, suffered intracerebral hemorrhages from cerebral cavernous malformations 87, 94, and 120 months, respectively, after they received whole-brain radiation therapy (WBRT) for acute lymphocytic leukemia. A 10-year-old girl and a 19-year-old man developed temporal lobe cavernous malformations 46 and 48 months, respectively, after they received radiation therapy for posterior fossa astrocytomas. A 12-year-old girl developed a temporal lobe cavernous malformation 45 months after WBRT was administered for a medulloblastoma. In all of these cases the cavernous malformation appeared in the irradiated field, was not known to be present prior to radiation therapy, and developed after a latency period following treatment. The incidence of cavernous malformations in these patients suggests that children who undergo radiation therapy of the brain may have an increased risk of hemorrhage. Conclusions. Two possible models may explain the formation of cavernous malformations following brain radiation in these patients. First, the cavernous malformations may form de novo in response to the radiation. Second, the cavernous malformations may have been present, but radiographically occult, at the time of radiation therapy and may have hemorrhaged in response to the radiation. The authors conclude that cavernous malformations may develop after brain radiation and propose a possible mechanism for this formation.

Dynamic nature of cavernous malformations: a prospective magnetic resonance imaging study with volumetric analysis

2000 ◽  
Vol 93 (6) ◽  
pp. 981-986 ◽  
Author(s):  
Richard E. Clatterbuck ◽  
John L. Moriarity ◽  
Ilhan Elmaci ◽  
Roland R. Lee ◽  
Steven N. Breiter ◽  
...  
Keyword(s):  
Mr Imaging ◽  
De Novo ◽  
Volume Data ◽  
Mr Images ◽  
Cavernous Malformations ◽  
Content Type ◽  
Signal Characteristics ◽  
The Mean ◽  
Fine Print

Object. Although cavernous malformations (CMs) are not detected in angiographic studies, they have a characteristic appearance on magnetic resonance (MR) images. A number of reports published in the last decade have focused on the behavior of these lesions within the clinical environment. However, little has been published about the evolution of CMs over time, as observed in imaging studies. To understand imaging-documented changes in CMs over time, we analyzed MR images of 114 cavernous malformations in 68 patients who were followed prospectively.Methods. For each CM the location, volume, and MR imaging signal characteristics were recorded. Volume data were available for 107 lesions from initial images. The mean volume of these 107 CMs was 2779 mm3. The lesions ranged in size from 0.5 to 46,533 mm3 (46.5 cm3). Volume data from a second set of images were available for 76 CMs (mean interval from first imaging session 26 months), and from a third set of images for 24 lesions (mean interval from second imaging session 18 months). Over the first follow-up interval, the mean volume change was −991 mm3 (a decrease of approximately 1 cm3) and over the second interval the mean volume change was −642 mm3. Although these mean volume changes appear modest, volume changes in single lesions during follow-up intervals were more dramatic, with decreases as large as 45,629 mm3 (45.6 cm3) and increases as large as 6,074 mm3 (6 cm3). Serial examinations of the MR imaging signal characteristics of these CMs demonstrate a trend for maturation of blood products from a subacute, to a mixed, and finally to a chronic appearance. Three lesions appeared de novo during the follow-up period.Conclusions. On the basis of their analysis, the authors conclude that CMs exhibit a range of dynamic behaviors including enlargement, regression, and de novo formation, as well as progression through a series of characteristic MR imaging appearances.

Biological activity of adult cavernous malformations: a study of 56 patients

2005 ◽  
Vol 102 (2) ◽  
pp. 342-347 ◽  
Author(s):  
Ulrich Sure ◽  
Sandra Freman ◽  
Oliver Bozinov ◽  
Ludwig Benes ◽  
Adrian M. Siegel ◽  
...  
Keyword(s):  
De Novo ◽  
Hypoxia Inducible Factor ◽  
Adult Patients ◽  
Nuclear Antigen ◽  
Cavernous Malformations ◽  
Content Type ◽  
Proliferative Markers ◽  
Endothelial Growth Factor ◽  
Fine Print ◽  
Mib 1

Object. Cerebral cavernous malformations (CCMs) have previously been considered as congenital and biologically static malformations. On the other hand, the potential for growth and de novo generation of CCMs have also been reported. It is therefore important to study the proliferative and neoangiogenetic capacity of these lesions. Methods. The authors studied the surgical specimens of 56 CCMs (23 deep and 33 superficial) obtained from adult patients. The proliferative activity of the endothelium and the neoangiogenetic capacity of these lesions were considered through immunohistochemical anaylsis of proliferating cell nuclear antigen (PCNA), MIB-1, Flk-1, vascular endothelial growth factor (VEGF), hypoxia-inducible factor (HIF)-1α, and endoglin antibodies. Positive immunostaining of endothelial cells occurred in 86% of patients for PCNA and in 38% of the cases for MIB-1. The expression of Flk-1 was observed in the endothelium of 71% of the cases, for VEGF in 41%, for HIF-1α in 48.1%, and for endoglin in 63.6% of the cases. The correlation of immunohistochemical and clinical data indicated that VEGF was expressed in significantly less deep-seated lesions when compared with superficial CCMs. Neither the expression of the proliferative markers nor the expression of the angiogenetic antibodies correlated with patient age at surgery, sex, or the number of recent prior hemorrhagic episodes in the patients. Conclusions. The CCMs from adult patients are active lesions exhibiting endothelial proliferation and neoangiogenesis. According to the data in this study, neoangiogenesis is more prominent in superficial CCMs than in deep-seated CCMs and is not associated with recent prior hemorrhages.

Pediatric spinal epidural metastases

1991 ◽  
Vol 74 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Steven L. Klein ◽  
Robert A. Sanford ◽  
Michael S. Muhlbauer
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Soft Tissue ◽  
Spinal Cord Compression ◽  
Osteogenic Sarcoma ◽  
Cord Compression ◽  
Decompressive Laminectomy ◽  
Content Type ◽  
Spinal Epidural ◽  
Fine Print

✓ A total of 2259 children with solid malignant tumors were treated at St. Jude Children's Research Hospital between the years 1962 and 1987. Of these, 112 (5%) developed spinal epidural metastasis with spinal cord compression during the course of their disease process. Metastatic epidural spinal cord compression was caused most commonly by Ewing's sarcoma and neuroblastoma, followed by osteogenic sarcoma, rhabdomyosarcoma, Hodgkin's disease, soft-tissue sarcoma, germ-cell tumor, Wilm's tumor, and (rarely) hepatoma. There was no significant difference in outcome between patients with small-cell tumors (neuroblastoma, Hodgkin's disease, and germ-cell tumors) who received only chemotherapy and/or radiation therapy and the patients with similar lesions who received a decompressive laminectomy alone or prior to chemotherapy and/or radiation therapy. Patients with spinal cord compression from metastatic sarcoma (Ewing's sarcoma, soft-tissue sarcoma, osteogenic sarcoma, and rhabdomyosarcoma) showed a significant improvement with decompressive laminectomy alone or before medical therapy, compared to those who received radiation therapy and/or chemotherapy without posterior decompression. Pediatric tumors invade the spinal canal via the neural foramen, compressing the spinal cord in a circumferential manner, allowing decompressive laminectomy (posterior approach) to be an effective surgical approach. Sixty-six percent of children who had no evidence of motor or sensory function below the level of the compression became ambulatory after surgical decompression and medical treatment, regardless of tumor type.

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