En bloc removal of the lower lumbar vertebral body for chordoma

2001 ◽  
Vol 94 (2) ◽  
pp. 284-291 ◽  
Author(s):  
Jark J. D. Bosma ◽  
Timothy J. D. Pigott ◽  
Bruce H. Pennie ◽  
David C. Jaffray
Keyword(s):  
Mr Imaging ◽  
En Bloc Resection ◽  
Retroperitoneal Approach ◽  
En Bloc ◽  
Content Type ◽  
First Case ◽  
Lumbar Vertebral Body ◽  
Anterior Retroperitoneal Approach ◽  
Lower Lumbar ◽  
Fine Print

✓ En bloc removal of the lower lumbar vertebral bodies (VBs) is a major surgical challenge. The authors describe the surgical technique used in two patients who presented with chordoma confined to the L-5 and L-4 VB, respectively. These tumors were diagnosed using magnetic resonance (MR) imaging during investigation for back pain. Both patients underwent a combined (two-stage) anterior—posterior approach. In the first case the posterior stage of the procedure was followed by an anterior retroperitoneal approach, and in the second case a lateral retroperitoneal approach was used. Complete en bloc excision of the tumor was achieved in each case, even though in the second case the VB fractured when it was mobilized. The correlation between the MR imaging findings and surgical specimens was remarkable. The authors conclude that en bloc resection is feasible in these cases. Because mobilization of the VB is more difficult in the lateral approach, the authors favor the anterior retroperitoneal approach. The authors anticipate the need for such procedures to increase with the widespread use of MR imaging, which demonstrates the extent of these tumors with remarkable accuracy.

Monostotic fibrous dysplasia of the thoracic spine: clinopathological description and follow up

2004 ◽  
Vol 100 (4) ◽  
pp. 378-381 ◽  
Author(s):  
Mehmet Arazi ◽  
Onder Guney ◽  
Mustafa Ozdemir ◽  
Omer Uluoglu ◽  
Nuket Uzum
Keyword(s):  
Fibrous Dysplasia ◽  
Thoracic Spine ◽  
Histopathological Examination ◽  
En Bloc Resection ◽  
Spinal Tumors ◽  
En Bloc ◽  
Content Type ◽  
Thoracic Spinal ◽  
Fine Print

✓ The authors report the case of a 53-year-old woman with monostotic fibrous dysplasia of the thoracic spine. The patient presented with a 1-month history of pain in the thoracic spinal region. En bloc resection of the lesion was successfully performed via a transthoracic approach, and a histopathological examination confirmed the diagnosis of fibrous dysplasia. At 24-month follow-up examination, pain and vertebral instability were absent. The findings in this case illustrate that, although very rare, monostotic fibrous dysplasia of the thoracic spine should be considered in the differential diagnosis of spinal tumors. Although a consensus for management of this disease has not been achieved, the authors recommend radical removal of all involved bone as well as internal fixation or bone graft—assisted fusion to achieve long-term stabilization.

Total spondylectomy for en bloc resection of lung cancer invading the chest wall and thoracic spine

2004 ◽  
Vol 100 (4) ◽  
pp. 353-357 ◽  
Author(s):  
Masashi Komagata ◽  
Makoto Nishiyama ◽  
Atshuhiro Imakiire ◽  
Hirobumi Kato
Keyword(s):  
Lung Cancer ◽  
Chest Wall ◽  
Thoracic Spine ◽  
Spinal Column ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Term Survival ◽  
Content Type ◽  
Fine Print

✓ Lung cancers invading the chest wall and spinal column are often considered unresectable, and consequently there are few reports describing resection of invasive vertebral lesions. The authors developed a new anterior approach procedure for the en bloc resection of primary lung adenocarcinoma invading the thoracic spine and chest wall, in which the primary tumor does not need to be separated from the vertebrae. The authors describe a total spondylectomy for the en bloc resection of lung cancer invading the spine. A combination of surgical techniques was required, including resection of the osseous elements T-2 and T-3 (the pedicles were excised using a thread saw), anterolateral thoracotomy, apical lobectomy, chest wall resection, vertebrectomy, anterior spinal column reconstruction with a titanium mesh cage containing bioactive glass ceramic, and placement of anterior and posterior spinal instrumentation. At 46 months after surgery, there is no evidence of local recurrence or distant metastasis, and the patient continues to improve. This new procedure allows for the en bloc resection of primary lung tumors and adherent vertebral invasion without separation of the lesion from the vertebra. Thus, surgical management by complete excision of Pancoast tumors can achieve longer-term survival rates without sequelae.

Retrobulbar optic nerve cysticercosis

1996 ◽  
Vol 84 (2) ◽  
pp. 293-296 ◽  
Author(s):  
Charles François Bousquet ◽  
Thierry François Laurent Dufour ◽  
Philippe Claude Eric Derome
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Pathological Findings ◽  
En Bloc ◽  
Content Type ◽  
Nerve Tumor ◽  
First Case ◽  
Aesthetic Results ◽  
Surgical Aspects ◽  
Fine Print

✓ The authors report a first case of intraoptic neurocysticercosis in a 12-year-old boy living on Reunion Island. Cysticercosis of the retrobulbar portion of the optic nerve is rare. Because of the patient's age and disturbances in both visual acuity and visual field, it was initially believed to be an optic nerve tumor. Computerized tomography scans and surgical aspects were confirmed by pathological findings. A conservative removal using en bloc orbitotomy showed good functional and aesthetic results.

Intramedullary plasma cell granuloma in the cervicothoracic spine

2002 ◽  
Vol 97 (2) ◽  
pp. 235-238 ◽  
Author(s):  
Toshimi Aizawa ◽  
Tetsuro Sato ◽  
Yasuhisa Tanaka ◽  
Koshi Kishimoto ◽  
Mika Watanabe ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Plasma Cell ◽  
Bladder Dysfunction ◽  
Imaging Modality ◽  
Plasma Cell Granuloma ◽  
Mr Images ◽  
Content Type ◽  
First Case ◽  
Fine Print

✓ Intraspinal plasma cell granuloma, which is a nonneoplastic entity, is extremely rare. To date, only four cases have been documented in the spinal meninges. The authors report the first case of a C7—T1 intramedullary plasma cell granuloma. After excision of the lesion, the patient's gait and bladder dysfunction improved. This plasma cell granuloma initially showed no delineated mass on T1-weighted magnetic resonance (MR) images, low signal intensity on T2-weighted images, and was well enhanced after administration of gadolinium diethylenetriamine pentaacetic acid. The latter MR imaging modality should help to detect this tumorous lesion. Histologically, the granuloma needs to be distinguished from lymphoplasmacyte-rich meningioma and plasmacytoma.

Dural ossification associated with cervical ossification of the posterior longitudinal ligament: frequency of dural ossification and comparison of neuroimaging modalities in ability to identify the disease

2005 ◽  
Vol 2 (4) ◽  
pp. 425-430 ◽  
Author(s):  
Junichi Mizuno ◽  
Hiroshi Nakagawa ◽  
Naoki Matsuo ◽  
Joonsuk Song
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Double Layer ◽  
Ct Scanning ◽  
Posterior Longitudinal Ligament ◽  
En Bloc ◽  
Content Type ◽  
Bone Window ◽  
Dural Ossification ◽  
Fine Print

Object. The authors' goal in this study was to understand the frequency and pattern of dural ossification (DO, and to evaluate the effectiveness of neuroimaging modalities used to identify this disease in association with ossification of the posterior longitudinal ligament (OPLL). Methods. One hundred eleven patients with OPLL underwent anterior procedures. Of these patients, 17 (15.3%) had associated ossification of the dura mater. There were 10 cases of DO in the 94 patients with segmental OPLL and seven in the 17 patients with nonsegmental OPLL (seven continuous and 10 mixed-type OPLL). Retrospective evaluation of DO was performed by examining plain x-ray films, polytomography studies, computerized tomography (CT) scans, and magnetic resonance (MR) images. A positive correlation was found between the type of OPLL and the frequency of DO (p < 0.01). The DO was classified into the following three types according to shape: 1) isolated type, 2) double-layer type, and 3) en bloc type, based on its relationship with OPLL. There were 10 lesions of the double-layer type, four en bloc type, and three isolated type; the double-layer pattern of DO was the most common. All DOs as well as OPLLs (17 cases) were identified using bone-window CT scanning. Polytomography was used successfully to identify all 12 OPLLs, whereas DO was recognized in seven of the 12 cases. Magnetic resonance imaging could not identify DO (none of the 17 cases), although OPLL was identified on MR imaging in 12 of the 17 cases. Conclusions. Three patterns of DO associated with OPLL, that is, isolated, double-layer, and en bloc types, were confirmed by retrospective analysis of neuroimaging findings. Nonsegmental OPLL was likely to be accompanied by DO. Bone-window CT scanning was most useful for identification of DO as well as OPLL, whereas MR imaging was ineffective in recognizing DO.

Modified approach for the selective treatment of temporal lobe epilepsy: transsylvian—transcisternal mesial en bloc resection

1998 ◽  
Vol 88 (5) ◽  
pp. 855-862 ◽  
Author(s):  
Peter Vajkoczy ◽  
Karsten Krakow ◽  
Stefan Stodieck ◽  
Bernd Pohlmann-Eden ◽  
Peter Schmiedek
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Parahippocampal Gyrus ◽  
Oculomotor Nerve Palsy ◽  
En Bloc ◽  
Content Type ◽  
Mesial Temporal Lobe ◽  
Fine Print

Object. The authors propose a novel surgical approach for amygdalohippocampectomy (AH) in patients with temporal lobe epilepsy. Via a transsylvian—transcisternal route, the parahippocampal gyrus is directly exposed from its medial aspect, thus allowing a standardized en bloc resection of the temporomesial epileptogenic structures—the amygdala, anterior hippocampus, parahippocampal gyrus, and subiculum. Additional anatomical studies have been performed for standardization of this approach. Methods. From 1990 to 1996, 32 patients presenting with medically intractable mesial temporal lobe epilepsy underwent AH via the transsylvian—transcisternal approach. Preoperative computerized tomography and magnetic resonance imaging revealed temporomesial lesions in 16 patients. Histopathological examination revealed cavernous malformations in seven patients, low-grade astrocytomas in four, hamartomas in three, and gangliogliomas in two patients. Specimens obtained in patients with no lesions were diagnosed as hippocampal sclerosis in all cases. No patient experienced permanent morbidity. Nine percent of the patients developed a temporary partial oculomotor nerve palsy. Only one patient developed a postoperative visual field deficit with a contralateral quadrantanopsia. With respect to seizure outcome, all patients benefited from surgery. At follow-up evaluation (mean 26.4 months), 80% of the patients were free from seizures (Engel Class I). Eight patients in this group were no longer receiving medication. Seventeen percent had experienced only one to several seizures since surgery (Engel Class II) and 3% reported a worthwhile improvement (Engel Class III). Conclusions. In contrast to previously described standard techniques for AH, the transsylvian—transcisternal approach presented in this study offers improved anatomical orientation and intraoperative control over the mesial temporal lobe and preserves the lateral as well as the laterobasal temporal lobe.

A rare case of primary sellar melanoma

2004 ◽  
Vol 100 (5) ◽  
pp. 931-934 ◽  
Author(s):  
Jochen Tüttenberg ◽  
Wolfram Fink ◽  
Walter Back ◽  
Frederik Wenz ◽  
Dirk Schadendorf ◽  
...  
Keyword(s):  
Mr Imaging ◽  
S100 Protein ◽  
Sella Turcica ◽  
Progression Free Survival ◽  
Residual Tumor ◽  
Optic Chiasm ◽  
Pituitary Macroadenoma ◽  
Content Type ◽  
First Case ◽  
Fine Print

✓ The authors report on the case of a 37-year-old woman in whom a primary sellar malignant melanoma mimicking a hemorrhagic pituitary macroadenoma was treated. This entity is exceedingly rare; only five cases are described in the literature. The patient presented with rapid deterioration of vision within a 2-week period. After an ophthalmological diagnosis of chiasmal syndrome was made, magnetic resonance (MR) imaging of the head revealed an intra- and suprasellar mass that was elevating and compressing the optic chiasm. Because of the signal heterogeneity of the lesion a hemorrhagic pituitary macroadenoma was assumed; the lesion was transsphenoidally resected. Histological examination of the specimen showed a malignant melanocytic tumor with immunopositivity for S100 protein and HMB-45. Despite extensive staging no other primary melanotic tumor was found. Thus, a primary sellar melanoma was diagnosed. Postoperative MR images demonstrated no residual tumor. For adjuvant therapy the region around the sella turcica received 40.4 Gy stereotactically guided radiation. A 24-month follow-up examination revealed no tumor recurrence. This represents the sixth case of such a lesion reported in the literature, the third case evaluated using MR imaging, and the first case with a progression-free survival of 24 months. Thus, the authors advocate that management of primary sellar melanoma should include gross-total removal and postoperative stereotactic radiotherapy.

Pilocytic astrocytoma of a spinal nerve root

2002 ◽  
Vol 97 (1) ◽  
pp. 110-112 ◽  
Author(s):  
Mark Robert Philipson ◽  
Jake Timothy ◽  
Aruna Chakrobarthy ◽  
Gerry Towns
Keyword(s):  
Mr Imaging ◽  
Pilocytic Astrocytoma ◽  
Nerve Root ◽  
Residual Tumor ◽  
Conus Medullaris ◽  
Spinal Nerve ◽  
Spinal Nerve Root ◽  
Content Type ◽  
First Case ◽  
Fine Print

✓ A case of pilocytic astrocytoma involving a spinal nerve root is reported. A 39-year-old woman presented with a 1-year history of progressive pain and numbness, predominantly in the S-1 dermatome. Magnetic resonance (MR) imaging revealed an intradural lesion at the tip of the conus medullaris. The intradural tumor was excised as was the sacrificed nerve root. Histological examination showed a pilocytic astrocytoma in which there were unusual features of calcification and ossification. At 3-year follow-up review MR imaging demonstrated no residual tumor. To the best of the authors' knowledge, this is the first case of a primary pilocytic astrocytoma, a tumor typically of central nervous system origin, arising from a spinal nerve root.

En bloc resection of multilevel cervical chordoma with C-2 involvement

2005 ◽  
Vol 2 (2) ◽  
pp. 199-205 ◽  
Author(s):  
Laurence D. Rhines ◽  
Daryl R. Fourney ◽  
Abdolreza Siadati ◽  
Ian Suk ◽  
Ziya L. Gokaslan
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Biological Behavior ◽  
Upper Cervical Spine ◽  
En Bloc ◽  
Content Type ◽  
Upper Cervical ◽  
The Right ◽  
Cervical Chordoma ◽  
Fine Print

✓ Chordomas are locally aggressive neoplasms with an extremely high propensity to recur locally following resection, despite adjuvant therapy. This biological behavior has led most authors to conclude that en bloc resection provides the best chance for the patient's prolonged disease-free survival and possible cure. The authors present a case of an extensive upper cervical chordoma treated by en bloc resection, reconstruction, and long-segment stabilization. Total spondylectomy of C2–4 with sacrifice of the right C2–4 nerve roots and a segment of the right vertebral artery was performed. The inherent anatomical complexities of en bloc resection in the upper cervical spine are discussed. To the authors' knowledge, this represents the first report of an en bloc resection for multilevel cervical chordoma.

Gamma knife radiosurgery in the management of cavernous sinus meningiomas

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 68-73 ◽  
Author(s):  
Pierre-Hugues Roche ◽  
Jean Régis ◽  
Henry Dufour ◽  
Henri-Dominique Fournier ◽  
Christine Delsanti ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Tumor Growth ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Gamma Knife Radiosurgery ◽  
Surgical Removal ◽  
Content Type ◽  
Cavernous Sinus Meningioma ◽  
The Mean ◽  
Fine Print

Object. The authors sought to assess the functional tolerance and tumor control rate of cavernous sinus meningiomas treated by gamma knife radiosurgery (GKS). Methods. Between July 1992 and October 1998, 92 patients harboring benign cavernous sinus meningiomas underwent GKS. The present study is concerned with the first 80 consecutive patients (63 women and 17 men). Gamma knife radiosurgery was performed as an alternative to surgical removal in 50 cases and as an adjuvant to microsurgery in 30 cases. The mean patient age was 49 years (range 6–71 years). The mean tumor volume was 5.8 cm3 (range 0.9–18.6 cm3). On magnetic resonance (MR) imaging the tumor was confined in 66 cases and extensive in 14 cases. The mean prescription dose was 28 Gy (range 12–50 Gy), delivered with an average of eight isocenters (range two–18). The median peripheral isodose was 50% (range 30–70%). Patients were evaluated at 6 months, and at 1, 2, 3, 5, and 7 years after GKS. The median follow-up period was 30.5 months (range 12–79 months). Tumor stabilization after GKS was noted in 51 patients, tumor shrinkage in 25 patients, and enlargement in four patients requiring surgical removal in two cases. The 5-year actuarial progression-free survival was 92.8%. No new oculomotor deficit was observed. Among the 54 patients with oculomotor nerve deficits, 15 improved, eight recovered, and one worsened. Among the 13 patients with trigeminal neuralgia, one worsened (contemporary of tumor growing), five remained unchanged, four improved, and three recovered. In a patient with a remnant surrounding the optic nerve and preoperative low vision (3/10) the decision was to treat the lesion and deliberately sacrifice the residual visual acuity. Only one transient unexpected optic neuropathy has been observed. One case of delayed intracavernous carotid artery occlusion occurred 3 months after GKS, without permanent deficit. Another patient presented with partial complex seizures 18 months after GKS. All cases of tumor growth and neurological deficits observed after GKS occurred before the use of GammaPlan. Since the initiation of systematic use of stereotactic MR imaging and computer-assisted modern dose planning, no more side effects or cases of tumor growth have occurred. Conclusions. Gamma knife radiosurgery was found to be an effective low morbidity—related tool for the treatment of cavernous sinus meningioma. In a significant number of patients, oculomotor functional restoration was observed. The treatment appears to be an alternative to surgical removal of confined enclosed cavernous sinus meningioma and should be proposed as an adjuvant to surgery in case of extensive meningiomas.

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