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.

Hydroxyapatite laminar spacers and titanium miniplates in cervical laminoplasty

2002 ◽  
Vol 97 (3) ◽  
pp. 323-329 ◽  
Author(s):  
Takeo Goto ◽  
Kenji Ohata ◽  
Toshihiro Takami ◽  
Misao Nishikawa ◽  
Naohiro Tsuyuguchi ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spinous Process ◽  
Spinal Tumors ◽  
Cervical Laminoplasty ◽  
En Bloc ◽  
Content Type ◽  
Hardware Failure ◽  
Fine Print ◽  
Posterior Elements

Object. The authors describe a new surgical technique for cervical laminoplasty that was performed in 25 patients. The posterior elements along with the various ligaments are removed en bloc and are stabilized in a lift-up position by placing hydroxyapatite (HA) laminar spacers and titanium miniplates and screws. The procedure and clinical results are discussed. Methods. The posterior spinal elements, including the lamina(e), spinous process(es), and various attached ligaments, are removed en bloc by incising the lamina in its lateral aspect. Trapezoid-shaped HA spacers are placed between the cut ends of the laminae or between the laminae and lateral masses bilaterally at each level. Malleable titanium miniplates and screws are used for fixation of the spacers. The fixation of transected laminae was judged to be successful. Postoperative care included application of a soft neck collar for 1 week but no further restriction of activity. Surgery-related outcome was assessed in the 21 patients who attended more than 6 months of follow up after laminoplasty. There were 18 men and three women who ranged in age from 27 to 81 years. Cervical stenotic myelopathy was demonstrated in 15 patients who underwent decompressive and expansive laminoplasty, and spinal tumors were documented in six patients who underwent a nonexpansive laminoplasty. Postoperative and follow-up computerized tomography scans demonstrated no hardware failure. Bone formation around the spacers was observed either at 6- or at 9-month follow-up examination in all 21 patients. Fusion of the reconstructed laminae was found to be completed at 12 months in all 18 patients able to attend follow up for this duration. Spinal alignment and the range of motion of the cervical spine were well preserved. In patients with stenotic cervical myelopathy, neurological and anatomical outcome of canal expansion were satisfactory. Conclusions. This technique enables rigid laminoplasty while maintaining anatomical and biomechanical integrity of posterior elements of cervical spine. Expansive and nonexpansive laminoplasty procedures are possible.

Preservation of olfaction in anterior craniofacial approaches

1993 ◽  
Vol 79 (1) ◽  
pp. 48-52 ◽  
Author(s):  
Robert F. Spetzler ◽  
James M. Herman ◽  
Stephen Beals ◽  
Edward Joganic ◽  
John Milligan
Keyword(s):  
Cribriform Plate ◽  
Csf Leak ◽  
En Bloc ◽  
Reconstructive Procedures ◽  
Content Type ◽  
The Mean ◽  
Ethmoid Sinuses ◽  
Fine Print ◽  
Csf Leaks

✓ Through the combined efforts of neurosurgeons, head and neck surgeons, and craniofacial surgeons, the standard transbasal approach to the frontal fossa has been modified to include removal of the orbital roofs, nasion, and ethmoid sinuses. This approach has been combined further with facial disassembly procedures to provide extensive midline exposure to the midface and clival region. Extended frontal approaches, however, necessitate removal of the crista galli and sectioning of the olfactory rootlets with the associated risk of anosmia, cerebrospinal fluid (CSF) leak, and the need for complex reconstruction of the frontal floor. To avoid these problems, the authors have modified the technique of handling the cribriform plate to preserve the olfactory unit. Circumferential osteotomy cuts are made around the cribriform plate to allow an en bloc removal with its attachment to both the dura and underlying mucosa. Opening of the dura is avoided and the cribriform bone is used to reconstruct the floor. Four patients underwent this approach, for treatment of an angiofibroma in three and a fibrosarcoma in one. The mean follow-up period was 7 months. No patients developed a CSF leak, and within 8 weeks olfaction had returned in all patients. There was no other associated morbidity. These data suggest that this modification of the transbasilar approach can alleviate extensive reconstructive procedures and CSF leaks while preserving olfaction.

CyberKnife stereotactic radiosurgical treatment of spinal tumors for pain control and quality of life

2005 ◽  
Vol 2 (5) ◽  
pp. 540-549 ◽  
Author(s):  
Jeffrey W. Degen ◽  
Gregory J. Gagnon ◽  
Jean-Marc Voyadzis ◽  
Donald A. McRae ◽  
Michael Lunsden ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Well Being ◽  
Spinal Tumors ◽  
Content Type ◽  
Cyberknife Radiosurgery ◽  
The Mean ◽  
Initial Score ◽  
Fine Print

Object. The authors conducted a study to assess safety, pain, and quality of life (QOL) outcomes following CyberKnife radiosurgical treatment of spinal tumors. Methods. Data obtained in all patients with spinal tumors who underwent CyberKnife radiosurgery at Georgetown University Hospital between March 2002 and March 2003 were analyzed. Patients underwent examination, visual analog scale (VAS) pain assessment, and completed the 12-item Short Form Health Survey (SF-12) before treatment and at 1, 3, 6, 8, 12, 18, and 24 months following treatment. Fifty-one patients with 72 lesions (58 metastatic and 14 primary) were treated. The mean follow-up period was 1 year. Pain was improved, with the mean VAS score decreasing significantly from 51.5 to 21.3 at 4 weeks (p < 0.001). This effect on pain was durable, with a mean score of 17.5 at 1 year, which was still significantly decreased (p = 0.002). Quality of life was maintained throughout the study period. After 18 months, physical well-being was 33 (initial score 32; p = 0.96) and mental well-being was 43.8 (initial score 44.2; p = 0.97). (The mean SF-12 score is 50 ± 10 [standard deviation].) Adverse effects included self-limited dysphagia (three cases), diarrhea (two cases), lethargy (three cases), paresthesias (one case), and wound dehiscence (one case). Conclusions. CyberKnife radiosurgery improves pain control and maintains QOL in patients treated for spinal tumors. Early adverse events are infrequent and minor. The authors await long-term follow-up data to determine late complications and tumor control rates.

Efficacy of percutaneous vertebroplasty combined with radiotherapy in osteolytic metastatic spinal tumors

2005 ◽  
Vol 2 (3) ◽  
pp. 243-248 ◽  
Author(s):  
Jee-Soo Jang ◽  
Sang-Ho Lee
Keyword(s):  
Pain Relief ◽  
Percutaneous Vertebroplasty ◽  
Invasive Procedure ◽  
Spinal Tumors ◽  
Percutaneous Injection ◽  
Content Type ◽  
Spinal Stabilization ◽  
Before And After ◽  
Fine Print

Object. Vertebroplasty involves the percutaneous injection of polymethylmethacrylate into collapsed vertebral bodies due to hemangioma, osteoporosis, or malignant tumor. The purpose of this study was to evaluate the merits and efficacy of percutaneous vertebroplasty (PVP) combined with radiotherapy in treating patients with osteolytic metastatic spinal tumors (OMSTs). Methods. Twenty-eight patients with OMSTs underwent PVP for the treatment of 72 vertebrae after administration of a local anesthetic or induction of general anesthesia for pain relief and spinal stabilization. Radiotherapy for suppressing tumor or inducing pain relief was performed immediately after PVP in 22 patients. Pain levels were assessed before and after the procedure by using a visual analog scale (VAS), and follow-up assessment was conducted at 1, 3, 6, and 9 months. On postoperative Day 3, marked-to-complete VAS score—based pain relief was achieved in 13 patients (48%) and moderate relief was demonstrated in 11 (41%). The mean VAS pain score was reduced from 8.2 to 3, and major complications were absent in all cases. Follow-up plain radiography was performed to assess vertebral column stability. Neither additional vertebral collapse in the treated vertebrae nor neurological deterioration was observed. Conclusions. Percutaneous vertebroplasty is a minimally invasive procedure and, when combined with radiotherapy, seems to be effective in providing pain relief and stabilization in patients with OMSTs.

Polymethylmethacrylate-augmented screw fixation for stabilization in metastatic spinal tumors

2002 ◽  
Vol 96 (1) ◽  
pp. 131-134 ◽  
Author(s):  
Jee Soo Jang ◽  
Sang Ho Lee ◽  
Chang Hun Rhee ◽  
Seung Hoon Lee
Keyword(s):  
Vertebral Column ◽  
Screw Fixation ◽  
Neurological Deficits ◽  
Spinal Tumors ◽  
Complete Relief ◽  
Content Type ◽  
Vertebral Bodies ◽  
The Mean ◽  
Fine Print

✓ Screw fixation augmented with polymethylmethacrylate (PMMA) or some other biocompatible bone cement has been used in patients with osteoporosis requiring spinal fusion. No clinical studies have been conducted on PMMA-augmented screw fixation for stabilization of the vertebral column in patients with metastatic spinal tumors. The purpose of this study was to determine whether screw fixation augmented with PMMA might be suitable in patients treated for multilevel metastatic spinal tumors. Ten patients with metastatic spinal tumors involving multiple vertebral levels underwent stabilization procedures in which PMMA was used to augment screw fixation after decompression of the spinal cord. Within 15 days, partial or complete relief from pain was obtained in all patients postoperatively. Two of four patients in whom neurological deficits caused them to be nonambulatory before surgery were able to ambulate postoperatively. Neither collapse of the injected vertebral bodies nor failure of the screw fixation was observed during the mean follow-up period of 6.7 months. Screw fixation augmented with PMMA may offer stronger stabilization and facilitate the instrumentation across short segments in the treatment of multilevel metastatic spinal tumors.

En bloc resection of an intracavernous oculomotor nerve schwannoma and grafting of the oculomotor nerve with sural nerve

1999 ◽  
Vol 91 (6) ◽  
pp. 1045-1049 ◽  
Author(s):  
Giuseppe Mariniello ◽  
Alenka Horvat ◽  
Vinko V. Dolenc
Keyword(s):  
Sural Nerve ◽  
Recovery Of Function ◽  
En Bloc Resection ◽  
Vertical Movement ◽  
Bloc Resection ◽  
Oculomotor Nerve ◽  
En Bloc ◽  
Upper Eyelid ◽  
Content Type

✓ A case in which a left oculomotor nerve schwannoma treated by en bloc resection of the lesion and grafting of the oculomotor nerve with sural nerve is presented. Recovery of nerve function was partial, but useful and cosmetically good. The last follow-up examination performed 2 years after surgery revealed recovery of function in the elevator muscle of the upper eyelid, together with slight vertical movement of the eye.

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.

Calcifying pseudoneoplasms of the spine with myelopathy

2000 ◽  
Vol 93 (2) ◽  
pp. 291-293 ◽  
Author(s):  
Matthew T. Mayr ◽  
Stephen Hunter ◽  
Scott C. Erwood ◽  
Regis W. Haid
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Thoracic Spine ◽  
Radiological Evaluation ◽  
Pathological Findings ◽  
Content Type ◽  
Progressive Myelopathy ◽  
Fine Print

✓ The authors describe two cases of calcifying pseudoneoplasms, rare degenerative lesions that mimic tumor or infection. One case involved the cervical spine and the second the thoracic spine. Both patients experienced progressive myelopathy from extradural compression of the spinal cord. The radiological evaluation, pathological findings in the lesions, treatment, and follow up are described. Total or subtotal excision can relieve symptoms and prevent recurrence of this lesion.

Trichinoechinococcosis T-5

2000 ◽  
Vol 92 (2) ◽  
pp. 225-228 ◽  
Author(s):  
H. S. Bhatoe ◽  
S. S. Bakshi ◽  
G. L. N. Swamy
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cystic Lesion ◽  
Histopathological Examination ◽  
Cord Compression ◽  
Resonance Imaging ◽  
Thoracic Spinal Cord ◽  
Content Type ◽  
Remarkable Improvement ◽  
Thoracic Spinal ◽  
Fine Print

✓ Echinococcosis affecting the spine is rare. The authors present the case of a 23-year-old man in whom features of thoracic spinal cord compression were demonstrated. Magnetic resonance imaging of the thoracic spine revealed an extradural cystic lesion involving the spine and paraspinal musculature. At surgery echinococcosis was confirmed, and subsequent histopathological examination also revealed Trichinella infestation of the paraspinal musculature. After undergoing decompressive surgery and albendazole therapy, the patient made a remarkable improvement. Although primary echinococcosis can affect the spine, concomitant infestation with Trichinella has not been reported. Surgery has to be followed by albendazole therapy.

Sign in / Sign up

Export Citation Format

Share Document