Epithelioid hemangioendothelioma of the spine

✓ Epithelioid hemangioendothelioma (EH) is a rare tumor of vascular origin. The authors describe two cases of spinal EH, one involving the T-10 vertebra and the second involving the upper cervical spine. In the first case the patient underwent resection of the tumor; this case represents the longest reported follow-up period for spinal EH. In the second case, extensive involvement of C-2, C-3, and C-4 as well as encasement of both vertebral arteries precluded safe tumor resection, and posterior occipitocervical stabilization was performed. The patient subsequently died of metastatic disease. The findings in these two cases underscore the difficulty in predicting the clinical behavior of spinal EH based solely on histological and clinical features as well as the uncertainty of the roles of surgery, chemotherapy, and radiotherapy in the oncological management of a spinal tumor for which clinical data are very limited.

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Posterior Resection via Atlantoaxial Lamina Space Without Internal Fixation for C1-C2 Intraspinal Tumors: A Novel Approach

10.21203/rs.3.rs-64404/v1 ◽

2020 ◽

Author(s):

Beiping Ouyang ◽

Xiaobao Zou ◽

Ling Ni ◽

Su Ge ◽

Yuyue Chen ◽

...

Keyword(s):

Cervical Spine ◽

Internal Fixation ◽

Statistical Significance ◽

Tumor Resection ◽

Neck Disability Index ◽

Upper Cervical Spine ◽

One Stage ◽

Flexion Extension ◽

Upper Cervical

Abstract Background: Intraspinal upper cervical C1-C2 tumors pose a challenge in resection. Internal fixation has routinely been used to prevent the occurrence of instability after atlantoaxial laminectomy for resection of C1-C2 intraspinal tumors, that sacrifices the motion of upper cervical spine. We therefore present this report to evaluate the efficacy and safety of one-stage posterior resection of these tumors through the atlantoaxial lamina space without internal fixation.Methods: Ten suitably selected patient with C1-C2 intraspinal tumors were included in this study (period January 2016 to January 2018). All the patients underwent one-stage posterior resection through atlantoaxial lamina space without internal fixation. The efficacy of the procedure was documented by comparing postoperative and preoperative outcome scores [The visual analogue scores (VAS), Japanese Orthopedic Association scores (JOA), neck disability index (NDI)], cervical physiological curvature and range of flexion-extension. Safety was assessed by documenting the complications associated with surgery and subsequent sequale. Results: 6 Male and 4 female patients with mean age 36 years (range 17 years to 50 years) underwent total tumor resection through posterior only approach using the atlantoaxial lamina space for the following tumors: 4 neurofibromas, 3 schwannomas and 3 meningiomas. The mean follow-up was 31.2 months (range 24–36 months). These patients’ pathological types included. Postoperative VAS and NDI were lower than those of pre-operation with statistical significance (p < 0.05) while postoperative JOA was higher than that of pre-operation (p < 0.05). The physiological curvature and activity of cervical spine were maintained at latest follow up. Three patients suffered cerebrospinal fluid leakages that was managed consertaviley with no added intervention required. No patient had local recurrence at latest follow-up.Conclusion: One-stage posterior resection through atlantoaxial lamina space without fixation is an effective and safe treatment for the upper cervical intraspinal tumor. In our experience this technique can remove tumor completely and does not cause instability to C1-C2 joint.

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Posterior resection via atlantoaxial lamina space without internal fixation for C1-C2 intraspinal tumors: A novel approach

10.21203/rs.3.rs-64404/v2 ◽

2020 ◽

Author(s):

Beiping Ouyang ◽

Xiaobao Zou ◽

Ling Ni ◽

Su Ge ◽

Yuyue Chen ◽

...

Keyword(s):

Cervical Spine ◽

Internal Fixation ◽

Statistical Significance ◽

Tumor Resection ◽

Neck Disability Index ◽

Upper Cervical Spine ◽

One Stage ◽

Flexion Extension ◽

Upper Cervical

Abstract Background: Intraspinal upper cervical C1-C2 tumors pose a challenge in resection. Internal fixation has routinely been used to prevent the occurrence of instability after atlantoaxial laminectomy for resection of C1-C2 intraspinal tumors, that sacrifices the motion of upper cervical spine. We therefore present this report to evaluate the efficacy and safety of one-stage posterior resection of these tumors through the atlantoaxial lamina space without internal fixation. Methods: Ten suitably selected patient with C1-C2 intraspinal tumors were included in this study (period January 2016 to January 2018). All the patients underwent one-stage posterior resection through atlantoaxial lamina space without internal fixation. The efficacy of the procedure was documented by comparing postoperative and preoperative outcome scores [The visual analogue scores (VAS), Japanese Orthopedic Association scores (JOA), neck disability index (NDI)], cervical physiological curvature and range of flexion-extension. Safety was assessed by documenting the complications associated with surgery and subsequent sequale. Results: 6 Male and 4 female patients with mean age 36 years (range 17 years to 50 years) underwent total tumor resection through posterior only approach using the atlantoaxial lamina space for the following tumors: 4 neurofibromas, 3 schwannomas and 3 meningiomas. The mean follow-up was 31.2 months (range 24–36 months). These patients’ pathological types included. Postoperative VAS and NDI were lower than those of pre-operation with statistical significance (p < 0.05) while postoperative JOA was higher than that of pre-operation (p < 0.05). The physiological curvature and activity of cervical spine were maintained at latest follow up. Three patients suffered cerebrospinal fluid leakages that was managed consertaviley with no added intervention required. No patient had local recurrence at latest follow-up. Conclusion: One-stage posterior resection through atlantoaxial lamina space without fixation is an effective and safe treatment for the upper cervical intraspinal tumor. In our experience this technique can remove tumor completely and does not cause instability to C1-C2 joint.

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Massive osteolysis of the skull and upper cervical spine

Journal of Neurosurgery ◽

10.3171/jns.1997.87.5.0773 ◽

1997 ◽

Vol 87 (5) ◽

pp. 773-780 ◽

Cited By ~ 5

Author(s):

Houman Khosrovi ◽

Orlando Ortiz ◽

Howard H. Kaufman ◽

Sydney S. Schochet ◽

Gurijala N. Reddy ◽

...

Keyword(s):

Cervical Vertebrae ◽

Disease Process ◽

The Body ◽

Spinal Instability ◽

Upper Cervical Spine ◽

New Bone Formation ◽

Content Type ◽

Massive Osteolysis ◽

Upper Cervical

✓ Massive osteolysis is a type of idiopathic osteolysis in which there is spontaneous onset of bone resorption. Almost any bone in the body can be affected. The authors present the case of a 62-year-old man diagnosed with massive osteolysis of the occipital bone and the upper two cervical vertebrae. Despite extensive pneumocephalus, no neurological sign or spinal instability was evident. In this case 4000 cGy of radiation in 200-cGy fractions was administered to the diseased area while the patient was kept in a Miami-J collar. At the 2-year follow-up examination, arrest of the disease process and new bone formation was evident on radiographic studies.

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A 3D-Printed Model-Assisted Cervical Spine Instrumentation after Tumor Resection in a 4-Year-Old Child: A Case Report

Pediatric Neurosurgery ◽

10.1159/000514248 ◽

2021 ◽

pp. 1-7

Author(s):

Marko Jug

Keyword(s):

Cervical Spine ◽

3D Model ◽

Intraoperative Complications ◽

Tumor Resection ◽

Upper Cervical Spine ◽

Spine Instrumentation ◽

Cord Injury ◽

Spinal Navigation ◽

Upper Cervical ◽

3D Printed

Introduction: In the case of tumor resection in the upper cervical spine, a multilevel laminectomy with instrumented fixation is required to prevent kyphotic deformity and myelopathy. Nevertheless, instrumentation of the cervical spine in children under the age of 8 years is challenging due to anatomical considerations and unavailability of specific instrumentation. Case Presentation: We present a case of 3D-printed model-assisted cervical spine instrumentation in a 4-year-old child with post-laminectomy kyphotic decompensation of the cervical spine and spinal cord injury 1 year after medulloblastoma metastasis resection in the upper cervical spine. Due to unavailability of specific instrumentation, 3D virtual planning was used to assess and plan posterior cervical fixation. Fixation with 3.5 mm lateral mass and isthmic screws was suggested and the feasibility of fixation was confirmed “in vitro” in a 3D-printed model preoperatively to reduce the possibility of intraoperative implant-spine mismatch. Intraoperative conditions completely resembled the preoperative plan and 3.5 mm polyaxial screws were successfully used as planned. Postoperatively the child made a complete neurological recovery and 2 years after the instrumented fusion is still disease free with no signs of spinal decompensation. Discussion/Conclusion: Our case shows that posterior cervical fixation with the conventional screw-rod technique in a 4-year-old child is feasible, but we suggest that suitability and positioning of the chosen implants are preoperatively assessed in a printed 3D model. In addition, a printed 3D model offers the possibility to better visualize and sense spinal anatomy “in vivo,” thereby helping screw placement and reducing the chance for intraoperative complications, especially in the absence of intraoperative spinal navigation.

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Lactotransferrin-Related Breast Amyloidosis: Report of a First Case

International Journal of Surgical Pathology ◽

10.1177/10668969211016053 ◽

2021 ◽

pp. 106689692110160

Author(s):

Mingfei Yan ◽

Mark Rodgers ◽

Aparna Harbhajanka ◽

Hannah Gilmore

Keyword(s):

Breast Lesion ◽

Hematologic Malignancy ◽

Genetic Disorders ◽

Rare Condition ◽

Myoepithelial Cells ◽

Hematological Disorders ◽

First Case ◽

Benign Nature ◽

Extensive Involvement

Breast amyloidosis is a rare condition which is mostly associated with hematological disorders or hereditary genetic disorders. Imaging findings of breast amyloidosis can mimic malignancy, which often leads to biopsy or excision of the lesion. Here, we presented a case of localized lactotransferrin-related breast amyloidosis in an elderly female patient. Histologic examination revealed extensive involvement of breast lobules by amorphous amyloid materials, with attenuation of lobular structures and prominent calcifications. Positive immunostains for myoepithelial cells helped to exclude the possibility of invasive carcinoma. The patient had no hematologic malignancy besides immunoglobulin G lambda monoclonal gammopathy of undetermined significance. Mass spectrometry of the breast amyloid identified lactotransferrin and no immunoglobulin or its light chain. On follow-up, the patient showed no recurrence of the breast lesion after local excision nor showed other systematic comorbidities, indicating the benign nature of the lesion. This first report of lactotransferrin-related amyloidosis may represent a special type of localized breast amyloidosis that has no correlation with systematic disorders.

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Posterior Temporary C1-2 Pedicle Screws Fixation for the Treatment of Unstable C1-2 Complex Fractures: Minimum of 2-Year Follow-Up

Global Spine Journal ◽

10.1177/21925682211039186 ◽

2021 ◽

pp. 219256822110391

Author(s):

Yakubu Ibrahim ◽

Hao Li ◽

Geng Zhao ◽

Suomao Yuan ◽

Yiwei Zhao ◽

...

Keyword(s):

Cervical Spine ◽

Internal Fixation ◽

Neck Disability Index ◽

Pedicle Screws ◽

Rotary Motion ◽

Upper Cervical Spine ◽

Complex Fractures ◽

Upper Cervical ◽

Better Than

Study Design: Retrospective. Objectives: To present rarely reported complex fractures of the upper cervical spine (C1-C2) and discuss the clinical results of the posterior temporary C1-2 pedicle screws fixation for C1-C2 stabilization. Methods: A total of 19 patients were included in the study (18 males and 1 female). Their age ranged from 23 to 66 years (mean age of 39.6 years). The patients were diagnosed with complex fractures of the atlas and the axis of the upper cervical spine and underwent posterior temporary C1-2 pedicle screws fixation. The patients underwent a serial postoperative clinical examination at approximately 3, 6, 9 months, and annually thereafter. The neck disability index (NDI) and the range of neck rotary motion were used to evaluate the postoperative clinical efficacy of the patients. Results: The average operation time and blood loss were 110 ± 25 min and 50 ± 12 ml, respectively. The mean follow-up was 38 ± 11 months (range 22 to 60 months). The neck rotary motion before removal, immediately after removal, and the last follow-up were 68.7 ± 7.1°, 115.1 ± 11.7°, and 149.3 ± 8.9° ( P < 0.01). The NDI scores before and after the operation were 42.7 ± 4.3, 11.1 ± 4.0 ( P < 0.01), and the NDI score 2 days after the internal fixation was removed was 7.3 ± 2.9, which was better than immediately after the operation ( P < 0.01), and 2 years after the internal fixation was removed. The NDI score was 2.0 ± 0.8, which was significantly better than 2 days after the internal fixation was taken out ( P < 0.001). Conclusions: Posterior temporary screw fixation is a good alternative surgical treatment for unstable C1-C2 complex fractures.

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Atlantoaxial instability in Dyggve-Melchior-Clausen syndrome

Journal of Neurosurgery Spine ◽

10.3171/spi.2002.96.1.0112 ◽

2002 ◽

Vol 96 (1) ◽

pp. 112-117 ◽

Cited By ~ 2

Author(s):

Frank Kandziora ◽

Luitgard Neumann ◽

Klaus John Schnake ◽

Cyrus Khodadadyan-Klostermann ◽

Stefan Rehart ◽

...

Keyword(s):

Screw Fixation ◽

Cord Compression ◽

Atlantoaxial Instability ◽

Posterior Fixation ◽

Content Type ◽

First Case ◽

Solid Fusion ◽

Specific Care ◽

Preventable Complication

✓ Dyggve-Melchior-Clausen (DMC) syndrome is a very rare disease. Only 58 cases have been reported in the literature. The syndrome is probably an autosomal recessive inherited disorder, one that is characterized by mental retardation, the short-spine type of dwarfism, and skeletal abnormalities, especially of the spine, hands, and pelvis. Atlantoaxial instability— induced spinal cord compression is a serious and preventable complication. The purpose of this report is to describe the first case of DMC syndrome in which anterior transarticular atlantoaxial screw fixation was used to treat atlantoaxial instability. The authors report on a 17-year-old man with DMC syndrome and concomitant severe atlantoaxial instability. Computerized tomography scanning and magnetic resonance angiography demonstrated an irregular course of the vertebral artery (VA) at C-2, which made a posterior fixation procedure impossible. Additionally, transoral fusion was impossible because the patient was unable to open his mouth sufficiently. Therefore, the patient underwent anterior transarticular screw fixation. Follow-up examination 36 weeks after surgery showed solid fusion without implant failure. In conclusion, treatment of atlantoaxial instability in DMC syndrome must be considered. Specific care must be taken to determine the course of the VA. If posterior and transoral fusion are impossible, anterior transarticular atlantoaxial screw fixation might be the only alternative.

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Syrinx shunt to posterior fossa cisterns (syringocisternostomy) for bypassing obstructions of upper cervical theca

Journal of Neurosurgery ◽

10.3171/jns.1992.77.6.0871 ◽

1992 ◽

Vol 77 (6) ◽

pp. 871-874 ◽

Cited By ~ 23

Author(s):

Thomas H. Milhorat ◽

Walter D. Johnson ◽

John I. Miller

Keyword(s):

Posterior Fossa ◽

Symptomatic Improvement ◽

Foramen Magnum ◽

Content Type ◽

Results Of Treatment ◽

Spinal Subarachnoid Space ◽

Upper Cervical ◽

Spinal Arachnoiditis ◽

Chiari I

✓ Syrinx shunts to the spinal subarachnoid space are likely to fail if the cerebrospinal fluid pathways rostral to the syrinx are blocked. To bypass obstructions at or below the level of the foramen magnum, a technique was developed for shunting the syrinx to the posterior fossa cisterns, termed “syringocisternostomy.” Syrinxes were shunted to the cisterna magna in two patients with spinal arachnoiditis and to the cerebellopontine angle cistern in four patients with Chiari I malformations. There was symptomatic improvement and collapse of the syrinx in each case, with no complications or recurrences over a follow-up interval of 14 to 27 months (average 20.3 months). The surgical technique and results of treatment are described.

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Atlantal fracture with transverse ligament disruption in a child

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.4.peds0973 ◽

2009 ◽

Vol 4 (3) ◽

pp. 196-198 ◽

Cited By ~ 2

Author(s):

Marcelo D. Vilela ◽

Eric C. Peterson

Keyword(s):

Cervical Spine ◽

Surgical Treatment ◽

Upper Cervical Spine ◽

Transverse Ligament ◽

Jefferson Fracture ◽

Fractures In Children ◽

Upper Cervical ◽

Almost All ◽

Ligament Disruption

Even though fractures in children with immature spines occur predominantly in the upper cervical spine, isolated C-1 fractures are relatively rare. The fractures in almost all cases reported to date were considered stable due to the presence of the intact transverse ligament. The authors report the case of a young child who sustained a Jefferson fracture and in whom MR imaging revealed disruption of the transverse ligament. Although surgical treatment has been suggested as the treatment of choice for children with unstable atlantoaxial injuries, external immobilization alone allowed a full recovery in the patient with no evidence of instability at follow-up.

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Intracerebral Whipple disease: unusual location and bone destruction

Journal of Neurosurgery ◽

10.3171/jns.2002.97.4.0988 ◽

2002 ◽

Vol 97 (4) ◽

pp. 988-991 ◽

Cited By ~ 9

Author(s):

Ziya Akar ◽

Necmettin Tanriover ◽

Saffet Tüzgen ◽

Bülent Canbaz ◽

Haldun Erman ◽

...

Keyword(s):

Chronic Diarrhea ◽

Bone Destruction ◽

Cns Involvement ◽

Content Type ◽

First Case ◽

Whipple Disease ◽

The Central Nervous System ◽

Mass Lesions ◽

Systemic Bacterial Infection

✓ Whipple disease is a rare systemic bacterial infection characterized by migratory polyarthralgia and chronic diarrhea. In 5 to 20% of patients with Whipple disease, the infection may present initially with or eventually develop symptoms related to the central nervous system (CNS). Although CNS involvement is a known feature of systemic Whipple disease, intracerebral mass lesions are uncommon. Mass lesions in these cases are typically deep seated and multifocal. Corticosubcortical regions are unusual sites of CNS involvement in cases of Whipple disease. In the present paper, the authors describe the first case of Whipple disease to feature a single corticosubcortical solid frontoparietal mass lesion that displayed homogeneous contrast enhancement on neuroimaging and was associated with bone destruction of the calvaria. Although CNS involvement has been observed in the form of deep-seated mass lesions in cases of systemic Whipple disease, unusual manifestations should be kept in mind during diagnosis and follow-up review in these patients.

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