Thoracic spinal iophendylate-induced arachnoiditis mimicking an intramedullary spinal cord neoplasm

✓Iophendylate (Pantopaque or Myodil) was commonly used from the 1940s until the late 1980s for myelography, cisternography, and ventriculography. Although such instances are rare, several different long-term sequelae have been described in the literature and associated with intrathecal iophendylate. The authors describe an unusual case of arachnoiditis caused by residual thoracic iophendylate imitating an expansile intramedullary lesion on magnetic resonance images obtained 30 years after the initial myelographic injection.

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An extramedullary plasmacytoma originating from the thoracic spinal cord: magnetic resonance imaging findings

Journal of Neurosurgery Spine ◽

10.3171/spi.2007.6.1.57 ◽

2007 ◽

Vol 6 (1) ◽

pp. 57-59 ◽

Cited By ~ 3

Author(s):

Bo Gao ◽

Xuejian Wang

Keyword(s):

Spinal Cord ◽

Magnetic Resonance ◽

Bone Marrow Involvement ◽

Magnetic Resonance Images ◽

Extramedullary Plasmacytoma ◽

Rare Tumor ◽

Histological Findings ◽

Resonance Imaging ◽

Thoracic Spinal Cord ◽

Thoracic Spinal

✓Extramedullary plasmacytoma (EMP) is a rare tumor. The authors report a case of an EMP originating in the thoracic spinal cord. To their knowledge this is the first report in which an EMP originating in this location is described. Isointense and hyperintense signals were seen on T1-weighted and T2-weighted magnetic resonance images, respectively, with marked irregular contrast enhancement and extensive edema. No evidence of bone marrow involvement or multiple myeloma was noted. The histological findings were compatible with an EMP.

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Intramedullary spinal cord ganglioglioma presenting with abnormal abdominal wall movement

Neurosurgical FOCUS ◽

10.3171/foc.2004.17.4.8 ◽

2004 ◽

Vol 17 (4) ◽

pp. 1-2 ◽

Cited By ~ 3

Author(s):

Saeid Aslanabadi ◽

Ramin Azhough ◽

Parviz Samad Motlagh ◽

Shahram Hadidchi ◽

Ali Dastranj Tabrizi ◽

...

Keyword(s):

Spinal Cord ◽

Magnetic Resonance ◽

Abdominal Wall ◽

Anterior Abdominal Wall ◽

Magnetic Resonance Images ◽

Intramedullary Tumor ◽

Belly Dance ◽

Good Recovery ◽

Intramedullary Spinal Cord ◽

Wall Movement

The authors present a case of intramedullary ganglioglioma in a 6-year-old girl. Since the age of 4 months the patient had experienced a spontaneous wavy undulating movement of her anterior abdominal wall resembling a severe peristalsis. The movement was continuous even during sleep, and this symptom was named “belly dance.” Magnetic resonance images revealed an intramedullary tumor with ill-defined borders, and the lesion was partially resected. The patient made a good recovery, although 4 years postsurgery her scoliosis had progressed.

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Surgical decompression of thoracic spinal stenosis in achondroplasia: indication and outcome

Journal of Neurosurgery Spine ◽

10.3171/2012.4.spine1220 ◽

2012 ◽

Vol 17 (2) ◽

pp. 164-172 ◽

Cited By ~ 4

Author(s):

Carmen Vleggeert-Lankamp ◽

Wilco Peul

Keyword(s):

Spinal Cord ◽

Magnetic Resonance ◽

Spinal Cord Compression ◽

Spinal Canal ◽

Japanese Orthopaedic Association ◽

Cord Compression ◽

Magnetic Resonance Images ◽

Kyphotic Angle ◽

Thoracic Spinal Cord ◽

Thoracic Spinal

Object The achondroplastic spinal canal is narrow due to short pedicles and a small interpedicular distance. Compression of neural structures passing through this canal is therefore regularly encountered but rarely described. Symptomatology, radiological evaluation, and treatment of 20 patients with achondroplasia who underwent decompression of the thoracic spinal cord are described and outcome is correlated with the size of the spinal canal and the thoracolumbar kyphotic angle. Methods Scores from the modified Japanese Orthopaedic Association scale, Nurick scale, European Myelopathy scale, Cooper myelopathy scale for lower extremities, and Odom criteria before and after surgery were compared. Magnetic resonance imaging was evaluated to determine the size of the spinal canal, spinal cord compression, and presence of myelomalacia. The thoracolumbar kyphotic angle was measured using fluoroscopy. Results Patient symptomatology included deterioration of walking pattern, pain, cramps, spasms, and incontinence. Magnetic resonance images of all patients demonstrated spinal cord compression due to degenerative changes. Surgery resulted in a slight improvement on all the ranking scales. Surgery at the wrong level occurred in 15% of cases, but no serious complications occurred. The mean thoracolumbar kyphotic angle was 20°, and no correlation was established between this angle and outcome after surgery. No postoperative increase in this angle was reported. There was also no correlation between size of the spinal canal and outcome. Conclusions Decompressive surgery of the thoracic spinal cord in patients with achondroplasia can be performed safely if anatomical details are taken into consideration. Spondylodesis did not appear essential. Special attention should be given to the method of surgery, identification of the level of interest, and follow-up of the thoracolumbar kyphotic angle.

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Nondysraphic pediatric intramedullary spinal cord lipomas

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.9.peds09238 ◽

2010 ◽

Vol 5 (2) ◽

pp. 172-178 ◽

Cited By ~ 10

Author(s):

Karen L. Fleming ◽

Laurence Davidson ◽

Ignacio Gonzalez-Gomez ◽

J. Gordon McComb

Keyword(s):

Spinal Cord ◽

Los Angeles ◽

Retrospective Chart Review ◽

Thoracic Spinal Cord ◽

Intramedullary Spinal Cord ◽

Institutional Review ◽

Thoracic Spinal ◽

Stabilization Procedure

Object Intramedullary spinal cord lipomas not associated with dysraphism are infrequently reported. When present, they typically occur in children and have a predilection for the cervical and thoracic spinal cord. The authors review the presentation, treatment, and disease course in 5 pediatric patients, and compare the outcomes with previously reported cases. Methods With institutional review board approval, a retrospective chart review was undertaken at Childrens Hospital Los Angeles. Results Four patients with intramedullary spinal cord lipomas and 1 patient with a lipoblastoma, none associated with dysraphism, were retrospectively reviewed. There were 2 boys and 3 girls ranging in age from 2 months to 4 years. Four patients underwent a laminectomy or laminoplasty with one or more subtotal resections. One patient initially underwent a decompressive laminoplasty without debulking. The median follow-up was 8 years (range 12 months–11 years). Two patients had regrowth of their lipoma, necessitating a second surgery in one patient and 3 debulking surgeries in the other. Postoperatively, 3 patients developed mild kyphosis, none significant enough to require orthopedic intervention. One patient underwent a stabilization procedure at the time of the initial laminectomy and tumor debulking. No patient received chemotherapy or radiation. At the most recent follow-up visit, patients demonstrated improved neurological function when compared with preoperative status. Conclusions In addition to a decompressive laminectomy, debulking of the lipoma provides the best long-term neurological outcome. Gross-total excision is not warranted and usually is not possible. Long-term follow-up is needed, and repeat debulking of the lipoma is indicated if there is an increase in tumor size due to hyperplasia of residual adipocytes, when tumor growth is associated with neurological deterioration.

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Intramedullary spinal cord ganglioglioma presenting as hyperhidrosis: unique symptoms and magnetic resonance imaging findings

Journal of Neurosurgery Spine ◽

10.3171/2012.11.spine12530 ◽

2013 ◽

Vol 18 (2) ◽

pp. 184-188 ◽

Cited By ~ 5

Author(s):

Tomohiro Murakami ◽

Izumi Koyanagi ◽

Takahisa Kaneko ◽

Akihiro Yoneta ◽

Yoshiko Keira ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Lower Extremity ◽

Initial Symptom ◽

Resonance Imaging ◽

Thoracic Spinal Cord ◽

Intramedullary Spinal Cord ◽

Thoracic Spinal ◽

The Right

Hyperhidrosis is caused by a sympathetic dysfunction of the central or peripheral nervous system. Intramedullary spinal cord lesions can be a cause of hyperhidrosis. The authors report a rare case of intramedullary thoracic spinal cord ganglioglioma presenting as hyperhidrosis. This 16-year-old boy presented with abnormal sweating on the right side of the neck, chest, and the right arm that had been occurring for 6 years. Neurological examination revealed mild motor weakness of the right lower extremity and slightly decreased sensation in the left lower extremity. Hyperhidrosis was observed in the right C3–T8 dermatomes. Magnetic resonance imaging showed an intramedullary tumor at the right side of the spinal cord at the T2–3 level. The tumor showed partial enhancement after Gd administration. The patient underwent removal of the tumor via hemilaminectomy of T2–3. Only subtotal resection was achieved because the margins of the tumor were unclear. Histopathological examination revealed ganglioglioma. Hyperhidrosis gradually improved after surgery. Hyperhidrosis is a rare clinical manifestation of intramedullary spinal cord tumors, and only a few cases have been reported in the literature. The location of the tumor origin, around the right gray matter of the lateral spinal cord, may account for the hyperhidrosis as the initial symptom in this patient. Physicians should examine the spinal cord using MRI studies when a patient has hyperhidrosis with some motor or sensory symptoms of the extremities.

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Multisession CyberKnife Radiosurgery for Intramedullary Spinal Cord Arteriovenous Malformations

Neurosurgery ◽

10.1227/01.neu.0000215891.25153.ba ◽

2006 ◽

Vol 58 (6) ◽

pp. 1081-1089 ◽

Cited By ~ 89

Author(s):

John Sinclair ◽

Steven D. Chang ◽

Iris C. Gibbs ◽

John R. Adler

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Arteriovenous Malformations ◽

Conus Medullaris ◽

Spinal Angiography ◽

Resonance Imaging ◽

Intramedullary Spinal Cord ◽

Cyberknife Radiosurgery

Abstract OBJECTIVE: Intramedullary spinal cord arteriovenous malformations (AVMs) have an unfavorable natural history that characteristically involves myelopathy secondary to progressive ischemia and/or recurrent hemorrhage. Although some lesions can be managed successfully with embolization and surgery, AVM size, location, and angioarchitecture precludes treatment in many circumstances. Given the poor outlook for such patients, and building on the successful experience with radiosurgical ablation of cerebral AVMs, our group at Stanford University has used CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) to treat selected spinal cord AVMs since 1997. In this article, we retrospectively analyze our preliminary experience with this technique. METHODS: Fifteen patients with intramedullary spinal cord AVMs (nine cervical, three thoracic, and three conus medullaris) were treated by image-guided SRS between 1997 and 2005. SRS was delivered in two to five sessions with an average marginal dose of 20.5 Gy. The biologically effective dose used in individual patients was escalated gradually over the course of this study. Clinical and magnetic resonance imaging follow-up were carried out annually, and spinal angiography was repeated at 3 years. RESULTS: After a mean follow-up period of 27.9 months (range, 3–59 mo), six of the seven patients who were more than 3 years from SRS had significant reductions in AVM volumes on interim magnetic resonance imaging examinations. In four of the five patients who underwent postoperative spinal angiography, persistent AVM was confirmed, albeit reduced in size. One patient demonstrated complete angiographic obliteration of a conus medullaris AVM 26 months after radiosurgery. There was no evidence of further hemorrhage after CyberKnife treatment or neurological deterioration attributable to SRS. CONCLUSION: This description of CyberKnife radiosurgical ablation demonstrates its feasibility and apparent safety for selected intramedullary spinal cord AVMs. Additional experience is necessary to ascertain the optimal radiosurgical dose and ultimate efficacy of this technique.

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A Survey of 65 Tumors within the Spinal Cord: Surgical Results and the Importance of Preoperative Magnetic Resonance Imaging

Neurosurgery ◽

10.1227/00006123-199111000-00002 ◽

1991 ◽

Vol 29 (5) ◽

pp. 651-657 ◽

Cited By ~ 82

Author(s):

Jacques Brotchi ◽

Olivier Dewitte ◽

Danielle Balériaux ◽

Arlette Vandesteene ◽

Christian Raftopoulos ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Surgical Results ◽

Resonance Imaging ◽

Intramedullary Spinal Cord ◽

Cavitron Ultrasonic Surgical Aspirator ◽

Highly Sensitive ◽

Previously Treated ◽

Ultrasonic Surgical Aspirator

Abstract Between January 1984 and December 1990. 65 intramedullary spinal cord tumors were diagnosed and operated on. In this series, all patients underwent magnetic resonance imaging investigations and were operated on with the Cavitron ultrasonic surgical aspirator whenever necessary. Major surgical difficulties have been found in patients previously treated by radiotherapy with or without biopsy. We found magnetic resonance imaging to be a highly sensitive imaging procedure and the method of choice for visualizing tumors within the spinal cord. Nevertheless, accurate diagnosis may only be suggested by magnetic resonance imaging, rather than made definitively. Surgery is necessary in every case in order to obtain a definite diagnosis. Radical surgery can be performed when a plane exists between the tumor and the normal spinal cord: biopsy or debulking with the Cavitron ultrasonic surgical aspirator should be performed when the tumor is infiltrative. We have performed 33 so-called total resections, 22 partial resections, and 10 biopsies, among which 5 were performed on lipomas. Surgical results were assessed at 3 months after surgery, showing 35 improvements (53%), 24 stabilizations (37%), and 6 deteriorations (10%).

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Feasibility of a novel diagnostic chart of intramedullary spinal cord tumors in magnetic resonance imaging

Spinal Cord ◽

10.1038/sc.2014.127 ◽

2014 ◽

Vol 52 (10) ◽

pp. 769-773 ◽

Cited By ~ 13

Author(s):

H Arima ◽

T Hasegawa ◽

D Togawa ◽

Y Yamato ◽

S Kobayashi ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Resonance Imaging ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord

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Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study

Cancers ◽

10.3390/cancers13133244 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3244

Author(s):

Jenny Pettersson-Segerlind ◽

Alexander Fletcher-Sandersjöö ◽

Charles Tatter ◽

Gustav Burström ◽

Oscar Persson ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cord Compression ◽

Magnetic Resonance Images ◽

Motor Deficit ◽

Tumor Control ◽

Time To Surgery ◽

Spinal Meningiomas

Spinal meningiomas are the most common adult primary spinal tumor, constituting 24–45% of spinal intradural tumors and 2% of all meningiomas. The aim of this study was to assess postoperative complications, long-term outcomes, predictors of functional improvement and differences between elderly (≥70 years) and non-elderly (18–69 years) patients surgically treated for spinal meningiomas. Variables were retrospectively collected from patient charts and magnetic resonance images. Baseline comparisons, paired testing and regression analyses were used. In conclusion, 129 patients were included, with a median follow-up time of 8.2 years. Motor deficit was the most common presenting symptom (66%). The median time between diagnosis and surgery was 1.3 months. A postoperative complication occurred in 10 (7.8%) and tumor growth or recurrence in 6 (4.7%) patients. Surgery was associated with significant improvement of motor and sensory deficit, gait disturbance, bladder dysfunction and pain. Time to surgery, tumor area and the degree of spinal cord compression significantly predicted postoperative improvement in a modified McCormick scale (mMCs) in the univariable regression analysis, and spinal cord compression showed independent risk association in multivariable analysis. There was no difference in improvement, complications or tumor control between elderly and non-elderly patients. We concluded that surgery of spinal meningiomas was associated with significant long-term neurological improvement, which could be predicted by time to surgery, tumor size and spinal cord compression.

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