Lumbosacral actinomycosis with direct involvement and compression of conus medullaris and cauda equina nerve roots: An extremely rare case

✓ A case of multiple hemangiomas of the cauda equina nerve roots, conus medullaris, and lower spinal cord is described. The 74-year-old male patient presented with a 9-month history of progressive bilateral leg weakness. He had a history of lymphoma at the age of 39 years and renal cell carcinoma in his early 40s. Neither disease was evident at the time of this presentation. A magnetic resonance image revealed multiple enhancing nodules in the cauda equina region as well as on the pial surface of the lower thoracic spinal cord and conus medullaris. The patient underwent an L2–3 laminectomy. Cauda equina nerve roots were found to be studded with numerous purple nodules, the largest measuring 6 to 8 mm. The nodules were adherent to nerve roots from which they could not be resected. Two lesions were histologically examined and found to be capillary hemangiomas. Twelve months into an uneventful postoperative course, the patient is neurologically unchanged. This unique case might represent a distinct form of hemangiomatosis confined to the cauda equina nerve roots and spinal cord.

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Endometriosis of the conus medullaris causing cyclic radiculopathy

Journal of Neurosurgery Spine ◽

10.3171/2014.7.spine14117 ◽

2014 ◽

Vol 21 (5) ◽

pp. 799-804 ◽

Cited By ~ 6

Author(s):

Jeffrey A. Steinberg ◽

David D. Gonda ◽

Karra Muller ◽

Joseph D. Ciacci

Keyword(s):

Spinal Cord ◽

Rare Case ◽

Cauda Equina ◽

Pain Syndrome ◽

Conus Medullaris ◽

Pelvic Cavity ◽

Review Of The Literature ◽

Intramedullary Spinal Cord ◽

Neoplastic Lesions ◽

Voiding Difficulties

Intramedullary spinal cord hematomas are a rare neurosurgical pathological entity typically arising from vascular and neoplastic lesions. Endometriosis is an extremely rare cause of intramedullary spinal cord hematoma, with only 5 previously reported cases in the literature. Endometriosis is characterized by ectopic endometrial tissue, typically located in the female pelvic cavity, that causes a cyclical pain syndrome, bleeding, and infertility. In the rare case of intramedullary endometriosis of the spinal cord, symptoms include cyclical lower-extremity radiculopathies and voiding difficulties, and can acutely cause cauda equina syndrome. The authors report a case of endometriosis of the conus medullaris, the first to include radiological, intraoperative, and histopathological imaging. A brief review of the literature is also presented, with discussion including etiological theories surrounding intramedullary endometriosis.

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Ganglioglioma of Conus Medullaris—A Rare Case

Indian Journal of Neurosurgery ◽

10.1055/s-0039-1700301 ◽

2019 ◽

Vol 08 (03) ◽

pp. 216-218

Author(s):

Sushil Kumar ◽

Rajneesh Misra ◽

Kundan Kumar ◽

Sandeep Sharma

Keyword(s):

Rare Case ◽

Surgical Intervention ◽

Cauda Equina ◽

Conus Medullaris ◽

Lower Limbs ◽

Histopathologic Examination ◽

Total Excision ◽

Postoperative Course ◽

Cauda Equina Roots ◽

Progressive Weakness

Abstract Gangliogliomas favor the temporal lobe. They are rarely reported in the spinal cord. Ganglioglioma of the conus medullaris is very rare. An 11-year-old boy presented with progressive weakness of bilateral lower limbs. Clinical examination and radiologic investigations revealed a lesion in the conus medullaris with an exophytic component involving the cauda equina roots. The lesion was excised near totally. Its histopathologic examination revealed it to be a ganglioglioma. Gangliogliomas of the conus medullaris are rare lesions. Subtotal or near-total excision with preservation of the function should be the aim of the surgical intervention. Because preoperative function largely dictates the postoperative course, it is advisable to intervene early at the first hint of neurologic compromise.

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Posttraumatic pseudomeningomyelocele (enlarging fracture?) in a vertebral body

Journal of Neurosurgery ◽

10.3171/jns.1981.54.4.0545 ◽

1981 ◽

Vol 54 (4) ◽

pp. 545-549 ◽

Cited By ~ 31

Author(s):

Ved P. Sachdev ◽

Yun P. Huang ◽

Chunilal P. Shah ◽

Leonard I. Malis

Keyword(s):

Vertebral Body ◽

Unusual Case ◽

Cauda Equina ◽

Lumbar Vertebra ◽

Conus Medullaris ◽

The Body ◽

Terminal Part ◽

Nerve Roots ◽

Content Type ◽

Progressive Neurological Deficit

✓ An unusual case is reported in which a posttraumatic pseudomeningomyelocele developed over many years inside the body of a fractured lumbar vertebra, eroding the pedicle and causing progressive neurological deficit. The wall of the sac was mostly formed by the scalloped bare bone, and partly by a membrane resembling the dura. The terminal part of the conus medullaris and some nerve roots of the cauda equina formed the contents and parts of the wall of the outpouching of the subarachnoid space into the vertebral body. A comparison is drawn between this lesion and formation of an “enlarging fracture” of the skull. The surgical technique used for obliteration of this pseudomeningomyelocele is described.

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Gross and microscopic study of the filum terminale: does the filum contain functional neural elements?

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.10.peds11102 ◽

2012 ◽

Vol 9 (1) ◽

pp. 86-92 ◽

Cited By ~ 15

Author(s):

Samson Sujit Kumar Gaddam ◽

Vissa Santhi ◽

Srinivasa Babu ◽

Geeta Chacko ◽

Ramakrishna Appala Baddukonda ◽

...

Keyword(s):

Cauda Equina ◽

Conus Medullaris ◽

Nerve Fibers ◽

Filum Terminale ◽

Vertebral Level ◽

Nerve Roots ◽

Fibrous Stroma ◽

Dural Sac ◽

Nerve Bundles ◽

Immunohistochemical Studies

Object The filum terminale (FT) is considered a fibrous structure that extends from conus medullaris of the spinal cord to coccyx. Based on previous studies and from their own experience with intraoperative electrophysiological monitoring of the sacral nervous system, the authors postulate that the FT contains functional neural elements in some individuals. Methods The FT was dissected from 13 fresh stillborn cadavers (7 male, 6 female; mean gestational age 36 weeks and 1 day). The gross anatomical features were recorded, and connections between the FT and the nerve roots of the cauda equina were noted. These connections, when present, were sectioned for histological studies. The fila (both interna and externa) were also sectioned for histological and immunohistochemical studies. In addition, FT specimens were obtained from 5 patients undergoing sectioning of the FT in an untethering surgical procedure. Results There were 5 gross connections between the FT and nerve roots demonstrating nerve fibers that were positive for S100. The FT showed islands of cells that were positive for GFAP in 10 cases, synaptophysin in 3 cases, S100 in 11 cases, and nestin in 2 cases. The nerve fibers in the FT were myelinated in 2 cases. The conus ended at the L-1 or L-2 vertebral level in all 13 specimens. The dural sac terminated at the S-2 vertebral level in most of the specimens. The 5 FT specimens that were obtained from patients revealed nerve bundles that were positive for S100 in 4 cases and cells that were positive for GFAP in 3 cases. Conclusions There are gross anatomical connections between the FT and nerve roots that contain nerve fibers. Apart from fibrous stroma, the FT may contain nerve bundles and cells that stain positive for GFAP, synaptophysin, S100, and nestin. These microscopic findings and previous intraoperative electrophysiological studies suggest a probable functional role for the FT in some individuals. At birth, the conus ends at a higher vertebral level (lower L-1 or upper L-2) than L-3.

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Implantation of cauda equina nerve roots through a biodegradable scaffold at the conus medullaris in rat

The Spine Journal ◽

10.1016/j.spinee.2014.01.059 ◽

2014 ◽

Vol 14 (9) ◽

pp. 2172-2177 ◽

Cited By ~ 5

Author(s):

Peter J. Grahn ◽

Sandeep Vaishya ◽

Andrew M. Knight ◽

Bingkun K. Chen ◽

Ann M. Schmeichel ◽

...

Keyword(s):

Cauda Equina ◽

Conus Medullaris ◽

Nerve Roots ◽

Biodegradable Scaffold

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Sudden paraparesis due to spinal cord ischemia with initial contrast enhancement of the cauda equina and time-delayed owl-eyes sign on follow-up MR imaging: a case report

Neurological Research and Practice ◽

10.1186/s42466-021-00112-5 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Benedict Breitling ◽

Frederic Carsten Schmeel ◽

Alexander Radbruch ◽

Oliver Kaut

Keyword(s):

Spinal Cord ◽

Case Report ◽

Contrast Enhancement ◽

Spinal Cord Ischemia ◽

Cauda Equina ◽

Conus Medullaris ◽

Spinal Ischemia ◽

Nerve Roots ◽

Anterior Portion

AbstractWe report on a case of a 52-year-old male with sudden paraparesis. The initial MRI showed contrast enhancement of the conus medullaris and the complete cauda equina. Follow-up MRI revealed a spinal ischemia in the anterior portion of the spinal cord. Only a few reports with similar findings have been published. We suggest that contrast enhancement of the conus medullaris and descending nerve roots can be a potential first indicator of a spinal cord ischemia.

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Use of GDNF-Releasing Nanofiber Nerve Guide Conduits for the Repair of Conus Medullaris/Cauda Equina Injury in the Nonhuman Primate

10.21236/ada581474 ◽

2012 ◽

Author(s):

Ahmet Hoke ◽

Hai-Quan Mao

Keyword(s):

Nonhuman Primate ◽

Cauda Equina ◽

Conus Medullaris

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Lumbosacral intersegmental epispinal axons and ectopic ventral nerve rootlets

Journal of Neurosurgery ◽

10.3171/jns.1987.67.2.0269 ◽

1987 ◽

Vol 67 (2) ◽

pp. 269-277 ◽

Cited By ~ 9

Author(s):

Wesley W. Parke ◽

Ryo Watanabe

Keyword(s):

Nerve Root ◽

Sensory Nerve ◽

Conus Medullaris ◽

Spinal Nerve ◽

Nerve Fibers ◽

Ventral Horn ◽

Spinal Nerve Roots ◽

Nerve Roots ◽

Content Type ◽

Almost All

✓ An epispinal system of motor axons virtually covers the ventral and lateral funiculi of the human conus medullaris between the L-2 and S-2 levels. These nerve fibers apparently arise from motor cells of the ventral horn nuclei and join spinal nerve roots caudal to their level of origin. In all observed spinal cords, many of these axons converged at the cord surface and formed an irregular group of ectopic rootlets that could be visually traced to join conventional spinal nerve roots at one to several segments inferior to their original segmental level; occasional rootlets joined a dorsal nerve root. As almost all previous reports of nerve root interconnections involved only the dorsal roots and have been cited to explain a lack of an absolute segmental sensory nerve distribution, it is believed that these intersegmental motor fibers may similarly explain a more diffuse efferent distribution than has previously been suspected.

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