Anaplastic pilocytic astrocytoma of the cerebellum presenting with conus medullaris drop metastasis

Due to its rarity, a complete understanding of the clinical behavior, pathogenesis, and diagnostic definition of anaplastic pilocytic astrocytoma (APA) is currently lacking. The optimal clinical management and use of adjuvant therapies has yet to be defined. We present a 64 year-old-female with progressive headaches, dysarthria, and ataxia, who was found to have right cerebellar mass. A gross total resection was achieved through two staged operations. Pathology demonstrated focal areas of necrosis, tumor infiltration, and increased mitotic activity most consistent with APA. Adjuvant chemotherapy and stereotactic radiosurgery were administered. Approximately two years later, the patient presented with symptoms of cauda equina syndrome, and lumbar spine imaging demonstrated a large intradural mass at the conus medullaris with diffuse leptomeningeal enhancement. A biopsy was performed and was consistent with metastatic APA. APA may rarely progress to metastatic disease, most frequently involving the leptomeninges of the posterior fossa and cervical spine. This report represents the first case of metastases distal to the cervicomedullary junction.

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Postoperative cauda equina syndrome in patients undergoing single-level lumbar microdiscectomy

Neurosurgical FOCUS ◽

10.3171/foc.2005.19.2.12 ◽

2005 ◽

Vol 19 (2) ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Vassilios Dimopoulos ◽

Kostas N. Fountas ◽

Theofilos G. Machinis ◽

Carlos Feltes ◽

Induk Chung ◽

...

Keyword(s):

Cauda Equina Syndrome ◽

De Novo ◽

Cauda Equina ◽

Conus Medullaris ◽

Clinical Findings ◽

Magnetic Resonance Images ◽

Single Level ◽

Lumbar Microdiscectomy ◽

First Case ◽

Intraoperative Electrophysiological Monitoring

Cauda equina syndrome is a well-documented complication of uneventful lumbar microdiscectomy. In the vast majority of cases, no radiological explanation can be obtained. In this paper, the authors report two cases of postoperative cauda equina syndrome in patients undergoing single-level de novo lumbar microdiscectomy in which intraoperative electrophysiological monitoring was used. In both patients, the amplitudes of cortical and subcortical intraoperative somatosensory evoked potentials (SSEPs) abruptly decreased during discectomy and foraminotomy. In the first patient, a slow, partial improvement of SSEPs was observed before the end of the operation, whereas no improvement was observed in the second patient. In the first case, clinical findings consistent with cauda equina syndrome were seen immediately postoperatively, whereas in the second one the symptoms developed within 1.5 hours after the procedure. Postoperative magnetic resonance images obtained in both patients, and a lumbar myelogram obtained in the second one revealed no signs of conus medullaris or nerve root compression. Both patients showed marked improvement after an intense course of rehabilitation. The authors' findings support the proposition that intraoperative SSEP monitoring may be useful in predicting the development of cauda equina syndrome in patients undergoing lumbar microdiscectomy. Nevertheless, further prospective clinical studies are necessary for validation of these findings.

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Arteriovenous Fistula in a Nerve Root of the Cauda Equina Fed by a Proximal Radiculo-Medullary Artery

Interventional Neuroradiology ◽

10.1177/159101991101700213 ◽

2011 ◽

Vol 17 (2) ◽

pp. 217-223 ◽

Cited By ~ 4

Author(s):

T. Ohtonari ◽

S. Ota ◽

N. Nishihara ◽

K. Suwa ◽

T. Ota ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Nerve Root ◽

Cauda Equina ◽

Conus Medullaris ◽

Magnetic Resonance Images ◽

Digital Subtraction ◽

Feeding Artery ◽

Spinal Arteriovenous Fistula ◽

First Case ◽

Flow Void

While there have been a few reports on cases of intradural spinal arteriovenous fistula located on the filum terminale, no cases of its location in a nerve root of the cauda equina have been reported to date. We describe two such cases and describe the intraoperative findings. A 40-year-old man presented weakness of his left leg. Another 62-year-old man presented paraparesis dominantly in his left leg with urinary hesitation. In both cases, spinal T2-weighted magnetic resonance images showed edema of the spinal cord, indicating a flow void around it. Digital subtraction angiography disclosed an anterior radicular artery branching from the anterior spinal artery on the surface of the conus medullaris and a turnaround vein running in the opposite direction within the cauda equina. In the first patient, while the feeding artery running along a nerve root was detected, the draining vein and the fistula were not identified at first sight. An incision into the respective nerve root exposed their location within it. In the second patient, unlike the first case, the feeding artery and the fistula were buried in a nerve root, while the draining vein was running along the nerve's surface. In both cases, permanent clips were applied to the draining vein closest to the fistula. The recognition of a hidden fistulous point in a nerve root of the cauda equina is essential for successful obliteration of the fistula.

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Growing mammary choristoma masquerading as a lumbosacral lipomyelomeningocele in a pubertal girl

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.6.peds10480 ◽

2011 ◽

Vol 8 (3) ◽

pp. 321-324 ◽

Cited By ~ 2

Author(s):

Xueyan Chen ◽

Josephine Harter ◽

Bermans J. Iskandar ◽

M. Shahriar Salamat

Keyword(s):

Cauda Equina ◽

Conus Medullaris ◽

Young Girl ◽

Pertinent Literature ◽

First Case

The authors report, to the best of their knowledge, the first case of lumbosacral choristoma of breast origin, presenting in a young girl with lumbosacral lipomyelomeningocele. Although choristomas are considered to be benign, the regrowth of this mass when the patient was 15 and 16 years of age, and its involvement in the conus medullaris and cauda equina, warranted 2 additional resections with spinal cordotomy resulting in cessation of any further growth. The authors describe the case and provide a review of pertinent literature and a discussion of the mechanisms involving the development and growth of this lesion.

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Pilocytic astrocytoma of a spinal nerve root

Journal of Neurosurgery Spine ◽

10.3171/spi.2002.97.1.0110 ◽

2002 ◽

Vol 97 (1) ◽

pp. 110-112 ◽

Cited By ~ 1

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.

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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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Successful Multimodality Management of Atypical Teratoid/Rhabdoid Tumour of the Lower Dorsal Spine with Spinal Drop Metastasis: Illustrated Review

Pediatric Neurosurgery ◽

10.1159/000513936 ◽

2021 ◽

pp. 1-13

Author(s):

Ahitagni Biswas ◽

Umesh Velu ◽

Seema Sharma ◽

Kalpana Kumari ◽

Mehar Chand Sharma ◽

...

Keyword(s):

Smooth Muscle Actin ◽

Primary Tumour ◽

Complete Response ◽

Malignant Cell ◽

Conus Medullaris ◽

Successful Outcome ◽

Rhabdoid Tumour ◽

Drop Metastasis ◽

Atypical Teratoid ◽

Atypical Teratoid Rhabdoid Tumour

Introduction: Spinal atypical teratoid/rhabdoid tumour (AT/RT) is exquisitely rare and constitutes 2% of all AT/RTs. Case Presentation: A 6-year-old boy presented with low backache for the last 5 months. MRI of the spine showed a 1.5 × 1.5 × 4.7 cm intradural extramedullary mass extending from D10 to D12, causing compression of the conus medullaris. With a preoperative diagnosis of ependymoma, a gross total resection (GTR) of tumour was performed. Post-operative histopathology showed AT/RT. The tumour cells were immunopositive for cytokeratin, epithelial membrane antigen, smooth muscle actin, and p53 and immunonegative for MIC2, desmin, glial fibrillary acidic protein, and INI1. Post-operative neuraxis MRI revealed post-operative changes (D10–D12) with a 9 mm enhancing lesion at L5-S1 junction suggesting drop metastasis. There was no lesion in brain. Cerebrospinal fluid cytology did not show any malignant cell. The metastatic work-up was normal. He received 3 cycles of chemotherapy with ICE regimen (ifosfamide, carboplatin, and etoposide). Subsequently, he received craniospinal irradiation (CSI)-36 Gy/20 fractions/4 weeks followed by focal boost to primary tumour bed and spinal drop metastasis-14.4 Gy/8 fractions/1.5 weeks. Thereafter, he received 3 more cycles of ICE regimen. End-of-treatment MRI spine showed post-op changes (D10–D12) and 38.9% reduction of the L5-S1 lesion suggesting partial response. Six monthly spinal MRI showed serial reduction of the metastatic lesion leading to complete response (CR) 1 year after completion of treatment. On last follow-up (30 months from the initial diagnosis), he was neurologically intact and in CR. Conclusion: Multimodality management comprising GTR of tumour, CSI followed by focal boost, and multiagent chemotherapy (ICE) can lead to successful outcome in patients with this rare and aggressive spinal tumour.

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ATRT-31. SUCCESSFUL MULTIMODALITY MANAGEMENT OF ATRT OF THE LOWER DORSAL SPINE WITH SPINAL DROP METASTASIS

Neuro-Oncology ◽

10.1093/neuonc/noaa222.029 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii282-iii282

Author(s):

Ahitagni Biswas ◽

Umesh Velu ◽

Kalpana Kumari ◽

Deepali Jain ◽

Sameer Bakhshi

Keyword(s):

Primary Tumour ◽

Brain Lesion ◽

Complete Response ◽

Malignant Tumour ◽

Malignant Cell ◽

Metastatic Lesion ◽

Conus Medullaris ◽

Successful Outcome ◽

Rhabdoid Tumour ◽

Drop Metastasis

Abstract A 6 year old boy presented with low backache for the last 5 months. MRI of the spine showed a 1.5x1.5x4.7cm intradural mass extending from D10-D12, causing compression of the conus medullaris. With a preoperative diagnosis of intradural ependymoma, a gross total resection (GTR) of tumour was performed. Post-operative histopathology showed a markedly cellular, malignant tumour with frequent mitotic figures. Cells were round to polygonal with vesicular nuclei, prominent nucleoli and were immunopositive for CK,EMA,p53 and immunonegative for MIC2,desmin,SMA,GFAP,INI-1(MIB1 labeling index-35–40%). The overall impression was spinal atypical teratoid rhabdoid tumour(ATRT). Post-operative neuraxis MRI revealed post-operative changes(D10-D12) with a 9 mm enhancing lesion at L5-S1 junction suggesting drop metastasis. There was no brain lesion. CSF cytology did not show any malignant cell. The metastatic work-up was normal. He was started on chemotherapy with ICE regimen (Ifosfamide-2g/m2IVD1–D3,Carboplatin-500mg/m2IVD3,Etoposide-100mg/m2IVD1–D3q3weeks). Subsequently he received craniospinal irradiation (CSI)-36Gray/20fractions/4weeks→ focal boost to primary tumour bed and spinal drop metastasis-14.4Gray/8fractions/1.5 weeks. Thereafter he received 3 more cycles of ICE regimen. End-of-treatment MRI spine showed post-op changes(D10-D12) and 38.9%reduction of the L5-S1 lesion suggesting partial response. Six monthly spinal MRI showed serial reduction of the metastatic lesion leading to complete response (CR) 1 year after completion of treatment. On last follow-up (30 months from initial diagnosis), he was neurologically intact and in CR. Multimodality management comprising GTR,CSI followed by focal boost and multiagent chemotherapy(ICE) can lead to successful outcome in patients with this rare and aggressive spinal tumour.

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Rash and Mucositis Associated With Mycoplasma pneumoniae and Chlamydophila pneumoniae: A Recurrence of MIRM?

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa028 ◽

2020 ◽

Cited By ~ 1

Author(s):

Danielle Brazel ◽

Brooke Kulp ◽

Geoanna Bautista ◽

Andrew Bonwit

Keyword(s):

Mycoplasma Pneumoniae ◽

Treatment Options ◽

Specific Treatment ◽

Corticosteroid Treatment ◽

Stevens Johnson Syndrome ◽

First Case ◽

Johnson Syndrome ◽

Vesicular Rash ◽

Recurrent Aphthous Ulcers ◽

Definition Of

Abstract Introduction A new concept has come to light recently, that is, Mycoplasma-induced rash and mucositis (MIRM). Here, we report the first case of recurrent rash, mucositis, and conjunctivitis involving Mycoplasma pneumoniae and C. pneumoniae that fits under the criteria of what is currently defined as MIRM. Case Presentation A patient aged 12 years with a history of recurrent aphthous ulcers presented in 2013 with worsening oral lesions, conjunctivitis, and vesicular rash. Her respiratory polymerase chain reaction (PCR) panel was positive for M. pneumoniae. She was diagnosed with Stevens-Johnson syndrome (SJS) secondary to M. pneumoniae and treated with a macrolide, acyclovir, and intravenous immunoglobulin (IVIG). The same patient returned 3 years later with an identical constellation of symptoms, at which time her PCR was positive for C. pneumoniae. In addition to IVIG and a macrolide, a corticosteroid treatment was administered. Discussion Here, we present the case of a pediatric patient with a recurrence of mucocutaneous disease that is more consistent with MIRM than the proposed SJS or erythema multiforme (EM) documented via histology. Our patient’s symptoms were controlled with azithromycin and IVIG and, in the second episode, with corticosteroids as well. This case adds to that of Mayor-Ibarguren et al, providing further evidence that C. pneumonia may also be a trigger for MIRM. Patients will benefit from expanding the definition of MIRM, as the pathogenesis differs from SJS and EM and could result in more specific treatment options.

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Pilocytic Midbrain Astrocytoma Presenting with Fresh Bleed after Twenty-one-years Survival Following First Surgery: A Unique Case of Longest Brainstem Glioma Survival

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.196452 ◽

2016 ◽

Vol 07 (S 01) ◽

pp. S088-S090 ◽

Cited By ~ 1

Author(s):

Guru Dutta Satyarthee ◽

M. D. Sudhan ◽

V. S. Mehta

Keyword(s):

Gamma Knife ◽

Pilocytic Astrocytoma ◽

Brainstem Glioma ◽

Prolonged Survival ◽

Histopathological Diagnosis ◽

Large Tumor ◽

Who Grade ◽

Mri Brain ◽

First Case ◽

Gamma Knife Therapy

ABSTRACTBrainstem glioma usually carries a poor prognosis and prolonged survival is very infrequent. In a detailed Pubmed, Medline search for prolonged survival, authors could got a longest survival only up to seventeen years, reported by Umehara et al, who was subjected to gamma knife therapy and got symptomatic, MRI brain reveled large tumor growth during pregnancy necessitating emergency surgery and histopathological diagnosis was pilocytic astrocytoma. Authors report an interesting case of midbrain glioma diagnosed 21 years back, who underwent gross resection in the year 1993, histopathology was pilocytic astrocytoma, WHO grade I, and received gamma knife surgery for residual subsequently and he presented with sudden onset left sided hemiplegia on the current admission. The cranial MRI imaging revealed an infarct involving right hemi midbrain, contrast MRI brain revealed no residual glioma. To the best knowledge of authors such prolonged survival is not reported with a case of brainstem glioma survived twenty- one years with non residual tumor on the last imaging study represents first case of its kind in the western literature and probably developed hemiplegia due to bleed, highlighting bleed as delayed complication following gamma knife therapy for cranial tumors

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