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Alektoroff K, Papanagiotou P. [Pediatric spinal tumors]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00117-023-01178-9. [PMID: 37407746 DOI: 10.1007/s00117-023-01178-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 07/07/2023]
Abstract
Pediatric spinal tumors are rare and manifest frequently with unspecific symptoms, frequently resulting in delayed diagnosis. Many spinal tumor entities in children and adults are similar, but the lesions demonstrate a different prevalence and sometimes a different molecular genetic profile in children. For radiological evaluation of spinal tumor lesions, it is helpful to define the affected anatomical compartment. Important intradural pediatric tumor entities are astrocytomas, ependymomas, nerve sheath tumors, and liquorgenic metastases of intracranial neoplasms. Extradural masses are mostly primary tumors originating from osseous elements of the spine. Bone metastases are rare in children and can occur, for example, in neuroblastoma. Magnetic resonance imaging (MRI) is the most important noninvasive method for radiological spinal tumor evaluation.
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Affiliation(s)
- Kirill Alektoroff
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Bremen-Mitte/Bremen-Ost, 28205, Bremen, Deutschland.
| | - Panagiotis Papanagiotou
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Bremen-Mitte/Bremen-Ost, 28205, Bremen, Deutschland
- Department of Radiology, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Griechenland
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Primiani CT, Hale DE, Sheth MS, Green KE. Clinical Reasoning: A 32-Year-Old Woman With Tunnel Vision and Back Pain. Neurology 2022; 99:800-804. [PMID: 36028324 DOI: 10.1212/wnl.0000000000201227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
The incidence of new onset visual disturbances in emergency departments across the country is frequent. A detailed history of events and thoughtful physical examination may produce a diagnosis; however, atypical cases may require further diagnostic testing to explain symptoms. We present a case of presumed increased intracranial pressure with atypical findings on diagnostic testing, which allowed our team to explore a broader differential diagnosis. This clinical reasoning article will benefit students, residents, and attendings alike to continue to uncover etiologies for symptoms of increased intracranial pressure and review differential diagnoses in similar presentations.
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Affiliation(s)
- Christopher T Primiani
- From the Department of Neurology (C.T.P., D.E.H., M.S.), and Division of Neuro-Visual & Vestibular Disorders (K.E.G.), Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - David E Hale
- From the Department of Neurology (C.T.P., D.E.H., M.S.), and Division of Neuro-Visual & Vestibular Disorders (K.E.G.), Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Manali Shah Sheth
- From the Department of Neurology (C.T.P., D.E.H., M.S.), and Division of Neuro-Visual & Vestibular Disorders (K.E.G.), Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kemar E Green
- From the Department of Neurology (C.T.P., D.E.H., M.S.), and Division of Neuro-Visual & Vestibular Disorders (K.E.G.), Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
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Freiburg Neuropathology Case Conference : A Hearing-Impaired Patient Presenting with Lower Limb Ataxia and Progressive Personality Changes. Clin Neuroradiol 2021; 30:413-418. [PMID: 32451609 PMCID: PMC7326865 DOI: 10.1007/s00062-020-00912-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Alektoroff K, Moulopoulos LA, Papanagiotou P. [Spinal tumors]. Radiologe 2021; 61:267-274. [PMID: 33570679 DOI: 10.1007/s00117-021-00815-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
Spinal tumors are often classified into three anatomical compartments on the basis of their relationship to the dural space and myelon. The most common primary spinal neoplasms are glial tumors (ependymoma, astrocytoma), nerve sheath tumors (schwannoma, neurofibroma) and meningioma. Metastases represent another common tumor entity and can occur in every spinal compartment. Magnetic resonance imaging (MRI) is the most important noninvasive method for spinal tumor imaging.
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Affiliation(s)
- K Alektoroff
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Bremen-Mitte/Bremen-Ost, 28205, Bremen, Deutschland.
| | - L A Moulopoulos
- Zentrum für Radiologie, Nationale und Kapodistrias-Universität Athen, Aretaieion Klinikum, Athen, Griechenland
| | - P Papanagiotou
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Bremen-Mitte/Bremen-Ost, 28205, Bremen, Deutschland
- Zentrum für Radiologie, Nationale und Kapodistrias-Universität Athen, Aretaieion Klinikum, Athen, Griechenland
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[Nonneoplastic lesions of the spinal canal]. Radiologe 2021; 61:283-290. [PMID: 33566131 DOI: 10.1007/s00117-021-00829-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
Numerous vascular, inflammatory, degenerative and tumorous lesions of the spinal canal can cause paraplegic symptoms. In addition to the neurological examination and the leading symptoms, the first topographical classification of the (suspected) disease is essential for further diagnostics. Hence, high-resolution magnet resonance imaging (MRI) is the gold standard for the majority of questions. To avoid diagnostic and therapeutic mistakes, differentiation of intraspinal tumors from tumor-like (nonneoplastic) lesions is indispensable, which is often only possible after follow-up imaging or surgical exploration.
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KİTİŞ S, GÜNDAĞ M. Analysis of 101 patients who underwent surgery due to spinal tumors: Single-center experience. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2020. [DOI: 10.25000/acem.759091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
CLINICAL ISSUE Spinal cysts can be classified as meningeal, not meningeal, and tumor-associated cysts. Due to the widespread availability of high-resolution computed tomography and magnet resonance imaging, spinal cysts can be detected with high sensitivity these days. Concerning the variety of potential cystic differential diagnoses, a precise classification is difficult and can often only be realized after surgical inspection or histological examination. PRACTICAL RECOMMENDATIONS Spinal cysts are generally incidental findings during a routine diagnostic workup and need no further therapy. Surgical treatment can be necessary if the spinal cyst reaches a certain size and causes neurological symptoms due to the compression of the spinal cord or the nerve root.
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Lehner B, Rehnitz C, Geisbüsch A, Akbar M, Omlor GW. [Diagnostics and treatment of benign spinal tumors]. DER ORTHOPADE 2017; 46:505-509. [PMID: 28477060 DOI: 10.1007/s00132-017-3432-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Benign tumors of the spine are rare and may lead to unspecific back pain. The classification of the lesion is typically achieved with a combination of imaging techniques (MRI and CT scans) and, in some cases, a histological sampling to allow differentiation from malignant processes. Both open and interventional (CT guided) biopsies are possible, depending on the localization of the tumor. Treatment strategies are diverse, require an interdisciplinary approach, and include operative and interventional procedures. The following article gives an overview of the most important benign tumors of the spine, the typical features in imaging, and treatment strategies.
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Affiliation(s)
- B Lehner
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - C Rehnitz
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - A Geisbüsch
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - M Akbar
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - G W Omlor
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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Pädiatrische intraspinale Neoplasien. Radiologe 2014; 54:792-9. [DOI: 10.1007/s00117-014-2669-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Putzier M, Haschke F. [Diagnostic standards for extradural tumors and metastases of the spinal column]. DER ORTHOPADE 2014; 42:691-9. [PMID: 23949685 DOI: 10.1007/s00132-013-2064-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Because of the heterogeneous clinical and paraclinical symptoms accompanied by the urgent necessity to rapidly find a diagnosis, the differential diagnostic delineation of spinal tumors from back pain related to other reasons is a special challenge in the orthopedic practice. Employing an algorithm based on anamnesis, clinical, radiological and paraclinical examinations, a guideline-related biopsy as well as histological processing of the biopsy material, tumor lesions can usually be classified regarding entity, dignity and extent. Following this a treatment strategy can be defined. Because of the necessity of an interdisciplinary approach the diagnostic algorithm should be planned during a tumor conference and performed in specialized centers.
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Affiliation(s)
- M Putzier
- Centrum für Muskuloskeletale Chirurgie, Klinik für Orthopädie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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