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Hallundbæk L, Hagstrøm S, Mathiasen R, Herlin T, Hasle H, Weile KS, Amstrup J, Brix N. Musculoskeletal misdiagnoses in children with brain tumors: A nationwide, multicenter case-control study. PLoS One 2023; 18:e0279549. [PMID: 37352313 PMCID: PMC10289381 DOI: 10.1371/journal.pone.0279549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/08/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE Childhood brain tumors belong to the cancer type with the longest diagnostic delay, the highest health care utilization prior to diagnosis, and the highest burden of long-term sequelae. We aimed to clarify whether prior musculoskeletal diagnoses in childhood brain cancer were misdiagnoses and whether it affected the diagnostic delay. STUDY DESIGN In this retrospective, chart-reviewed case-control study we compared 28 children with brain tumors and a prior musculoskeletal diagnosis to a sex and age-matched control group of 56 children with brain tumors and no prior musculoskeletal diagnosis. Using the Danish registries, the cases were identified from consecutive cases of childhood brain cancers in Denmark over 23 years (1996-2018). RESULTS Of 931 children with brain tumors, 3% (28/931) had a prior musculoskeletal diagnosis, of which 39% (11/28) were misdiagnoses. The misdiagnoses primarily included torticollis-related diagnoses which tended to a longer time interval from first hospital contact until a specialist was involved: 35 days (IQR 6-166 days) compared to 3 days (IQR 1-48 days), p = 0.07. When comparing the 28 children with a prior musculoskeletal diagnosis with a matched control group without a prior musculoskeletal diagnosis, we found no difference in the non-musculoskeletal clinical presentation, the diagnostic time interval, or survival. Infratentorial tumor location was associated with a seven-fold risk of musculoskeletal misdiagnosis compared to supratentorial tumor location. CONCLUSION Musculoskeletal misdiagnoses were rare in children with brain tumors and had no significant association to the diagnostic time interval or survival. The misdiagnoses consisted primarily of torticollis- or otherwise neck-related diagnoses.
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Affiliation(s)
- Laura Hallundbæk
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Hagstrøm
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Rene Mathiasen
- Department of Pediatric and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Troels Herlin
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Hasle
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kathrine Synne Weile
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Amstrup
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Ninna Brix
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
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Si Z, Meng W. Multimodal Imaging Evaluation and Clinical Progress of Spinal Osteoblastoma: A Comprehensive Review. World Neurosurg 2023; 170:28-37. [PMID: 36455846 DOI: 10.1016/j.wneu.2022.11.118] [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] [Received: 07/28/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 11/29/2022]
Abstract
Spinal osteoblastoma is rare clinically, with insidious onset, atypical symptoms, and various imaging manifestations, which can easily lead to misdiagnosis and delayed diagnosis. It can cause severe neurological dysfunction in patients with intermediate to advanced stages and may easily recur after surgery. Imaging examinations such as radiography, computed tomography, magnetic resonance imaging, and positron emission tomography have different value for the diagnosis of spinal osteoblastoma, but they lack specificity. The preferred treatment is surgical resection, which is technically difficult, and in some cases, osteoblastoma cannot be completely removed. New clinical approaches such as radiofrequency ablation, radiotherapy, targeted chemotherapy, and other comprehensive treatments have emerged and are progressing rapidly, but no unified norms have yet been developed. This manuscript provides a systematic review of the literature and provides an extensive and comprehensive review of this rare tumor in terms of multimodality imaging manifestations and clinical progress.
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Affiliation(s)
- Zhiguang Si
- Department of Medical Imaging, People's Hospital of Dehong Prefecture, Yunan, P.R. China.
| | - Wangpin Meng
- Department of Surgery, People's Hospital of Dehong Prefecture, Yunan, P.R. China
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Abstract
BACKGROUND Primary benign osseous tumors and tumor-like lesions at the sacrum are rare in the pediatric population and exact surgical strategy is still unclear. In this study, we evaluate the outcome for pediatric patients with benign tumors and tumor-like lesions at the sacrum who were receiving surgical treatment according to our proposed surgical strategy and classification. METHODS We analyzed 49 pediatric patients with sacral benign tumors or tumor-like lesions aged 18 years and below from 2005 to 2018. There were 23 men and 26 women with a mean age of 14.0±3.8 years. Nineteen patients had giant cell tumors (GCTs), 9 aneurysmal bone cysts, 5 osteoblastomas, 5 neurogenic tumors, 3 hemangiomas, 3 teratomas, 2 Langerhans cell histiocytosis, 1 chondroblastoma, 1 fibrous dysplasia, and 1 GCT of tendon sheath. We proposed our surgical plan and surgical classification for pediatric patients with sacral benign tumors or tumor-like lesions. RESULTS The mean follow-up duration was 6.2 years (range, 1.0 to 18.9 y). GCTs (39%, 19/49) and primary aneurysmal bone cysts (18%, 9/49) are the top 2 common histologic types. Preoperative selective arterial embolization (SAE) was performed in 12 cases and 24 patients received intraoperative aortic balloon occlusion (ABO) as the preoperative surgical plan. Furthermore, according to tumor location at the sacrum, we classified surgical excision of sacral benign tumors and tumor-like lesions into 3 types. Fourteen cases were classified as type I, 27 as type II, 3 as type III, and 5 patients with neurogenic tumors cannot be classified into this surgical classification. Ten patients had wound complications. Two had femoral artery thrombosis because of ABO application. One had mechanical failure. Rate of local recurrence was 16%. Seven patients with GCTs and 1 with neurogenic tumor had local recurrence. No patient died of disease at the last follow-up. For the assessment of neurological function, the rate of neurological dysfunction was 12% (6/49). Four cases had urinary incontinence, 3 fecal incontinence, and 3 had bowel obstruction. Next, univariate analysis for influence of preoperative SAE and intraoperative ABO on complications demonstrated that both of them exerted no significant influence on the occurrence of oncological and nononcological complications. CONCLUSIONS The proposed surgical strategy can provide an excellent therapeutic effect for pediatric benign tumors and tumor-like lesions at the sacrum. Preoperative SAE and intraoperative ABO can safeguard pediatric patients with high vascularity of benign tumor at the sacrum during the operation. LEVEL OF EVIDENCE Level IV.
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Chigurupati SV, Shukla M, Pandey M. Primary sacral non-Hodgkin's lymphoma: report of a case and systematic review of literature. World J Surg Oncol 2021; 19:61. [PMID: 33627139 PMCID: PMC7905564 DOI: 10.1186/s12957-021-02153-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/31/2021] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Isolated primary sacral diffuse large B cell non-Hodgkin's lymphoma is a very rare entity, and only 11 cases have been reported previously. CASE PRESENTATION A 36-year-old man was referred with low backache and radiculopathy pain with a clinico-radiological and cytological diagnosis of sacral metastasis. Histopathological examination and immunohistochemistry of image-guided tissue core biopsy from the sacral mass confirmed it as high-grade diffuse large B cell lymphoma (DLBCL). With normal blood counts and bone marrow, and no lesions elsewhere on imaging, he was staged IAE and received 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) regimen chemotherapy followed by radiotherapy. The patient has completed a 3-year follow-up and is doing well with yearly imaging showing no evidence of active disease or recurrence. CONCLUSIONS The case shows the importance of an image-guided core biopsy and immunohistochemistry over a fine needle aspiration cytology in select cases as it can alter the treatment and outcome in patients. Because of rarity, the treatment and prognosis in primary sacral NHL is not still very clear as it is treated as per the guidelines of treatment of bone lymphoma.
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Affiliation(s)
- Satya Vijay Chigurupati
- Department of Surgical Oncology, Institute of Medical Science, Banaras Hindu University, Varanasi, 221005, India
| | | | - Manoj Pandey
- Department of Surgical Oncology, Institute of Medical Science, Banaras Hindu University, Varanasi, 221005, India.
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Wang J, Li D, Yang R, Tang X, Yan T, Guo W. Outcome of surgical treatment of children and adolescents with primary malignant sacral tumours. INTERNATIONAL ORTHOPAEDICS 2020; 44:1841-1851. [DOI: 10.1007/s00264-020-04641-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 05/14/2020] [Indexed: 12/20/2022]
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Marhx Bracho A, Muñoz Montoya JE, Peña Rosas NP, Carrillo Marhx G, Ramírez Ferrer E. Costotransversectomy plus hemilaminectomy as alternative surgical approach for extramedullary intradural thoracic schwannoma resection with and without extradural extension in pediatric population three cases and literature review. JOURNAL OF SPINE SURGERY 2019; 5:285-290. [PMID: 31380483 DOI: 10.21037/jss.2019.05.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Extramedullary intradural tumors constitute up to 25% of the spinal tumors. Commonly, schwannomas that presents with extradural and intradural compromise are called dumbbell-shaped tumor. The thoracic spine is a common localization for these tumors, especially in pediatric population. Given this surgically difficult localization, some classic approaches for spine tumors can be mixed with modified approaches like the costotransversectomy. The main objective of this report is expose three different pediatric cases in which mixed approach (costotransversectomy plus hemilaminectomy) was implemented for thoracic spine dumbbell-shaped schwannoma resection. It was achieved complete surgical resection without major perioperative complications in the three cases.
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Affiliation(s)
- Alfonso Marhx Bracho
- Pediatric Neurosurgery Department, Instituto Nacional de Pediatría, Mexico City, Mexico
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Berger GK, Nisson PL, James WS, Kaiser KN, Hurlbert RJ. Outcomes in different age groups with primary Ewing sarcoma of the spine: a systematic review of the literature. J Neurosurg Spine 2019; 30:664-673. [PMID: 30771777 DOI: 10.3171/2018.10.spine18795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/04/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Ewing sarcoma (ES) is among the most prevalent of bone sarcomas in young people. Less often, it presents as a primary lesion of the spine (5%-15% of patients with ES). METHODS A systematic literature search was performed, querying several scientific databases per PRISMA guidelines. Inclusion criteria specified all studies of patients with surgically treated ES located in the spine. Patient age was categorized into three groups: 0-13 years (age group 1), 14-20 years (age group 2), and > 21 (age group 3). RESULTS Eighteen studies were included, yielding 28 patients with ES of the spine. Sixty-seven percent of patients experienced a favorable outcome, with laminectomies representing the most common (46%) of surgical interventions. One-, 2-, and 5-year survival rates were 82% (n = 23), 75% (n = 21), and 57% (n = 16), respectively. Patients in age group 2 experienced the greatest mortality rate (75%) compared to age group 1 (9%) and age group 3 (22%). The calculated relative risk score indicated patients in age group 2 were 7.5 times more likely to die than other age groups combined (p = 0.02). CONCLUSIONS Primary ES of the spine is a rare, debilitating disease in which the role of surgery and its impact on one's quality of life and independence status has not been well described. This study found the majority of patients experienced a favorable outcome with respect to independence status following surgery and adjunctive treatment. An increased risk of recurrence and death was also present among the adolescent age group (14-20 years).
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Affiliation(s)
- Garrett K Berger
- 1College of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Whitney S James
- 3Division of Neurosurgery, High Desert Surgery Center, Prescott, Arizona
| | - Kristen N Kaiser
- 1College of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - R John Hurlbert
- 4Division of Neurosurgery, University of Arizona, Tucson; and
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Wu M, Xu K, Xie Y, Yan F, Deng Z, Lei J, Cai L. Diagnostic and Management Options of Osteoblastoma in the Spine. Med Sci Monit 2019; 25:1362-1372. [PMID: 30785872 PMCID: PMC6391855 DOI: 10.12659/msm.913666] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Osteoblastoma is a rare, benign, osteolytic neoplasm commonly found in the spine in early adulthood. Here, we review the clinical characteristics, radiographic findings, and surgical management of patients with spinal osteoblastoma. Material/Methods Thirteen patients with osteoblastoma who underwent surgery at our institute from June 2008 to November 2017 were enrolled in this study. The American Spinal Injury Association (ASIA) impairment scale was used to assess neurological function. All patients were treated with either total excision or intralesional piecemeal excision without postoperative radiotherapy. Clinical efficacy was evaluated by visual analog scale (VAS) scores, the Oswestry Disability Index (ODI) of nerve function, physical and radiographic examinations, bone fusion, and neurologic status. Results The follow-up lasted 23–82 months (average, 43.8 months). The average surgical time was 178.1 minutes (range, 100–230 minutes), with an average intraoperative blood loss of 574 mL (range, 230–1100 mL). Postoperatively, VAS scores decreased from 6.2±1.7 to 0.5±0.7 (P<0.001). The preoperative and final ODI scores were 51.1±7.7 and 22.6±4.9, respectively, reflecting a significant decrease (P<0.001). According to the ASIA classification, 3 patients had grade C, 3 patients had grade D, and 7 patients had grade E disease. Three months postoperatively, 1 patient had grade D and 10 patients had grade E disease; ultimately, all cases were grade E disease. Only 1 patient experienced local recurrence and underwent en bloc marginal resection with postoperative radiotherapy. All patients remained neurologically stable without any major complications. Conclusions Accurate intraoperative localization with complete resection is the key to preventing recurrence. Aggressive surgical resection can achieve satisfactory clinical and radiographic outcomes.
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Affiliation(s)
- Minhao Wu
- Department of Bone and Musculoskeletal Tumor Center, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China (mainland)
| | - Keke Xu
- Department of Bone and Musculoskeletal Tumor Center, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China (mainland)
| | - Yuanlong Xie
- Department of Bone and Musculoskeletal Tumor Center, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China (mainland)
| | - Feifei Yan
- Department of Bone and Musculoskeletal Tumor Center, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China (mainland)
| | - Zhouming Deng
- Department of Bone and Musculoskeletal Tumor Center, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China (mainland)
| | - Jun Lei
- Department of Bone and Musculoskeletal Tumor Center, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China (mainland)
| | - Lin Cai
- Department of Bone and Musculoskeletal Tumor Center, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China (mainland)
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Tanki H, Singh H, Raswan US, Bhat AR, Saija Y, Kirmani AR, Javaid I. A Rare Case of Spinal Schwannoma in a Child Presenting with Subarachnoid Hemorrhage: A Case Report with Review of Literature. J Pediatr Neurosci 2018; 13:503-507. [PMID: 30937101 PMCID: PMC6413608 DOI: 10.4103/jpn.jpn_83_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Pediatric spinal schwannomas/neurofibromas constitute only 2.5%–4% of all pediatric spinal tumors. However, subarachnoid hemorrhage (SAH) because of spinal pathologies is very rare, representing 1.5% of all cases of SAH. Spinal nerve sheath tumors such as schwannomas rarely present with SAH, especially before the appearance of overt signs of spinal cord or root compression. We report a case of dorsolumbar schwannoma in an 11-year-old girl presenting clinically with signs and symptoms mimicking meningitis, but meningeal signs later proved to be due to SAH associated with spinal (D12-L1) schwannoma and hydrocephalus. Mass was excised and ventriculoperitoneal shunt was inserted. In our clinical practice, we may sometimes come across some uncommon diseases with even more uncommon presentations as happened with us at our institute. We must always consider that there is a possibility of SAH owing to silent spinal lesion in patients with angiographic negative intracranial SAH as in this case.
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Affiliation(s)
- Humam Tanki
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Jammu and Kashmir, India
| | - Harshita Singh
- Department of Ophthalmology, Dr. Manzoor Eye Care Centre, Jammu and Kashmir, India
| | - Uday S Raswan
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Jammu and Kashmir, India
| | - Abdul R Bhat
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Jammu and Kashmir, India
| | - Yagnesh Saija
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Jammu and Kashmir, India
| | - Altaf R Kirmani
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Jammu and Kashmir, India
| | - Iqbal Javaid
- Department of Paediatrics, Sher-i-Kashmir Institute of Medical Sciences, Jammu and Kashmir, India
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Abstract
Abstract
Pediatric spinal schwannomas constitute 2.5-4% of all pediatric spinal tumors. They often occur in the setting of neurofibromatosis type 2 (NF-2) and are almost always intradural (with/without dumbbell extension). Rarely are they confined to extradural space alone. Till date only one case of totally extradural lumbosacral schwannoma in a non NF child has been reported. We here report the second case of totally extradural spinal schwannoma in a non NF child. A five year old female child presented with progressively increasing paraperesis and bladder symptoms, with no clinical features of Neurofibromatosis type I or II. Imaging revealed a dorsolumbar extradural lesion from DV11 to LV1. Patient underwent laminoplasty with total excision of tumour. Intraoperatively, the tumor was confined to extradural space alone. Histopathology confirmed Schwannoma. This case highlights that possibility of schwannomas should be considered as a differential diagnosis for intraspinal extradural tumors even in children without NF.
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Hung PC, Wu CT, Jaing TH, Sheen JM, Chou ML, Lin KL. Primary spinal tumors in childhood: A single institution 15 year experience. Asian J Neurosurg 2016; 11:440-443. [PMID: 27695552 PMCID: PMC4974973 DOI: 10.4103/1793-5482.144148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Pediatric primary spinal tumors (PST) are fairly uncommon, with little available data regarding incidence and outcomes. MATERIALS AND METHODS We conducted a retrospective review of the 22 consecutive patients less than 18 years old diagnosed with PST between March 1997 and May 2011 and treated at Chang Gung Children Hospital. All patients had undergone magnetic resonance imaging (MRI) for pre-operative evaluation and operations for PST. The extent of tumor removal was assessed by surgical report by the neurosurgeon or by post-operative MRI if available. RESULTS Ten of them had intramedullary tumors and 12 had intradural extramedullary tumors. All patients were treated with surgery to the primary site. A total of 15 patients underwent gross total tumor resection and seven patients received post-operative radiotherapy. Five patients received adjuvant chemotherapy for their primary tumor. Fourteen patients (64%) survived from study entry without tumor progression. CONCLUSIONS PST encompassed a diverse group of pathologic entities that differ markedly based on the location and age of the children. Total resection of pediatric PST in children could be performed with acceptable risk and satisfactory long-term results.
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Affiliation(s)
- Po-Cheng Hung
- Department of Pediatrics, Division of Neurology, Chang Gung Children's Hospital, Taoyuan, Taiwan
| | - Chieh-Tsai Wu
- Department of Surgery, Division of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tang-Her Jaing
- Department of Pediatrics, Divisions of Hematology and Oncology, Chang Gung Children's Hospital, Taoyuan, Taiwan
| | - Jiunn-Ming Sheen
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Liang Chou
- Department of Pediatrics, Division of Neurology, Chang Gung Children's Hospital, Taoyuan, Taiwan
| | - Kuang-Lin Lin
- Department of Pediatrics, Division of Neurology, Chang Gung Children's Hospital, Taoyuan, Taiwan
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Galgano MA, Goulart CR, Iwenofu H, Chin LS, Lavelle W, Mendel E. Osteoblastomas of the spine: a comprehensive review. Neurosurg Focus 2016; 41:E4. [DOI: 10.3171/2016.5.focus16122] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Osteoblastomas are primary bone tumors with an affinity for the spine. They typically involve the posterior elements, although extension through the pedicles into the vertebral body is not uncommon. Histologically, they are usually indistinguishable from osteoid osteomas. However, there are different variants of osteoblastomas, with the more aggressive type causing more pronounced bone destruction, soft-tissue infiltration, and epidural extension. A bone scan is the most sensitive radiographic examination used to evaluate osteoblastomas. These osseous neoplasms usually present in the 2nd decade of life with dull aching pain, which is difficult to localize. At times, they can present with a painful scoliosis, which usually resolves if the osteoblastoma is resected in a timely fashion. Neurological manifestations such as radiculopathy or myelopathy do occur as well, most commonly when there is mass effect on nerve roots or the spinal cord itself. The mainstay of treatment involves surgical intervention. Curettage has been a surgical option, although marginal excision or wide en bloc resection are preferred options. Adjuvant radiotherapy and chemotherapy are generally not undertaken, although some have advocated their use after less aggressive surgical maneuvers or with residual tumor. In this manuscript, the authors have aimed to systematically review the literature and to put forth an extensive, comprehensive overview of this rare osseous tumor.
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Affiliation(s)
| | | | - Hans Iwenofu
- 2Pathology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - William Lavelle
- 3Orthopedics, State University of New York, Upstate Medical University, Syracuse, New York; and
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Haghnegahdar A, Sedighi M. Anterior Reconstruction of C2-C3 Bodies in a 6-Year-Old Patient with a Huge Osteoblastoma: A Novel Technique. Global Spine J 2016; 6:e21-9. [PMID: 26835212 PMCID: PMC4733373 DOI: 10.1055/s-0035-1550340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 02/24/2015] [Indexed: 11/02/2022] Open
Abstract
Study Design Case report. Objective We report the youngest child diagnosed with upper cervical osteoblastoma and the first case operated on with our novel surgical approach. Methods Our patient underwent a two-stage surgery. During the first operation via a posterior approach, a subtotal resection of a C2 bony mass was performed. C3 was also subtotally resected due to tumor extension. Posterior fixation of C1-C5 was performed by C1 sublaminar hooks and C4 and C5 lateral mass screws. Ten days later, a total resection of the residual bony mass was performed through an anterior approach (between the sternocleidomastoid muscle and carotid sheath). Reconstruction of C1-C3 was performed with C1 anterior sublaminar wiring and an expandable titanium cage. Results Successful reconstruction of C2-C3 vertebral bodies was achieved. At 2-year follow-up, the child was symptom-free. Imaging studies revealed no recurrence of tumor or instability. Conclusion A novel technique for reconstruction of C2-C3 vertebral bodies is demonstrated for the youngest case (a 6-year-old boy) of osteoblastoma in the literature. We recommend this approach for cervical spine reconstruction in patients who have an intact C1 arc and resected lower bodies.
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Affiliation(s)
- Ali Haghnegahdar
- Department of Neurosurgery, Neurospine Section, Chamran Hospital, Shiraz University of Medical Sciences (SUMS), Shiraz, Iran,Address for correspondence Ali Haghnegahdar, MD Department of Neurosurgery, Neurospine SectionChamran Hospital, Shiraz University of Medical Sciences (SUMS)PO Box 71345-1536, ShirazIran
| | - Mahsa Sedighi
- Department of Neurosurgery, Neurospine Section, Chamran Hospital, Shiraz University of Medical Sciences (SUMS), Shiraz, Iran
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Clinical characteristics and treatment options for two types of osteoblastoma in the mobile spine: a retrospective study of 32 cases and outcomes. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:411-6. [PMID: 24081688 DOI: 10.1007/s00586-013-3049-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 09/25/2013] [Accepted: 09/25/2013] [Indexed: 01/06/2023]
Abstract
PURPOSE A retrospective study of 32 patients with osteoblastoma (OBL) in the mobile spine was performed to analyze the clinical characteristics of two types of spinal OBL. We also aimed to find influential factors for OBL in the mobile spine. METHODS Between 2002 and 2011, 32 patients with either conventional osteoblastoma (CO) or aggressive osteoblastoma (AO) in the mobile spine were treated in our center. All patients were treated with either total excision or subtotal excision + postoperative radiotherapy. The mean follow-up was 45.8 (18-128) months. Clinical data and surgery efficacy were analyzed to search for clinical characteristics of two subtypes of spinal OBL and discuss the possible factors influencing relapse. RESULTS There is significant difference between CO and AO in tumor size (p < 0.0005), preoperative alkaline phosphatase (ALP, p < 0.0005) and intraoperative blood loss (p = 0.013). Multivariate logistic regression was used to find the influential factors for relapse and the results were: preoperative ALP, b = 0.023, p = 0.029; surgery protocol, b = -7.597, p = 0.007; tumor size, ≥3/<3, b = 24.805, p < 0.0005; age, b = 0.054, p = 0.632; and pathology type, b = 1.998, p = 0.34. CONCLUSIONS Tumor size, preoperative ALP and CT images were helpful for distinguishing AO from CO. The difference in intraoperative blood loss between CO and AO is mainly attributed to the size of the lesion. Preoperative ALP, surgery protocol and tumor size (≥3/<3) were considered to significantly influence relapse of spinal OBL.
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Kulkarni A, Srinivas D, Somanna S, Indira DB, Ananthakrishna CB. Pediatric spinal schwannomas: An institutional study. J Pediatr Neurosci 2012; 7:1-3. [PMID: 22837767 PMCID: PMC3401644 DOI: 10.4103/1817-1745.97608] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The objective was to analyze the demography, clinical presentation, and management of spinal intradural schwannomas in pediatric population. MATERIALS AND METHODS This retrospective study includes 21 pediatric patients (under 18 years of age) who underwent surgery for spinal intradural schwannomas from January 1998 to April 2008. The medical records were reviewed retrospectively and the information regarding clinical presentation, tumor location, operative findings, and postoperative status and functional outcome were analyzed. RESULTS A total of 21 patients (14 females and 7 males) were operated for spinal schwannomas. Six patients had associated neurofibromatosis (five were NF I and one was NF II) at presentation. The most common presenting symptom was progressive myelopathy (86%). The tumor location was either cervical or dorsal in 18 cases. All patients underwent surgery. Gross total excision was achieved in 20 cases. The median follow-up was 38 months. All the patients had neurological improvement in both power and bladder symptoms. CONCLUSION Pediatric spinal neurofibromas/schwannomas are an uncommon but completely treatable group of tumors. Complete surgical excision gives excellent outcome.
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Affiliation(s)
- Anirudh Kulkarni
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Wang XQ, Zeng XW, Zhang BY, Dou YF, Wu JS, Jiang CC, Zhong P, Chen H. Spinal meningioma in childhood: clinical features and treatment. Childs Nerv Syst 2012; 28:129-36. [PMID: 21947034 DOI: 10.1007/s00381-011-1570-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 08/11/2011] [Indexed: 01/31/2023]
Abstract
OBJECT The purpose of this retrospective study is to determine the clinical characteristics and the prognosis of the spinal meningioma in childhood (under 18 years of age) based on the treatment at our institution. METHODS Ten spinal meningioma cases in children were treated during the last 9 years. The clinical data was retrospectively analyzed and the results were compared with those in the literature. RESULTS The series included eight males and two females and the mean age was 13.2 years. The most common initial symptoms were pain (6/10) and the common signs were limb weakness (4/10) and gait disturbance (2/10) and distal paresthesia (1/10) and bladder disturbance (1/10). Four patients had other clinical signs of neurofibromatosis type II (NF-2) such as tumors elsewhere. All the tumors were located in cervical and thoracic vertebrae. Resection according to Simpson Grade I (6/10), II (2/10), III (1/10), and IV (1/10) were performed. Grade II meningiomas accounted for 3/10 in this series. All patients were followed up with mean follow-up period of 43 months. Seven patients had recurrence of the tumor in that period and one had died. CONCLUSIONS Spinal meningioma is an uncommon pediatric neoplasm and has a poor prognosis. It has a male predominance and is inclined to be associated with NF-2, and those that are associated with higher pathologic subtypes and NF-2 have more unfavorable outcome. Every effort should be made to achieve total removal which may decrease the incidence of recurrence.
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Affiliation(s)
- Xiao-Qiang Wang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
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Amirjamshidi A, Abbassioun K. Osteoblastoma of the third cervical vertebra in a 16-year-old boy: case report and review of the literature. Pediatr Neurosurg 2010; 46:396-401. [PMID: 21412027 DOI: 10.1159/000323422] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 12/03/2010] [Indexed: 11/19/2022]
Abstract
UNLABELLED BACKGROUND/SUBJECT: A rare case of osteoblastoma of the third cervical vertebra (C3) occurring in a 16-year-old adolescent is presented. He was admitted suffering from neck pain for more than 3 years. METHOD Plain X-rays, technetium bone scanning, CT scan and MRI indicated an expansile, partially sclerotic lesion of the C3 involving the superior facet and pedicle on the right side. The lesion was excised through a posterior approach. RESULT Even though the 18-month follow-up is still a very short interval in our case, the subject's neck pain has resolved completely and there has been no sign of tumor recurrence in the recently taken imaging. There has been no clinical or radiologic sign of instability in the follow-up investigations. To the best of our knowledge, this is the third case of C3 osteoblastoma reported in the literature, highlighting the predilection of the reported cases to occur in 14- to 16-year-old boys. CONCLUSION A full investigation is indicated in youngsters suffering from persisting neck pain and complete resection of the lesion can prevent recurrence and malignant transformation. Long-term follow-up is needed to declare a lifelong cure of the disease.
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Laser literature watch. Photomed Laser Surg 2006; 24:424-53. [PMID: 16875454 DOI: 10.1089/pho.2006.24.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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