Paragangliomes de la queue de cheval : à propos de six cas et revue de la littérature

Paraganglioma of the filum terminal: Case report and review of the literature

Paraganglioma of the filum terminal/cauda equina is a rare slow growing tumor which originates from the ectopic sympathetic neurons. Surgically, total excision may be difficult for this well demarcated tumor surrounded by couple of rootlets but is usually possible in nearly all cases. Actually, final diagnosis cannot be determined intraoperatively, but is possible only after an immunohistochemical staining. Herein, the authors present a middle age woman whose initial symptoms were lower back pain and radiculopathy. Her MRI was found to be compatible with a cauda equina tumor. During her excisional surgery a hard and relatively vascular tumor was fully removed. The Immunohistochemical results were compatible with paraganglioma of the filum terminale. In addition to case presentation, thorough review of the literature is also done.

Locally invasive giant spinal paraganglioma

Cauda equina paragangliomas are neuroendocrine tumours rarely encountered in neurosurgical practice. Large cauda equina paragangliomas with an intradural and extradural component, dense adhesion to nerve roots and high vascularity are surgically challenging and mandate meticulous operative dissection. The presence of extensive bony erosion can lead to spinal instability requiring solid instrumentation and fixation. We recommend resection of large cauda equina paragangliomas in a staged fashion with the aim of gross total resection and spinal stabilisation.

Paraganglioma of the filum terminale mimicking neurinoma: Case report

Background:

Paraganglioma of the filum terminale is an uncommon tumor of cauda equina region. Lumbar radiculopathies are revelations that can get complicated from cauda equina syndrome. Magnetic resonance imaging (MRI) allows the diagnosis without distinguishing it from a neurofibroma. Only histopathological study can bring certainty in the diagnosis. The treatment of choice is a complete removal.

Case Description:

We report a case of paraganglioma of the filum terminale in a 74-year-old female patient, admitted for cauda equina syndrome, which has been progressing for 2 years. MRI of medulla objectified an extramedullary lesion at L3–L4, diagnosed as neurinoma. A complete resection of the tumor was performed with a section of the filum terminale, which she was taking since birth. Histology confirmed the diagnosis of paraganglioma. The clinical course was characterized by a complete recovery of the deficit.

Conclusion:

Through this case report, the authors discuss clinical and radiological aspects of this tumor, as well as the management in the light of published data.

Paraganglioma of the Filum Terminale: Case Report, Pathology and Review of the Literature

Spinal paragangliomas are very rare neuroendocrine tumors often presenting with low back pain and radicular symptoms; once resected, they often show benign clinical outcomes. Radiographically spinal paragangliomas mimic more commonly described tumors, such as ependymomas, schwannomas, meningiomas, and even hemangiomas, but a “salt and pepper” appearance related to a serpiginous vascular structure is instructive. Indeed, the rarity of this tumor makes the diagnosis rather challenging radiographically. Graded as a WHO Grade I tumor, they are slow-growing with low proliferation indices. Gross total resection is the mainstay of operative treatment but is often limited by tumor adherence to functional nerves. Here, we present a case of this rare tumor and its management, including a review of the pathology and literature related to this tumor.