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Oyemolade TA, Balogun JA, Badejo OA, Malomo AO, Shokunbi MT, Idowu OK, Adeolu AA. Clinical profile and outcome of surgical management of intramedullary spinal cord tumours: A single center study in a developing country. World Neurosurg X 2023; 20:100228. [PMID: 37456686 PMCID: PMC10344788 DOI: 10.1016/j.wnsx.2023.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Objective There is as yet a paucity of data on intramedullary spinal cord tumours (IMSCTs) in sub-Saharan Africa. This study aims to define the clinical profile and outcome of management of IMSCTs in a Nigerian tertiary hospital. Methods This is a retrospective study of all the patients who had surgery for IMSCTs in our hospital over a 14 year period. Results There were 20 patients, 9 males, 11 females, in this study. The median age was 33 years (range = 7-78 years). The median duration of symptoms was 12 months (range = 1-120 months). Motor deficit was present in all but one (95%) of our patients. Only 25% of the patients presented in good functional status (McCormick grades I and II). The tumours were confined to the thoracic region in 10 patients (50%), while tumours in the thoracic region extending to the adjoining cervical and lumbar regions were seen in 6 patients (30%). Gross total tumour resection was achieved in 60% of the patients and subtotal resection in the remaining 40%. Astrocytoma and ependymoma were the most common tumours, each occurring in 35% of the cases. Six patients (30.0%) improved, 12 patients (60.0%) remained neurologically the same, while 2 patients (10.0%) deteriorated at the time of last follow up. The mortality rate was 15%. The preoperative functional status was a significant predictor of postoperative outcome (p = 0.03). Conclusion Astrocytoma and ependymoma were the most common histological tumour types among our patients. Late presentation and poor pre-operative functional status were prominent features of our patients' cohort.
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Affiliation(s)
- Toyin Ayofe Oyemolade
- Department of Neurological Surgery, University College Hospital, UCH, PMB 5116, Ibadan, Oyo State, Nigeria
- Division of Neurosurgery, Department of Surgery, Federal Medical Centre, PMB 1053, Owo, Ondo State, Nigeria
| | - James Ayokunle Balogun
- Department of Neurological Surgery, University College Hospital, UCH, PMB 5116, Ibadan, Oyo State, Nigeria
- Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Oluwakemi Aderonke Badejo
- Department of Neurological Surgery, University College Hospital, UCH, PMB 5116, Ibadan, Oyo State, Nigeria
- Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Adefolarin Obanisola Malomo
- Department of Neurological Surgery, University College Hospital, UCH, PMB 5116, Ibadan, Oyo State, Nigeria
- Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Matthew Temitayo Shokunbi
- Department of Neurological Surgery, University College Hospital, UCH, PMB 5116, Ibadan, Oyo State, Nigeria
- Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Olusola Kayode Idowu
- Department of Anaesthesia, College of Medicine University, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Augustine Abiodun Adeolu
- Department of Neurological Surgery, University College Hospital, UCH, PMB 5116, Ibadan, Oyo State, Nigeria
- Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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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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Girardo M, Zenga F, Bruno LL, Rava A, Massè A, Maule M, Fusini F. Treatment of Aggressive Vertebral Hemangiomas with Poly Vinyl Alcohol (PVA) Microparticles Embolization, PMMA, and Short Segment Stabilization: Preliminary Results with at Least 5 Years of Follow-up. World Neurosurg 2019; 128:e283-e288. [PMID: 31028979 DOI: 10.1016/j.wneu.2019.04.138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/14/2019] [Accepted: 04/15/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Vertebral hemangiomas (VHs) are the most common incidental lesions of vertebral body, but they are very challenging to treat if they become symptomatic. Several treatments have been proposed but none was superior to others. The aim of this study is to analyze blood loss and long-term clinical and neurological results of aggressive VHs treated with arterial embolization the day before operation, followed by vertebroplasty, posterior decompression, and short segment stabilization. METHODS Ten patients (4 males and 6 females) were treated for aggressive VHs with polyvinyl alcohol microparticles embolization, posterior short segment stabilization, and poly methyl methacrylate. Clinical and neurological outcomes were assessed with visual analog, Nurick, and American Spinal Injury Association (ASIA) scales. RESULTS At last follow-up mean, visual analog scale was 1.8 ± 1.3, with a significant difference with preoperative values (P = 0.00018). Neurological deficits persisted in 4 patients (ASIA scale: C in 1 patient [10%], D in 3 patients [30%]), but they improved from baseline in all cases. Also, Nurick scale rating improved in all patients (0 in 3 patients [30%], 1 in 4 patients [40%], 2 in 2 patients [20%], and 3 in the last one [10%]). A statistically significant difference between pre- and postoperative values was observed for both scores (ASIA, P = 0.0102; Nurick, P = 0.026). Relapse of pathology was recorded in 2 patients. CONCLUSIONS Polyvinyl alcohol microparticles embolization, short segment fixation, and vertebroplasty is an effective treatment option for aggressive VHs, with a fast surgical time, poor blood loss, and improvement of preoperative clinical and neurological outcomes.
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Affiliation(s)
- Massimo Girardo
- Spine Surgery Unit, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesco Zenga
- Department of Neurosurgery, Molinette Hospital, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Laura Lorien Bruno
- Spine Surgery Unit, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Alessandro Rava
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
| | - Alessandro Massè
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Milena Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
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Long-term outcome of treatment of vertebral body hemangiomas with direct ethanol injection and short-segment stabilization. Spine J 2019; 19:131-143. [PMID: 29890263 DOI: 10.1016/j.spinee.2018.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/13/2018] [Accepted: 05/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Vertebral body hemangiomas with myelopathy are difficult to manage. OBJECTIVE The objective of this study was to evaluate the role of intraoperative ethanol embolization, surgical decompression, and instrumented short-segment fusion in vertebral hemangioma (VH) with myelopathy and long-term outcome (>24 months). CLINICAL MATERIALS AND METHODS This prospective study included symptomatic VH with cord compression with myelopathy. Pathologic fractures and deformity or multilevel pathologies were excluded from the study. Surgery consisted of intraoperative bilateral pedicular absolute alcohol (<1% hydrated ethyl alcohol) injection, laminectomy, and cord decompression at the level of pathology followed by a short-segment instrumented fusion using pedicle screws. RESULTS The study included 33 patients (mean 26.9±13.2, range: 10-68 years, 18 females). The clinical features of the study were myelopathy in all patients (5 paraplegic), sphincter involvement (13), and mid back or lower back pain (7). The preoperative American Spinal Injury Association (ASIA) scores were A (7), B (11), C (6), D (8), and E (1). Majority of the patients had single vertebral involvement (30) and three patients had multiple-level involvement. Six patients underwent surgery earlier (one underwent alcohol embolization). The mean surgical time was 124±39 minutes, and the average blood loss was 274±80 cc. The mean amount of absolute alcohol injected was 14.6±5.7 cc (two patients required 20 and 25 cc). Immediate embolization was achieved in all patients, allowing laminectomy and easy removal of soft-tissue hemangioma. Post surgery, one patient had transient deterioration, and the condition of the rest of the patients improved (sphincters improved in nine patients) at a follow-up ranging 28-103 months (mean 47.6±22.3). Follow-up ASIA scores were E (26), D (4), B (2), and C (1). All patients showed evidence of bone sclerosis and relief of cord compression on follow-up imaging. CONCLUSIONS This is the largest study in literature showing excellent improvement, low reoperation rates after ethanol embolization, and short-segment fixation.
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Chikani MC, Okwunodulu O, Mesi M, Mezue WC, Ohaegbulam SC, Ndubuisi CC. Surgically Treated Primary Spinal Cord Neoplasms in Southeastern Nigeria. J Neurosci Rural Pract 2018; 9:137-139. [PMID: 29456358 PMCID: PMC5812138 DOI: 10.4103/jnrp.jnrp_391_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Primary spinal cord tumors are not as frequently encountered as their cranial counterparts. They could present in such an indolent manner that requires a reasonable index of suspicion for their diagnosis to be considered. Objective: The objective of this study is to analyze the incidence and pattern of primary spinal cord and appendage neoplasms in patients surgically treated in our institution over a decade of practice. Materials and Methods: A retrospective review of clinical, radiological, and histopathology profiles of patients surgically treated for primary spinal cord tumor from 2006 to 2016 was carried out. Retrieved data were analyzed using SPSS version 21. Results: Out of 472 spine procedures were performed within the study period 17 (3.6%) cases of histologically proven primary spinal cord tumors were identified. The age of patients ranged between 17 and 77 years with a mean age was 45 years. The male: female ratio was 1:1.1. Motor deficit and pain were the most common presenting symptoms seen in 35.3% and 29.4% of patients, respectively. Meningiomas are the most common histological diagnosis (70.6%), distantly followed by Schwannoma (17.6%). The most common location of the tumors was intradural extramedullary (70.6%). All patients had gross total resection of tumor with no perioperative mortality. Conclusion: Meningioma is the most common surgically treated primary spinal cord tumor in our setting. Surgery is associated with good outcome.
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Affiliation(s)
- Mark Chukwunweike Chikani
- Department of Surgery, Division of Neurosurgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Okwuoma Okwunodulu
- Department of Surgery, Memfy's Hospital for Neurosurgery, Enugu, Nigeria
| | - Mathew Mesi
- Department of Surgery, Division of Neurosurgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Wilfred C Mezue
- Department of Surgery, Division of Neurosurgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Chika C Ndubuisi
- Department of Surgery, Memfy's Hospital for Neurosurgery, Enugu, Nigeria
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