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Gader G, Mansour W, Kharrat MA, Hdhili H, Chelly I, Bahri K, Zammel I. Intradural extramedullary cervical cavernoma. Surg Neurol Int 2024; 15:294. [PMID: 39246765 PMCID: PMC11380909 DOI: 10.25259/sni_542_2024] [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: 07/04/2024] [Accepted: 07/20/2024] [Indexed: 09/10/2024] Open
Abstract
Background Spinal cavernomas (SCs) account for about 5% of all spinal vascular malformations. Intradural SCs occur in just 3% of cases and are typically intramedullary. Case Description A 58-year-old female presented with progressive left occipital neuralgia, left cervicobrachial neuralgia, and paresthesia of all four extremities. The magnetic resonance imaging (MRI) revealed an intradural extramedullary C2-C4 lesion causing significant spinal cord compression. Gross total tumor excision was accomplished through a midline laminectomy pathologically; the lesion proved to be a cavernoma. The postoperative follow-up MRI obtained 4 months postoperatively showed complete tumor resection. Conclusion A 58-year-old female successfully underwent gross total excision of a C2-C4 intradural extramedullary SC.
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Affiliation(s)
- Ghassen Gader
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia
| | - Wiem Mansour
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia
| | | | - Houssem Hdhili
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia
| | - Ines Chelly
- Department of Pathology, La Rabta Hospital, Tunis, Tunisia
| | - Kamel Bahri
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia
| | - Ihsèn Zammel
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia
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2
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Burgess L, Malone J, dos Santos MP, Sinclair J, Zalay O, Malone S. Clinical and radiographic response of a paravertebral hemangioma to radiotherapy. Radiol Case Rep 2024; 19:988-993. [PMID: 38155745 PMCID: PMC10751835 DOI: 10.1016/j.radcr.2023.11.032] [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: 05/24/2023] [Revised: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 12/30/2023] Open
Abstract
Hemangiomas can arise anywhere in the body. While vertebral hemangiomas are common, atypical hemangiomas with paraspinal and epidural extension are rare. We present a case of a patient who presented with persistent cough and anorexia from a paravertebral hemangioma that invaded the adjacent vertebrae and neural foramen causing moderate spinal canal stenosis. She was treated with stereotactic body radiotherapy to prevent the development of symptomatic spinal cord compression. The hemangioma underwent significant shrinkage and her cough resolved. This case demonstrates impressive and sustained clinical and radiographic response of a paraspinal hemangioma to stereotactic body radiotherapy.
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Affiliation(s)
- Laura Burgess
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Radiology, Division of Radiation Oncology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Julia Malone
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Radiology, Division of Radiation Oncology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marlise P. dos Santos
- Department of Radiology, Radiation Oncology and Medical Physics, Section of Neuroradiology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Surgery Divisions of Neurosurgery and Interventional Neuroradiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - John Sinclair
- Department of Surgery, Division of Neurosurgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Osbert Zalay
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Radiology, Division of Radiation Oncology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shawn Malone
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Radiology, Division of Radiation Oncology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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3
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Muacevic A, Adler JR, Wichmann W, Magagna-Poveda A, Fandino J. Lumbar Epidural Cavernous Hemangioma: A Case Report and Review of the Literature. Cureus 2023; 15:e33677. [PMID: 36788892 PMCID: PMC9918856 DOI: 10.7759/cureus.33677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/14/2023] Open
Abstract
Pure epidural cavernous hemangioma (ECH) of the spine are rare and account for only 4% of all epidural spinal lesions. We report a case of epidural cavernoma at L3/4 presenting with L4 radiculopathy. Radiological, intraoperative findings and histopathology are presented. We present the case of a 56-year-old man who was admitted with a right L4 radiculopathy including an M4 paresis of the right leg, hypoesthesia L4, and radicular pain. Magnetic resonance imaging (MRI) confirmed an extradural lesion L3/4 partially expanding into the right intervertebral foramen. The lesion had a heterogeneous signal, isointense on T1-weighted and hyperintense on proton density (PD) and T2-weighted images. At surgery, an epidural, ovoid, gray-red, soft mass, lightly adherent to the dura and extending to the right L4 foramen was observed. Findings in the histological examination indicated a cavernous hemangioma without signs of hemorrhage. Symptoms and paresis improved rapidly after surgery. The follow-up MRI showed complete resection of the lesion with no signs of radicular compression. Spinal ECH should be considered as a cause of chronic lumbar radiculopathy with atypical radiological findings. Early diagnosis and total removal of the spinal ECH might prevent hemorrhage and neurological deficits. Fewer than 50 cases of lumbar epidural spinal hemangioma have been reported until today, and our case report is adding valuable knowledge to the existing literature.
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Brindisino F, Scrimitore A, Pennella D, Bruno F, Pellegrino R, Maselli F, Lena F, Giovannico G. Aggressive Vertebral Hemangioma and Spinal Cord Compression: A Particular Direct Access Case of Low Back Pain to Be Managed-A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13276. [PMID: 36293852 PMCID: PMC9603351 DOI: 10.3390/ijerph192013276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Hemangiomas are the most common benign tumours affecting the spine, with an incidence of 10-12% of the general population. Although most hemangiomas are asymptomatic, there are aggressive forms which can develop symptoms, leading patients to show signs of disability. This case report aims to highlight the importance of red flags screening, and to report the physiotherapist's clinical reasoning that led him to refer his patient to other healthcare professionals. This case also illustrated the pre- and post-surgical treatment of a specific low back pain case in a patient affected by aggressive vertebral hemangioma and spinal cord compression. The patient is a 52-year-old man, who reported intense pain in his sacral region about three months prior, which worsened while in sitting position. The physiotherapist proceeded with a complete medical history investigation and clinical examination. After an impaired neurological examination, the patient was referred to another health professional, who diagnosed multiple vertebral hemangiomas in the patient's lumbosacral tract. The therapeutic intervention included the patient's post-surgical rehabilitation following a vascular embolization. This case report shows the importance of proper patient screening. Indeed, during patients' assessment, it is paramount to recognize red flags and to investigate them appropriately. An early referral of patients with conditions that require the support and expertise of other professionals can lead to a timely diagnosis and avoid costly and unnecessary rehabilitation procedures. In this case, the interdisciplinary collaboration between physiotherapist and neurosurgeon was crucial in guiding the patient towards recovery.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Angelo Scrimitore
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Denis Pennella
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Francesco Bruno
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Raffaello Pellegrino
- Antalgic Mini-Invasive and Rehab-Outpatients Unit, Department of Medicine and Science of Aging, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano, Switzerland
| | - Filippo Maselli
- Department of Human Neurosciences, University of Rome “Sapienza”, 00185 Rome, Italy
- Sovrintendenza Sanitaria Regionale Puglia INAIL, 70121 Bari, Italy
| | - Francesco Lena
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
- Department of Neurology, IRCCS INM Neuromed, 86077 Pozzilli, Italy
| | - Giuseppe Giovannico
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
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D’Onofrio GF, Capo G, Vasiljevic A, Barrey CY. Pure lumbar foraminal cavernous malformation in a patient with Cowden syndrome-a case report. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:390-396. [PMID: 36285093 PMCID: PMC9547691 DOI: 10.21037/jss-22-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Spinal cavernous malformations (CMs) are slow flow venous vascular malformations which can occur in vertebral body, epidural space or intramedullary. Only 7 cases were described confined in foraminal space. Cowden syndrome (CS) is an autosomal dominant genodermatosis that may present and develop vascular malformations, which include CM. They were found intracranial, and rarely visceral. No association with spinal CM and CS has been reported to date. CASE DESCRIPTION A 46-year-old patient with CS came to our attention with a L5 radiculopathy secondary to a slow-growing intra-foraminal mass lesion, with bony scalloping. The lesion mimicked a schwannoma at radiological imaging and intraoperative findings. En bloc resection with root sacrifice was performed. No excessive bleeding was observed. After surgical resection, anatomical pathology demonstrated a CM. Postoperative review of neuroimaging revealed features compatible with chronic resolved peripheral haemorrage. The patient had no intra- or post-operative complications, and an immediate relief of symptoms was observed. The follow-up spinal magnetic resonance imaging (MRI) obtained 3 months after surgery, demonstrated the total removal of the lesion. CONCLUSIONS CMs can be confined to foraminal space and associated with CS. They may mimic peripheral nerve sheath tumors. Diagnosis may be challenging. No pathognomonic imaging features were found. Complete resection with root sacrifice seems to be a safe and efficient technique.
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Affiliation(s)
- Ginevra Federica D’Onofrio
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon-Bron, France
- Agostino Gemelli Hospital, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriele Capo
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon-Bron, France
| | - Alexandre Vasiljevic
- Department of Pathology and Neuropathology, Lyon Civils Hospitals, Lyon-Bron, France
| | - Cédric Y. Barrey
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon-Bron, France
- Laboratory of Biomechanics, ENSAM, Arts et Metiers ParisTech, Paris, France
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6
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Case report of cavernous hemangioma with a 4 year follow up. Ann Med Surg (Lond) 2022; 80:104027. [PMID: 35855876 PMCID: PMC9287775 DOI: 10.1016/j.amsu.2022.104027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/22/2022] Open
Abstract
Cavernous hemangiomas are vascular malformations that can affect any part of the central nervous system. In general, epidural hemangiomas are secondary extensions of spinal lesions. These tumors grow slowly and are expressed as slow spinal cord compression syndromes, radiculopathy, or both. History, clinical examination, routine radiographs, MRI, and histopathologic studies are aids to a definitive diagnosis. This is a 61-year-old chronic smoker with a history of cholecystectomy in 2017. History of the disease: dates to 1 month by a progressive installation of heaviness of the left lower limb, then of the right one 15 days later. The state was complicated one week before his admission by sphincter disorders such as urinary leakage. Clinically, the patient walked with assistance, with a paraparesis of the two lower limbs at 4/5 on muscle testing, with a posterior cord syndrome, a D6 sensory level and normal osteotendinous reflexes. Spinal cord MRI showed a tissue-like process at D6-D7 extra-medullary extradural. Spinal cavernous extradural hemangioma is a frequent lesion, represented by a malformation of the microcirculation, whose diagnosis has become easier with the advent of MRI, revealed essentially by a spinal cord compression syndrome, whose evolution is favorable if treated in time. This article presents a case of a dorsal epidural cavernous hemangioma. The clinical examination revealed a posterior cord syndrome associated with sphincter disorders such as urinary leakage. The medullary MRI confirmed the suspected diagnosis of medullary compression. The total removal of the tumor was done, the diagnosis of cavernous hemangioma was suspected intraoperatively, and confirmed in anatomopathological examination. The follow up done up to 4 years showed the complete recovery of the patient showing the importance of time-based care.
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7
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Frank F, Maybaum J, Frydrychowicz C, Stoll K, Gaber K, Meixensberger J. Cervical intradural extramedullary cavernous malformation as a rare cause of subarachnoid hemorrhage without spinal dysfunction: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21463. [PMID: 36130539 PMCID: PMC9379632 DOI: 10.3171/case21463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/01/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Intradural extramedullary cavernoma is a very rare lesion of the spinal cord, especially of the cervical spine. Its clinical presentation can vary with symptoms of sensory or motor deficits and even with symptoms of subarachnoid hemorrhage (SAH).
OBSERVATIONS
The authors present a case of a 45-year-old man with SAH with prolonged neck pain and increasing headache confirmed by lumbar puncture. Head computed tomography revealed only discrete blood deposits in the right frontal and biparietal lobes. The finding of pan-cerebral angiography was negative for the cause of bleeding. Spinal magnetic resonance imaging revealed an intradural extramedullary mass lesion at cervical level C5–6. The finding of subsequent cervical angiography was negative. The diagnosis of a cavernous malformation was confirmed histopathologically after surgery. The cavernoma was completely removed, and full recovery of the initial symptoms was achieved.
LESSONS
Spinal lesions should be considered in the diagnostic work-up for SAH with excluded origin of bleeding in cranial neuroimaging. An intradural extramedullary cavernous malformation is an extremely rare entity in the differential diagnosis of SAH, and surgical resection is the treatment of choice to prevent further bleeding and neurological deficits.
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Affiliation(s)
| | | | | | - Kristin Stoll
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
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Colamaria A, Sacco M, Iodice S, D’Oria S, Parbonetti G, Carbone F, de Notaris M. Intradural extramedullary cavernous hemangioma of the cervicothoracic junction: A case report and review of the literature. Surg Neurol Int 2022; 13:53. [PMID: 35242419 PMCID: PMC8888298 DOI: 10.25259/sni_964_2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Intradural extramedullary cavernous hemangiomas of the spine are rare, benign lesions with only 40 published cases to date. Case Description: The authors report a rare case of a histologically diagnosed intradural extramedullary cavernous hemangioma of the spine involving the cervicothoracic junction and causing sudden gait disturbances and urinary retention in a 24-year-old male. Gross total tumor removal allowed complete spinal decompression and sensible improvement of the clinical condition with no evidence of tumor relapse at 12-month follow-up examination. Conclusion: More frequently found in the lower thoracic and lumbar spine, these tumors often cause subtle clinical manifestations including sensory and motor dysfunction secondary to nerve root compression; nonetheless, occasional cases of rapidly progressive worsening of the neurological condition with evidence of myelopathy and autonomic dysfunction have been described. In such cases, urgent surgical resection is crucial since the degree of neurological impairment and the time spanned from the onset of the symptoms are paramount for a good recovery.
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Affiliation(s)
- Antonio Colamaria
- Department of Neurosurgery, “Riuniti” Hospital, Foggia, Puglia, Italy
| | - Matteo Sacco
- Department of Neurosurgery, “Riuniti” Hospital, Foggia, Puglia, Italy
| | - Savino Iodice
- Department of Neurosurgery, “Riuniti” Hospital, Foggia, Puglia, Italy
| | - Salvatore D’Oria
- Neurosurgical Unit, Miulli Hospital, Acquaviva delle Fonti, Puglia, Italy
| | | | - Francesco Carbone
- Department of Neurosurgery, University of Foggia, Foggia, Puglia, Italy
| | - Matteo de Notaris
- Department of Neurosurgery, “Rummo” Hospital, Benevento, Campania, Italy
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9
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Joshi GK, Krishna KN, Krishna DG, Murthy GK, Herur A, Karnam SV. Dorsal Spinal Epidural Cavernous Angioma; A Case Report. Asian J Neurosurg 2021; 16:144-149. [PMID: 34211883 PMCID: PMC8202371 DOI: 10.4103/ajns.ajns_150_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/23/2020] [Accepted: 07/18/2020] [Indexed: 11/04/2022] Open
Abstract
Spinal cavernous angiomas are lesions formed by vessels lined by closely clustered endothelial cells. They are common in the vertebral body and less common in an intradural location. However, these are very rare in the extra-osseous and epidural region. Less than 100 cases have been reported. Here, we report a case of dorsal spinal extradural cavernous angioma in a 52-year-old man who presented with back pain and difficulty in walking. Magnetic resonance imaging brain showed D7-D8 (thoracic) extradural spinal lesion, enhancing homogeneously on contrast administration. He underwent D7-D8 hemilaminectomy and tumor decompression. The tumor was extradural, tightly adherent to the dura, and highly vascular. He recovered completely after surgical removal with no recurrence 2 years after removal. He was not administered adjuvant radiotherapy. In this article, we review the literature regarding clinical features, imaging findings, and outcome of spinal epidural cavernous angioma.
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Affiliation(s)
- Girish Krishna Joshi
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
| | - K N Krishna
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
| | - Dilip Gopal Krishna
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
| | - Ganesh K Murthy
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
| | - Ajay Herur
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
| | - Sundeep V Karnam
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
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10
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Zhao L, Jiang Y, Wang Y, Bai Y, Sun Y, Li Y. Spinal Epidural Cavernous Hemangiomas: A Clinical Series of 9 Cases and Literature Review. Front Oncol 2021; 11:572313. [PMID: 33816222 PMCID: PMC8010302 DOI: 10.3389/fonc.2021.572313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Spinal epidural cavernous hemangiomas are very rare vascular lesions and are, therefore, seldom reported and easily misdiagnosed. Herein, we present a series of 9 cases with spinal epidural cavernous hemangiomas and discuss their pathogenesis, clinical characteristics, radiological findings, differential diagnosis, surgical interventions, pathological characteristics, and prognosis. Methods We retrospectively retrieved and analyzed the data of patients with pure epidural cavernous hemangiomas, who underwent spinal magnetic resonance imaging, and surgical intervention at the First Hospital of Jilin University, China, between January 2005 and December 2019. The data on patients’ clinical manifestations, imaging characteristics, surgical intervention, histopathological findings, and postoperative follow-up were also recorded and analyzed. Results In all, 5 men and 4 women with the mean age of 61 years (range, 41–78 years) were recruited. All patients experienced a gradual onset of symptoms and a slowly progressive clinical course, and no patient presented an acute onset of symptoms. The clinical manifestations include myelopathic signs in 8 patients (88.9%) and radicular symptoms in 3 patients (33.3%). On T1-weighted imaging, 6 lesions appeared isointense (55.6%), and 4 lesions exhibited hypointense (44.4%) signals. On T2-weighted imaging, 8 lesions appeared hyperintense (88.9%), and 1 lesion was heterogeneously intense (11.1%). Following gadolinium administration, 5 lesions appeared homogeneous with significant enhancement (55.6%), 1 lesion was homogeneous and mild enhancement (11.1%), and 3 lesions were heterogeneous with mild enhancement (33.3%). All patients received early microsurgery assisted by intraoperative electrophysiologic monitoring and neuronavigation in the lateral position via the posterior midline approach. Five patients underwent total laminectomy (55.6%), and 4 underwent hemilaminectomy (44.4%). Total excision was achieved in all cases. The average follow-up period was 55.1 months (ranging 10–123 months). All patients exhibited significant clinical improvement of their neurological deficits and achieved a favorable outcome with no recorded recurrence at last follow-up. Conclusions Spinal epidural cavernous hemangiomas are rare vascular malformations. Early surgical treatment with total resection is an optimum treatment, particularly for patients with an acute exacerbation onset. The prognosis is mostly good and depends predominantly on the severity of the preoperative status.
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Affiliation(s)
- Liyan Zhao
- Department of Clinical Laboratory, Second Hospital of Jilin University, Changchun, China
| | - Yining Jiang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yubo Wang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yang Bai
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Ying Sun
- Department of Clinical Laboratory, Second Hospital of Jilin University, Changchun, China
| | - Yunqian Li
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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11
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Shamhoot EA, Balaha AM, Ganna AA. Role of Combined Vertebroplasty and Spinal Decompression in the Management of Aggressive Vertebral Hemangiomas. Asian J Neurosurg 2021; 15:919-925. [PMID: 33708663 PMCID: PMC7869295 DOI: 10.4103/ajns.ajns_291_20] [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: 06/12/2020] [Revised: 08/04/2020] [Accepted: 09/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background: There are different surgical modalities designed to manage aggressive vertebral hemangioma (VH) that causes neurological symptoms. The selection of the best approach is still controversial. It is crucial to safely achieve neurological recovery with the elimination of the risk of recurrence. The combined use of surgical decompression and vertebroplasty is one of the surgical modalities that are used to manage these cases. Patients and Methods: From January 2012 to January 2019, nine patients with aggressive VH were retrospectively included in the study. All of them were operated upon using combined surgical decompression and vertebroplasty. We evaluated all the patients preoperatively, immediate postoperative, 1 month, and 12 months later. Clinical and radiological outcomes were assessed. Results: Affected spinal levels were dorsal in six cases and lumbar in three cases. There was no postoperative worsening of the preoperative neurological status. For the cases presented with sciatica, the mean VAS score has dropped from 8.33 preoperatively to 2.67 postoperatively. One month later, all of them are free from the radicular pain. For the cases presented with myelopathy, they regain their motor power in both lower limbs over a period of 4 weeks with a mean Nurick grade of 1.17. The postoperative radiological studies revealed near total occlusion of the VH with the maintenance of the vertebral body height. No clinical or radiological signs of spinal instability or recurrence are observed over the period of follow-up. Conclusions: The combined use of surgical decompression and vertebroplasty is considered a safe and effective modality in the management of aggressive VHs.
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Affiliation(s)
| | | | - Ahmed Atef Ganna
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Egypt
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12
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Mariniello G, Pagano S, Meglio V, Barbato M, Russo C, Pontillo G, Di Stasi M, Elefante A. Multiple vertebral hemangiomas of the thoracic spine with atypical radiological features and aggressive behavior causing myelopathy: A case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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13
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Kim CH, Kim SW. Rapidly Progressive Atypical Vertebral Hemangioma: A Case Report. Korean J Neurotrauma 2020; 16:320-325. [PMID: 33163444 PMCID: PMC7607043 DOI: 10.13004/kjnt.2020.16.e24] [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: 05/12/2020] [Revised: 07/01/2020] [Accepted: 07/10/2020] [Indexed: 11/21/2022] Open
Abstract
Vertebral hemangiomas are common, benign, and asymptomatic tumors that rarely extend into the epidural space or involve the posterior elements. Surgery is recommended for aggressive vertebral hemangiomas if symptoms are severe or evolve rapidly. A 57-year-old male patient was admitted to our department for several months of back pain. A computed tomography (CT) scan and magnetic resonance imaging (MRI) were suggestive of T12 hemangioma without the involvement of the spinal canal or posterior elements. Despite aggressive conservative treatments, such as medications or nerve blocks, the back pain worsened. The CT and MRI 2 months later revealed a lesion involving the vertebral body and posterior elements with extension into the epidural space and with spinal cord compression. The patient underwent surgery for bone cement-augmented percutaneous screw fixation followed by low-dose radiotherapy. Histological examination confirmed the diagnosis of atypical hemangioma, specifically an epithelioid hemangioendothelioma.
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Affiliation(s)
- Chi Ho Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Seok Won Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
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14
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Rapidly Progressive Myelopathy Caused by Aggressive Vertebral Hemangioma. Case Rep Orthop 2019; 2019:8927310. [PMID: 31827961 PMCID: PMC6885279 DOI: 10.1155/2019/8927310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/08/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Vertebral hemangiomas are the most common benign tumors of the spine, having an incidence of 10-12% in the general population. They are asymptomatic, incidental findings in the vast majority of patients; however, in rare cases, they can expand to cause neural compression. Aggressive lesions of this sort are most commonly found in the thoracic spine, and expansion leads to the subacute development of myelopathy. Case Report The authors report a rare case of aggressive vertebral hemangioma at the T1 vertebral body which caused rapidly progressive myelopathy over the course of 7 days. Clinical and radiological findings are shown as well as surgical management of the lesion. The patient regained the ability to ambulate, and there was no evidence of disease recurrence at 2-year follow-up. Conclusions Although aggressive vertebral hemangiomas are a rare cause of myelopathy, they must be kept in mind in the differential diagnosis of cord compressive lesions. In this case, contrary to most, the expansion of the hemangioma led to rapid development of neurological decline necessitating urgent surgical intervention.
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Panero I, Eiriz C, Lagares A, Toldos O, Panero A, Paredes I. Intradural-Extramedullary Capillary Hemangioma with Acute Bleeding: Case Report and Literature Review. World Neurosurg 2017; 108:988.e7-988.e14. [PMID: 28823662 DOI: 10.1016/j.wneu.2017.08.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Capillary hemangiomas are benign vascular tumors. They are commonly founded in the vertebral bodies but very seldom in the spinal cord. The most common symptom at onset is long-lasting axial pain without neurologic deficit. In rare cases, the onset may be acute with neurological deficit due to an intratumoral hemorrhage. PATIENT AND METHODS We report a case of a 58-year-old male with a history of 15 days upper back pain triggered by a mild traumatism that evolves acutely to paraplegia and urinary and fecal retention. An urgent MR showed an intradural lesion with signs of intratumoral haemorrhage. RESULTS Urgent surgical intervention was performed and the anatomopathological results were capillary hemangioma. The symptoms of the patient improved after the surgery. CONCLUSIONS Intradural capillary hemangioma with acute intratumoral hemorrhage is a rare pathology, but it must be kept in mind because early diagnosis and treatment are key to achieve a good outcome. As far as we know, this is the first case reported of an intradural-extramedular capillary hemangioma that presents sudden neurologic deficit due to intratumoral bleeding.
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Affiliation(s)
- Irene Panero
- Department of Neurosurgery, 12 de Octubre University Hospital, Madrid, Spain.
| | - Carla Eiriz
- Department of Neurosurgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Oscar Toldos
- Department of Neuropathology, 12 de Octubre University Hospital, Madrid, Spain
| | | | - Igor Paredes
- Department of Neurosurgery, 12 de Octubre University Hospital, Madrid, Spain
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Golnari P, Ansari SA, Shaibani A, Hurley MC, Potts MB, Kohler ME, Sugrue PA, Jahromi BS. Intradural extramedullary cavernous malformation with extensive superficial siderosis of the neuraxis: Case report and review of literature. Surg Neurol Int 2017; 8:109. [PMID: 28680728 PMCID: PMC5482162 DOI: 10.4103/sni.sni_103_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/05/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Spinal cavernous malformations usually affect the vertebral bodies and are seldom intradural. Here, we report a rare spinal intradural-extramedullary cavernous malformation associated with extensive superficial siderosis along the neuraxis in a patient with radicular complaints. Case Description: A 60-year-old male presented with subacute headaches, intermittent fever, and acute back and radicular leg pain for 1–2 weeks. Magnetic resonance imaging revealed an intradural-extramedullary lesion just below the conus medullaris (at the L2 level). There was associated subarachnoid hemorrhage in the lumbar cistern and superficial siderosis along the entire spinal neuraxis. Following surgical resection, the patient's symptoms resolved. Histopathology of the lesion was of a cavernous malformation. Conclusions: There are only 56 cases of spinal intradural-extramedullary cavernous malformations published in the literature; however, only 3 described superficial neuraxis siderosis as noted in this case. In the present case, slowly recurring hemorrhages of the lesion located at the conus likely contributed to the complete neuraxis superficial siderosis. Timely evaluation and treatment of these lesions is warranted to avoid further compressive and/or hemorrhagic complications.
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Affiliation(s)
- Pedram Golnari
- Department of Neurological Surgery and Radiology, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Sameer A Ansari
- Department of Neurological Surgery and Radiology, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Ali Shaibani
- Department of Neurological Surgery and Radiology, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Michael C Hurley
- Department of Neurological Surgery and Radiology, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Matthew B Potts
- Department of Neurological Surgery and Radiology, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Missia E Kohler
- Department of Neuropathology, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Patrick A Sugrue
- Department of Neurological Surgery, Advocate Good Samaritan Hospital, Downers Grove, Illinois, USA
| | - Babak S Jahromi
- Department of Neurological Surgery and Radiology, Northwestern Memorial Hospital, Chicago, Illinois, USA
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Abstract
OBJECTIVE Vertebral hemangiomas are common tumors that are benign and generally asymptomatic. Occasionally these lesions can exhibit aggressive features such as bony expansion and erosion into the epidural space resulting in neurological symptoms. Surgery is often recommended in these cases, especially if symptoms are severe or rapidly progressive. Some surgeons perform decompression alone, others perform gross-total resection, while others perform en bloc resection. Radiation, embolization, vertebroplasty, and ethanol injection have also been used in combination with surgery. Despite the variety of available treatment options, the optimal management strategy is unclear because aggressive vertebral hemangiomas are uncommon lesions, making it difficult to perform large trials. For this reason, the authors chose instead to report their institutional experience along with a comprehensive review of the literature. METHODS A departmental database was searched for patients with a pathological diagnosis of "hemangioma" between 2008 and 2015. Medical records were reviewed to identify patients with aggressive vertebral hemangiomas, and these cases were reviewed in detail. RESULTS Five patients were identified who underwent surgery for treatment of aggressive vertebral hemangiomas during the specified time period. There were 2 lumbar and 3 thoracic lesions. One patient underwent en bloc spondylectomy, 2 patients had piecemeal gross-total resection, and the remaining 2 had subtotal tumor resection. Intraoperative vertebroplasty was used in 3 cases to augment the anterior column or to obliterate residual tumor. Adjuvant radiation was used in 1 case where there was residual tumor as well. The patient who underwent en bloc spondylectomy experienced several postoperative complications requiring additional medical care and reoperation. At an average follow-up of 31 months (range 3-65 months), no patient had any recurrence of disease and all were clinically asymptomatic, except the patient who underwent en bloc resection who continued to have back pain. CONCLUSIONS Gross-total resection or subtotal resection in combination with vertebroplasty or adjuvant radiation therapy to treat residual tumor seems sufficient in the treatment of aggressive vertebral hemangiomas. En bloc resection appears to provide a similar oncological benefit, but it carries higher morbidity to the patient.
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Affiliation(s)
| | - John H Chi
- Brigham and Women's Hospital, Harvard Medical School; and.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Michael W Groff
- Brigham and Women's Hospital, Harvard Medical School; and.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Abstract
AIM Cavernous malformations in the spinal canal are rare. We review previous reports and present our own case of a cervical intradural extramedullary cavernoma, associated with a ventral cervical rootlet. METHODS A 65 year old woman presented with radicular pain and paresthesias of the neck and right arm. PubMed search was used to compare her case to those previously published. RESULTS The cavernoma was successfully removed with excellent recovery and no deficits. Histopathology confirmed the diagnosis. CONCLUSION Gross total resection of symptomatic lesions continues to be the recommended approach, and resection outcomes have restored function in all cases but one, where the deficit persisted.
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Affiliation(s)
- Fraser Henderson
- a Department of Neurosurgery , Medical University of South Carolina , Charleston , South Carolina , USA
| | - Daniel Carl Skipper
- b Department of Pathology and Laboratory Medicine , Medical University of South Carolina , Charleston , South Carolina , USA
| | - Sunil Patel
- a Department of Neurosurgery , Medical University of South Carolina , Charleston , South Carolina , USA
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Mataliotakis G, Perera S, Nagaraju S, Marchionni M, Tzerakis N. Intradural extramedullary cavernoma of a lumbar nerve root mimicking neurofibroma. A report of a rare case and the differential diagnosis. Spine J 2014; 14:e1-7. [PMID: 25200326 DOI: 10.1016/j.spinee.2014.08.447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 06/16/2014] [Accepted: 08/18/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intradural extramedullary (IDEM) cavernomas are rare vascular malformations. They are well-circumscribed dark berry-like lesions with a histologic appearance of sinusoidal vascular channels. Neurofibromas are the most common IDEM tumors, originating from all nerve elements and leading to firm enlargement of the affected nerve root. These lesions are completely different; however, they may involve the spinal nerve roots or the major nerve trunks. Any similarities in clinical findings are based on different pathophysiology. PURPOSE To present a rare resemblance of an IDEM cavernoma to a neurofibroma. STUDY DESIGN This is a case report with review of the literature focused on the differential diagnosis. METHODS A 79-year-old patient presented with acute sensorimotor disturbance from L2-S1 levels. The investigations showed an L2-L3 lesion occupying the canal. Findings resembled a neurofibroma and a surgical resection was decided. RESULTS The complete surgical resection revealed a vascular lesion originating from a nerve root. The histology confirmed an IDEM cavernoma. This is a unique case as such a clinical resemblance and a macroscopical appearance has not been reported for an IDEM cavernoma as yet. The patient showed full postoperative recovery from his initial symptoms. CONCLUSIONS Intradural extramedullary cavernoma is a rare cause of compression to spinal cord or nerve roots. Its manifestation characteristics are well defined and should always be part of the differential diagnosis. Intraoperative findings aid the diagnosis in nontypical cases before the final histology. The nontraumatic and nerve tissue sparing surgical resection warrants optimal postoperative results and excellent prognosis.
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Affiliation(s)
- George Mataliotakis
- Orthopaedic Spine Department, City General Hospital, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, UK.
| | - Stravinsky Perera
- Orthopaedic Spine Department, City General Hospital, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, UK
| | - Santhosh Nagaraju
- Pathology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Birmingham B15 2TH, UK
| | - Marco Marchionni
- Orthopaedic Spine Department, City General Hospital, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, UK
| | - Nikolaos Tzerakis
- Orthopaedic Spine Department, City General Hospital, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, UK
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Intradural extramedullary capillary hemangioma in the upper thoracic spine: a review of the literature. Case Rep Orthop 2014; 2014:604131. [PMID: 25045565 PMCID: PMC4087253 DOI: 10.1155/2014/604131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 06/09/2014] [Indexed: 11/24/2022] Open
Abstract
Capillary hemangiomas are benign tumors found in the skin and soft tissues in younger people. They occur in the central nervous system only rarely, and intradural occurrence is extremely rare. We report here a 60-year-old man presenting with thoracic girdle pain and progressive gait disturbance. Magnetic resonance images of the thoracic spine showed a 12 × 8 × 20 mm, well-defined intradural mass at the T2 level, compressing the spinal cord laterally. Relative to the spinal cord, the mass was hypo- to isointense on T1-weighted images and relatively hyperintense on T2-weighted images, with strong enhancement on contrast-enhanced T1-weighted images. The patient underwent T1-2 hemilaminectomy with resection of the intradural extramedullary tumor, which showed characteristics of a capillary hemangioma on histologic examination. The patient's symptoms improved following the surgery and no clinical or radiological evidence of recurrence was noted at the 2-year follow-up. We present this case with a review of the literature, highlighting features for differential diagnosis.
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Park MS, Deukmedjian AR, Uribe JS. Minimally invasive anterolateral corpectomy for spinal tumors. Neurosurg Clin N Am 2014; 25:317-25. [PMID: 24703449 DOI: 10.1016/j.nec.2013.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Traditional open anterior and posterior approaches for the thoracic and thoracolumbar spine are associated with approach-related morbidity and limited surgical access to the level of abnormality. This article describes the minimally invasive anterolateral corpectomy for the treatment of spinal tumors, and reviews the current literature.
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Affiliation(s)
- Michael S Park
- Department of Neurosurgery & Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, 7th Floor, Tampa, FL 33606, USA.
| | - Armen R Deukmedjian
- Department of Neurosurgery & Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, 7th Floor, Tampa, FL 33606, USA
| | - Juan S Uribe
- Department of Neurosurgery & Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, 7th Floor, Tampa, FL 33606, USA
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Takeshima Y, Marutani A, Tamura K, Park YS, Nakase H. A case of cauda equina cavernous angioma coexisting with multiple cerebral cavernous angiomas. Br J Neurosurg 2013; 28:544-6. [PMID: 24066686 DOI: 10.3109/02688697.2013.841856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The simultaneous presence of cavernous angiomas in both the brain and spinal cord is a very rare finding, as is the location of a cavernous angioma in the cauda equina. We reported a unique case of coexisting with multiple cerebral cavernous angiomas in the brain and cauda equina.
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Affiliation(s)
- Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University School of Medicine , Nara , Japan
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23
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Cantu C, Murillo-Bonilla L, Arauz A, Higuera J, Padilla J, Barinagarrementeria F. Predictive Factors for Intracerebral Hemorrhage in Patients with Cavernous Angiomas. Neurol Res 2013; 27:314-8. [PMID: 15845215 DOI: 10.1179/016164105x39914] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Prediction of intracerebral hemorrhage (ICH) in patients with cavernous angiomas is not totally elucidated. The aims of our study were to determine the rate of cerebral hemorrhage, its associated factors, and the clinical outcome in patients with cavernous angiomas in a Hispanic population. METHODS We studied 133 patients with cavernous angiomas. The patients were classified into two groups depending on whether they presented an ICH. A comparative analysis of demographics and clinical data, neuroimaging characteristics, and prognosis was carried out in patients with and without hemorrhage. The hemorrhage rate (expressed as the percentage per patient per year) was also estimated. RESULTS Seventy-eight patients (59%) had hemorrhage. Non-lobar location of angiomas was associated with hemorrhage [OR 4.82 (CI 95% 2.17-10.73; p=<0.001)]. In contrast, factors associated with a decreased risk of hemorrhage were a family history of epilepsy [OR 0.30 (CI 95% 0.10-0.79; p=0.016)] and lobar location of the angiomas [OR 0.21 (CI 95% 0.09-0.46; p=<0.001)]. The hemorrhagic rate of 1.71% per patient per year was influenced by the location. It was only 1.22% per patient per year in lobar angiomas and 2.33, 2.39, and 2.82% per patient per year for brainstem, cerebellum, and deep hemispheric angiomas, respectively. CONCLUSIONS The non-lobar location of cavernous angiomas gives a higher risk of hemorrhage in our Mexican mestizo population, without the hemorrhage being related to either age or sex.
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Affiliation(s)
- Carlos Cantu
- Stroke Clinic, Manuel Velasco Suarez National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, Colonia La Fama, Delegación Tlalpan, Mexico, DF, CP 14269
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Abstract
STUDY DESIGN Retrospective cohort analysis. OBJECTIVE To evaluate the neurological outcomes after resection of intramedullary, intradural extramedullary, and extradural hemangiomas. SUMMARY OF BACKGROUND DATA Spinal hemangiomas most commonly arise in the vertebral bodies and are typically asymptomatic. Uncommonly, hemangiomas may cause significant neurological deficits via extraosseous extension. Intramedullary hemangiomas may also occur and account for approximately 5% of all spinal cord lesions, with those located intradural extramedullary occurring rarely. Although retrospective studies have primarily examined the neurological outcome of intramedullary and vertebral hemangiomas, there is little literature comparing outcomes after surgical treatment of hemangiomas of varying location. METHODS We performed a retrospective review of all patients treated for hemangiomas affecting the spinal cord at our institution between 1999 and 2012. Various patient, clinical, and tumor data were collected including patient demographics, neurological examinations, and procedure, clinic, and pathology notes. Imaging studies were evaluated to determine the extent of resection, presence of recurrence, and lesion volume. Functional status was defined using the Modified McCormick Scale (MMS). RESULTS A total of 19 patients were evaluated, with our cohort consisting of 8 intramedullary, 5 intradural extramedullary, and 6 vertebral hemangiomas with extraosseous extension. Cavernous hemangiomas were most common (47.4%), followed by those of the capillary type. At long-term follow-up, 73.7% of patients had improved neurological outcome and 15.8% had worsened. However, only 50% of patients with intramedullary hemangiomas improved, compared with 80% and 100% for intradural extramedullary and vertebral hemangiomas, respectively. Also, those with intramedullary lesions more frequently had worse outcomes after surgery (25%) than those with intradural extramedullary (20%) and vertebral hemangiomas (0%). CONCLUSION Although all patients typically present with a similar functional status, patients with intramedullary lesions are more unlikely to improve after surgical resection and derive less of a benefit compared with those with intradural extramedullary and vertebral hemangiomas.
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Bozinov O, Burkhardt JK, Woernle CM, Hagel V, Ulrich NH, Krayenbühl N, Bertalanffy H. Intra-operative high frequency ultrasound improves surgery of intramedullary cavernous malformations. Neurosurg Rev 2011; 35:269-75; discussion 275. [DOI: 10.1007/s10143-011-0364-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 06/28/2011] [Accepted: 09/25/2011] [Indexed: 11/30/2022]
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Choi GH, Kim KN, Lee S, Ji GY, Oh JK, Kim TY, Yoon DH, Ha Y, Yi S, Shin H. The clinical features and surgical outcomes of patients with intramedullary spinal cord cavernous malformations. Acta Neurochir (Wien) 2011; 153:1677-84; discussion 1685. [PMID: 21720938 DOI: 10.1007/s00701-011-1016-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 04/01/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cavernous malformations (CMs) are not uncommon, but most of them are found to be located intracranially. Intramedullary CMs are rare, accounting for only 3-5% of identified total central nervous system lesions. The natural history of intramedullary CMs and their clinical features, including the risk of hemorrhage from a large series, still remains unclear and needs to be elucidated. We review our experience with surgically treated patients with intramedullary CMs and discuss the clinical features and surgical outcomes. METHODS Between March 2004 and March 2010, a total of 21 patients with intramedullary spinal cord CMs were surgically treated in a single institution. Data from 21 patients were retrospectively analyzed. RESULTS There were 13 females and 8 males ranging in age from 10 to 70 years (mean age 39.3 years). All patients harbored single symptomatic CM of the nervous system, and multiple lesions were not found. The annual retrospective hemorrhage rate was 2.18% per patient/year. All but one CM were completely resected, and the average follow-up period was 22.1 months (1-73 months). Ten of the 21 patients experienced an improvement in neurological state, 9 patients remained unchanged, and 2 patients experienced worsening of their conditions. CONCLUSIONS Symptomatic intramedullary CMs should be surgically removed to avoid further neurological deterioration. Though there are some limitations due to the retrospective nature of this study and its small number of patients, the prognosis was found to be related to the preoperative neurological state and to the type of symptom presentation.
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Affiliation(s)
- Gwi Hyun Choi
- Department of Neurosurgery, College of Medicine, Yonsei University, Seoul, Korea
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Jankowski R, Nowak S, Zukiel R, Szymaś J, Sokół B. Surgical treatment of symptomatic vertebral haemangiomas. Neurol Neurochir Pol 2011; 45:577-582. [DOI: 10.1016/s0028-3843(14)60125-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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AOYAMA T, HIDA K, HOUKIN K. Intramedullary Cavernous Angiomas of the Spinal Cord: Clinical Characteristics of 13 Lesions. Neurol Med Chir (Tokyo) 2011; 51:561-6. [DOI: 10.2176/nmc.51.561] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Takeshi AOYAMA
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | - Kazutoshi HIDA
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | - Kiyohiro HOUKIN
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
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Urrutia J, Postigo R, Larrondo R, Martin AS. Clinical and imaging findings in patients with aggressive spinal hemangioma requiring surgical treatment. J Clin Neurosci 2010; 18:209-12. [PMID: 21177111 DOI: 10.1016/j.jocn.2010.05.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/18/2010] [Accepted: 05/22/2010] [Indexed: 11/19/2022]
Abstract
Vertebral hemangiomas (VHs) are frequently asymptomatic lesions found incidentally during investigations for other spinal problems. Symptomatic VHs are less common, and there are few reports of compressive VHs in the literature. VHs with aggressive behavior present with low signal intensity on T1-weighted and high signal intensity on T2-weighted MRI. We present a case series of four patients with compressive VH, all of whom were neurologically compromised. Each of the four patients underwent preoperative arterial embolization followed by surgical treatment of their VHs. All patients recovered normal motor function after surgery. At follow-up (average 53 months), one patient had a recurrent tumor requiring reoperation and radiotherapy. Although it is rare, aggressive VH can be a devastating condition. Total surgical resection or subtotal resection with radiotherapy may be warranted.
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Affiliation(s)
- Julio Urrutia
- Department of Orthopaedic Surgery, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile.
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30
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Kivelev J, Niemelä M, Hernesniemi J. Outcome after microsurgery in 14 patients with spinal cavernomas and review of the literature. J Neurosurg Spine 2010; 13:524-34. [PMID: 20887151 DOI: 10.3171/2010.4.spine09986] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Spinal cavernomas are rare, but can cause significant neurological deficits due to mass effect and extralesional hemorrhage. The authors present their results of microsurgical treatment of 14 consecutive patients with spinal cavernoma, and review the literature.
Methods
Of the 376 patients with cavernomas of the CNS treated at Helsinki University Central Hospital (a catchment area close to 2 million inhabitants) between January 1980 and June 2009, 14 (4%) had a spinal cavernoma. The authors reexamined and analyzed the patient files and images retrospectively. Median patient age at presentation was 45 years (range 20–57 years). The female/male ratio was equal. Median duration of symptoms before admission to the department was 12 months (range 0.1–168 months). Patients suffered from sensorimotor paresis, radicular pain, or neurogenic micturition disorders in different combinations or separately. Hemorrhage had occurred in 7 patients (50%) before surgery. In 9 patients (64%) the cavernoma was intramedullary, in 4 (29%) extradural, and in 1 intradural extramedullary. On MR imaging, 6 patients (43%) had a cavernoma in the cervical region, 7 (50%) in the thoracic region, and 1 (7%) in the lumbar region.
Results
Postoperatively, patients were followed up for a median of 3 years (range 1–10 years). At follow-up, 13 patients (93%) experienced significant improvement in motor ability after surgery, and all patients were able to walk with or without aid. Ten of the 11 patients with pain syndrome (91%) showed significant pain relief without recurrence. Micturition disorder was noted in 6 patients (43%) at follow-up, but in 5 the condition had existed before surgery. No patient improved in bladder function after surgery, and 1 patient developed micturition dysfunction postoperatively.
Conclusions
Microsurgical removal of spinal cavernomas alleviates sensorimotor deficits and pain caused by mass effect and hemorrhage. However, bladder dysfunction remains unchanged after surgery.
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Heyd R, Seegenschmiedt MH, Rades D, Winkler C, Eich HT, Bruns F, Gosheger G, Willich N, Micke O. [The significance of radiation therapy for symptomatic vertebral hemangiomas (SVH)]. Strahlenther Onkol 2010; 186:430-5. [PMID: 20803283 DOI: 10.1007/s00066-010-2140-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 03/05/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the efficacy of radiation therapy (RT) for symptomatic vertebral hemangioma (SVH). MATERIAL AND METHODS Based on the Registry for Rare Benign Disorders (RRBD) of the German Cooperative Group on Radiation Therapy for Benign Diseases (GCG-BD), the clinical information, treatment plans and outcome data from seven cooperating German RT institutions were analyzed retrospectively. RESULTS Over a period of 39 years (1969-2008), a total of 84 patients with 96 symptomatic lesions underwent RT. The predominant indication was pain in 97.6%, and, in addition, 28.6% of patients had neurological deficits. The median total dose was 34 Gy (4.5-45 Gy), and the median single dose 2.0 Gy (0.5-3.0 Gy). After a median follow-up of 68 months (6-422 months), complete symptom relief (CR) occurred in 61.9% of patients, 28.6% had partial relief, and 9.5% had no relief (NR). The overall response rate (CR + PR) was 90.5%. In 26.2% of patients, radiologic signs of remineralization were noted. After a median follow-up of 70 months (8-124 months), symptom progression occurred in eight patients (9.5%). Therefore, the long-term rate of local control was 80.9%. Multivariate statistical analysis revealed a significantly higher rate of symptom relief and local control for total doses > or = 34 Gy. Side effects > RTOG/EORTC grade 2 were not observed. CONCLUSION RT is a safe and effective for treatment of SVH. Total doses of at least 34 Gy are recommended to achieve optimal treatment response.
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Affiliation(s)
- Reinhard Heyd
- Strahlenklinik, Klinikum Offenbach, Offenbach, Germany.
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Chun SW, Kim SJ, Lee TH, Koo HS. Intra-root cavernous angioma of the cauda equina : a case report and review of the literature. J Korean Neurosurg Soc 2010; 47:291-4. [PMID: 20461171 DOI: 10.3340/jkns.2010.47.4.291] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 11/01/2009] [Accepted: 03/22/2010] [Indexed: 11/27/2022] Open
Abstract
Authors experienced intra-root cavernous angioma which is very rare case among cavernous angiomas of cauda equina. Our intra-root cavernous angioma was confirmed by findings from operating field and microscopic examination. We report this case with review of the literature.
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Affiliation(s)
- Sang Woo Chun
- Department of Neurosurgery, Ewha Womans University School of Medicine, Seoul, Korea
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33
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Heyd R, Seegenschmiedt MH, Rades D, Winkler C, Eich HT, Bruns F, Gosheger G, Willich N, Micke O. Radiotherapy for symptomatic vertebral hemangiomas: results of a multicenter study and literature review. Int J Radiat Oncol Biol Phys 2009; 77:217-25. [PMID: 19699592 DOI: 10.1016/j.ijrobp.2009.04.055] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 04/21/2009] [Accepted: 04/22/2009] [Indexed: 11/18/2022]
Abstract
PURPOSE The current study analyzes the potential role of radiotherapy (RT) in symptomatic vertebral hemangioma (SVH). METHODS AND MATERIALS Seven cooperating German institutions collected clinical information, treatment plans, and outcome data for all patients with SVH referred for local RT. RESULTS From 1969 to 2008, a total of 84 patients with 96 symptomatic lesions were irradiated for SVH. The primary indication for radiotherapy was pain (97.6%), and 28.6% of patients had additional neurological symptoms. RT was performed at a median total dose of 34 Gy, with a median single dose of 2.0 Gy. After receiving a median follow-up of 68 months, the overall patient response rate was 90.5%. Complete symptom remission occurred in 61.9% of patients, 28.6% of patients had partial pain relief, and 9.5% of patients had no pain relief. In 26.2% of patients, radiological signs of reossification were observed in long-term follow-up but not significantly correlated with pain relief. Most importantly, total doses of >/=34 Gy resulted in significantly greater symptomatic relief and control rate than total doses of <34 Gy. CONCLUSIONS This study consists of the largest database of cases reported so far using RT for SVH. RT is easy, safe, and effective for pain relief treatment for SVH. Total doses of at least 34 Gy give the best symptomatic response.
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Affiliation(s)
- Reinhard Heyd
- Department of Radiotherapy, Offenbach Hospital, Offenbach, Germany
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Bian L, Bertalanffy H, Sun Q, Shen JK. Intramedullary cavernous malformations: Clinical features and surgical technique via hemilaminectomy. Clin Neurol Neurosurg 2009; 111:511-7. [DOI: 10.1016/j.clineuro.2009.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2008] [Revised: 12/11/2008] [Accepted: 02/07/2009] [Indexed: 10/21/2022]
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Sohn MJ, Lee DJ, Jeon SR, Khang SK. SPINAL RADIOSURGICAL TREATMENT FOR THORACIC EPIDURAL CAVERNOUS HEMANGIOMA PRESENTING AS RADICULOMYELOPATHY. Neurosurgery 2009; 64:E1202-3; discussion E1203. [DOI: 10.1227/01.neu.0000345940.21674.ae] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Image-guided stereotactic radiosurgery (SRS) was applied to a case of spinal epidural cavernous hemangioma in the thoracic spine. This report demonstrates the potential for spinal SRS in treating diseases that have previously required extensive invasive surgery.
CLINICAL PRESENTATION
A 27-year-old woman with gait disturbance and shoulder pain radiating into the right upper arm and back presented for clinical evaluation. Magnetic resonance imaging revealed an extraforaminal epidural mass compressing the spinal cord at the T1–T2 and T2–T3 levels of the intervertebral foramen. The patient had previously undergone a decompressive laminectomy and open biopsy. Several months after this surgery, her radiculomyelopathy had not improved and appeared to be progressing.
INTERVENTION
Intensity-modulated hypofractionated radiosurgery was performed on the lesion. The patient's radicular pain was remarkably improved within days, and associated neurological symptoms had largely disappeared within a few months. Subsequent follow-up magnetic resonance imaging at 12 and 36 months showed that the tumor mass was greatly reduced. No evidence of any complications associated with irradiation was apparent, and the patient continued to demonstrate a positive prognosis.
CONCLUSION
A thoracic epidural cavernous hemangioma of proven pathology was successfully treated using state-of-the-art, spinal image-guided SRS. Based on our experience with other types of tumors, we determined that an effective treatment modality for this pathology would be a hypofractionated dose of 32 Gy in 4 fractions. This treatment protocol delivered rapid clinical benefits and long-term tumor control demonstrating the viability of SRS in the treatment of this difficult and rare condition.
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Affiliation(s)
- Moon-Jun Sohn
- Department of Neurosurgery, Inje University Ilsan-Paik Hospital, Goyang, Korea
| | - Dong-Joon Lee
- Department of Neurosurgery, Inje University Ilsan-Paik Hospital, Goyang, Korea
| | - Sang-Ryong Jeon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Shin Kwang Khang
- Department of Pathology, Asan Medical Center, University of Ulsan, Seoul, Korea
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36
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Cavernous angiomas of the brain stem and spinal cord. J Clin Neurosci 2008; 5 Suppl:20-5. [PMID: 18639094 DOI: 10.1016/s0967-5868(98)90005-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/1996] [Accepted: 10/30/1996] [Indexed: 11/24/2022]
Abstract
This article reviews the pathology, clinical course and management of cavernous angiomas in the brain stem and spinal cord. Both lesions have been diagnosed with increasing frequency as a result of magnetic resonance image scanning. Brain stem lesions tend to present dramatically; their treatment remains microsurgical excision despite some studies that have looked at the use of radiosurgery. Spinal lesions are either extra-, or more commonly, intramedullary. Intramedullary cavernomas present with a wide spectrum of symptoms ranging from acute haematomyelia to presentations that mimic demylelinating conditions; extramedullary cavernous angiomas tend to produce radicular symptoms or subarachnoid haemorrhage. Both are treated by microsurgical excision.
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Spinal cavernous malformations: a report of 5 cases. ACTA ACUST UNITED AC 2008; 69:602-7; discussion 607. [DOI: 10.1016/j.surneu.2007.01.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2006] [Accepted: 01/24/2007] [Indexed: 11/19/2022]
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Noudel R, Litré F, Vinchon M, Patey M, Rousseaux P. Intramedullary spinal cord cavernous angioma in children: case report and literature review. Childs Nerv Syst 2008; 24:259-63. [PMID: 17849122 DOI: 10.1007/s00381-007-0441-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 05/28/2007] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Intramedullary cavernous angiomas (ImCA) of the spinal cord are very uncommon malformations especially in the pediatric population where only ten cases have yet been reported within the available literature. CASE REPORT In this paper, the authors report the case of a 12-year-old girl presenting with a T11 level hematomyelia because of a cavernous angioma. Microsurgical excision was performed with good clinical outcome and no magnetic resonance imaging evidence of residual cavernoma 30 months later. DISCUSSION Despite the small number of cases reported in children, this one contributes to the literature identifying special features of presentation and management of ImCA for pediatric patients. Because a higher risk of recurrent bleeding has been demonstrated for ImCA, with dramatic clinical consequences, microsurgical removal remains the only definitive treatment.
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Affiliation(s)
- Rémy Noudel
- Department of Neurosurgery, Maison Blanche Hospital, University of Reims, Reims, France.
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39
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Cavernoma raquídeo epidural en reloj de arena. Presentación de un caso y revisión de la literatura. Neurocirugia (Astur) 2008. [DOI: 10.1016/s1130-1473(08)70228-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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40
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Heyd R, Seegenschmiedt MH. Vertebral Hemangioma (VH). RADIOTHERAPY FOR NON-MALIGNANT DISORDERS 2008. [DOI: 10.1007/978-3-540-68943-0_23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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41
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Lee JW, Cho EY, Hong SH, Chung HW, Kim JH, Chang KH, Choi JY, Yeom JS, Kang HS. Spinal epidural hemangiomas: various types of MR imaging features with histopathologic correlation. AJNR Am J Neuroradiol 2007; 28:1242-8. [PMID: 17698523 PMCID: PMC7977664 DOI: 10.3174/ajnr.a0563] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Because of the high vascularization of hemangiomas, preoperative misinterpretation may result in unexpected intraoperative hemorrhage and incomplete resection, which results in the persistence of clinical symptoms or recurrence. Our purpose was to analyze various MR imaging features of a spinal epidural hemangioma with histopathologic correlation. MATERIALS AND METHODS After searching through the pathology data bases in 3 hospitals, we included 14 patients (9 male and 5 female; mean age, 38 years; age range, 2-62 years) with spinal epidural hemangiomas confirmed by surgical resection after MR imaging. Three radiologists reviewed the MR imaging in consensus and categorized the features into subtypes on the basis of histopathologic findings. RESULTS We categorized the MR imaging features as follows: type A for a cystlike mass with T1 hyperintensity (2 cases, arteriovenous type with an organized hematoma), type B for a cystlike mass with T1 isointensity (3 cases, venous type), type C for a solid hypervascular mass (7 cases, cavernous type), and type D for an epidural hematoma (2 cases, cavernous type with hematoma). Types A and B had frequent single segmental involvement (4/5), whereas types C and D had multisegmental involvement in all. Regardless of MR types, lobular contour (8/14) and a rim of low T2 signal intensity (8/14) of the mass were common. T1 hyperintensity of the mass was occasionally seen (5/14). CONCLUSIONS Spinal epidural hemangiomas can have various MR imaging features according to their different histopathologic backgrounds. In addition to common features such as solid hypervascularity, lobular contour, and a rim of low T2 signal intensity, T1 hyperintensity or multisegmental involvement may also be a clue in the differential diagnosis of a spinal epidural hemangioma.
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Affiliation(s)
- J W Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeongi-Do, Korea
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42
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Santoro A, Piccirilli M, Brunetto GMF, Delfini R, Cantore G. Intramedullary cavernous angioma of the spinal cord in a pediatric patient, with multiple cavernomas, familial occurrence and partial spontaneous regression: case report and review of the literature. Childs Nerv Syst 2007; 23:1319-26. [PMID: 17643250 DOI: 10.1007/s00381-007-0395-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Indexed: 10/23/2022]
Abstract
OBJECT The authors present their experience with the 17th pediatric intramedullary cavernoma reported in English literature. METHODS The patient firstly underwent surgery for a left frontal cavernoma when he was 2 years old. Also the child's mother was operated for a C2-C3 intramedullary cavernoma. He grew up normally and the radiological follow-up was negative for other brainstem cavernous malformations. When he was 11 years old he complained a worsening tetraparesis. A cerebral and spinal magnetic resonance (MR) imaging revealed the presence of a C1 intramedullary cavernoma and a pontine cavernoma. He underwent surgery for the cervical lesion, which was completely removed. The postoperative course was regular with a total recovery from the neurological deficit. The boy underwent a radiological follow-up, monitoring the pontine lesion, which spontaneously regressed when he was 19 years old. CONCLUSION The rarity of the pediatric intramedullary cavernoma, the familial occurrence, and the spontaneous regression of the pontine cavernoma make this case very peculiar.
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Affiliation(s)
- Antonio Santoro
- Department of Neurological Sciences-Neurosurgery, University of Rome La Sapienza, Neurochirurgia1, Viale del Policlinico, 155, 00185 Rome, Italy.
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43
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Armstrong MJ, Hacein-Bey L, Schneck MJ, Nockels RP, Biller J. Thoracic intramedullary cavernous malformation with posttraumatic hematomyelia: case report and literature review. J Stroke Cerebrovasc Dis 2007; 15:74-8. [PMID: 17904054 DOI: 10.1016/j.jstrokecerebrovasdis.2006.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2005] [Revised: 01/04/2006] [Accepted: 01/10/2006] [Indexed: 10/25/2022] Open
Abstract
Although intramedullary spinal cord cavernous malformations are now well described, there have been, to our knowledge, no prior reports focusing on presentation after trauma. We report a patient with a thoracic intramedullary cavernous malformation presenting with hematomyelia and acute neurologic deterioration after spinal chiropractic manipulation. A review of previously published case reports then identifies additional cases of deterioration after spinal cord trauma or exertion. Traumatic injury and exertion may be uncommon but real causes of hematomyelia in intramedullary cavernous malformations of the spinal cord. The frequency of such presentations is estimated to be 1.37% to 4.79%.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois, USA
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44
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Ergun T, Lakadamyali H, Lakadamyali H, Mukaddem A. Acute Spinal Cord Compression From an Extraosseous Vertebral Hemangioma With Hemorrhagic Components: A Case Report. J Manipulative Physiol Ther 2007; 30:602-6. [DOI: 10.1016/j.jmpt.2007.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2006] [Revised: 05/02/2007] [Accepted: 06/09/2007] [Indexed: 12/12/2022]
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45
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Kharkar S, Shuck J, Conway J, Rigamonti D. The natural history of conservatively managed symptomatic intramedullary spinal cord cavernomas. Neurosurgery 2007; 60:865-72; discussion 865-72. [PMID: 17460522 DOI: 10.1227/01.neu.0000255437.36742.15] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The presentation and natural history of untreated, symptomatic intramedullary spinal cavernomas at our institution were analyzed. The objective is to provide additional information regarding the natural history of conservatively managed, symptomatic, intramedullary spinal cord cavernous malformations. METHODS The medical records of patients treated in our institution between 1989 and 2002 were reviewed to identify those with intramedullary cavernomas. The medical, radiological, surgical, and pathological records from these patients were retrospectively reviewed and analyzed. RESULTS Fourteen patients were included in the study. The mean age at presentation was 42 years. Four lesions (29%) were located in the cervical region and 10 lesions (71%) were present in the thoracolumbar spinal cord. All patients were symptomatic at the time of presentation. In this cohort of 14 patients, 10 patients (71%) were conservatively managed. For these patients, the mean duration of symptoms before presentation was 10 months. The mean duration of follow-up from the time of presentation was 80 months. The median McCormick grade for conservatively treated patients at presentation was II. During this period, none of the conservatively managed patients had an acute intramedullary bleed. In nine patients, the McCormick grade at the last follow-up evaluation was the same as or better than their score at presentation. Four patients (29%) were treated surgically. The mean duration of symptoms before presentation was 33 months. The mean duration of follow-up from the time of presentation was 42 months. In two surgical patients, the McCormick grade at the last follow-up evaluation remained unchanged compared with their score at presentation, whereas the McCormick grade improved in one patient and deteriorated in another patient. CONCLUSION This cohort of conservatively managed patients with symptomatic, intramedullary spinal cord cavernomas was clinically stable throughout the follow-up period. In this series, patients harboring symptomatic spinal cord cavernous malformation did not have significant, permanent neurological decline during the follow-up period when treated with the conservative approach of observation. This data provides additional information for determining the appropriate treatment strategy for patients with intramedullary spinal cavernomas.
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Parker F, Lejeune JP, Bouly S, Lonjon M, Emery E, Proust F, Auque J, Loiseau H, Gallas S, Boetto S, Labauge P. [Natural history of intramedullary cavernomas. Results of the French Multicentric Study]. Neurochirurgie 2007; 53:208-16. [PMID: 17507049 DOI: 10.1016/j.neuchi.2007.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 02/28/2007] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The prevalence of cerebral cavernomas is about 0.5% in the general population. In contrast, spinal cord cavernomas are considered as rare. The objective of this study was to determine the natural history of spinal cord cavernomas in a multicentric study. METHODS Clinical and neuroradiological findings were retrospectively collected. Diagnosis was based on pathological criteria or magnetic resonance (MR) findings. RESULTS Fifty-three patients were included (26 males, 27 females). Mean age at onset of symptoms was 40.2 years (range: 11-80). Initial symptoms were progressive (32) and acute myelopathy (20). One patient was asymptomatic. Clinical symptoms were related to spinal cord compression (24) and hematomyelia (19). Cavernoma location was dorsal (41) and cervical (12.). MR findings consisted of hyperintense signal on T1 and T2 sequences (19 cases), mixed hyperintense and hypointense signal (33 cases), and hypointense signal on T1 and T2 sequences in 1 case. Mean size was 16.3 mm (range: 3-54). Forty patients underwent surgical resection. Improvement was observed in 20 patients and worsening of neurological symptoms in 11. Length of follow up was 7.1 years. At the end of the study, 26 patients were autonomous, 18 handicapped and 1 bedridden. CONCLUSION This study provided precise data on the clinical and MR patterns of these lesions. The natural history is associated with a higher risk of hemorrhage recurrence, but is favorable in many operated patients. Microsurgery is the treatment of choice for most of these lesions.
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Affiliation(s)
- F Parker
- Service de neurochirurgie, CHU de Bicêtre, université Paris-XI, 78 rue du Général-Leclerc, 94275 Le-Kremlin-Bicêtre cedex, France.
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Caruso G, Galarza M, Borghesi I, Pozzati E, Vitale M. Acute presentation of spinal epidural cavernous angiomas: case report. Neurosurgery 2007; 60:E575-6; discussion E576. [PMID: 17327768 DOI: 10.1227/01.neu.0000255345.48829.0b] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Spinal extramedullary hematomas stemming from cavernous angiomas in the epidural compartment are rare. It is more common for spinal epidural cavernous angiomas to present with slow and progressive myelopathy or radiculopathy. They seldom present with clinical evidence of acute spinal cord or nerve root compression. CLINICAL PRESENTATION Three consecutive cases of acute spinal cavernous angiomas with overt neurological deficits were presented. These presentations included acute onset of neck pain and tetraparesis, bilateral lower extremity pain and paraparesis, and acute sciatic pain with plantar flexor weakness. The lesions were located in the cervical, thoracic, and sacral spine, respectively. The cases included either abrupt lesion enlargement secondary to a pure intralesional hemorrhage or a cavernous hemorrhage that invaded the epidural space. INTERVENTION All patients were treated with either laminotomy or complete resection of the hematoma and cavernoma within 12 hours after admission. CONCLUSION Spontaneous spinal epidural hematomas presented with significant pain and acute spinal cord and nerve root compression may represent the manifestation of a cavernous angioma. Appropriate interpretation of preoperative imaging studies may prevent delay in proper management, especially for patients in whom nerve root deficit is the only clinical expression.
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Affiliation(s)
- Giuseppe Caruso
- Division of Neurosurgery, Villa Maria Cecilia Hospital, Cotignola, Italy
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48
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Er U, Yigitkanli K, Simsek S, Adabag A, Bavbek M. Spinal intradural extramedullary cavernous angioma: case report and review of the literature. Spinal Cord 2006; 45:632-6. [PMID: 17091120 DOI: 10.1038/sj.sc.3101990] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Case report and review of the literature. OBJECTIVE To report an unusual case of a spinal intradural extramedullary cavernous angioma (CA), located at the cauda equina, and to compare it with the previously published 22 surgically treated cases in the literature. SETTING Ankara, Turkey. METHOD A 67-year-old man presented with a 4-month history of back pain and sciatica and a 4-week history of progressive lower extremity paresthesia, difficulty walking, and loss of bladder and bowel sphincter control. Neurological examination revealed bilateral hypoesthesia below the T12 dermatome with spastic paraparesis. Magnetic resonance imaging (MRI) of the cauda equina revealed a heterogeneous enhancing intradural extramedullary mass obliterating the spinal canal and expanding the spinal cord. T12 laminectomy and total tumor removal were performed without additional neurological deficit. Pathological examination confirmed the diagnosis of a CA. RESULT The patient's neurological status improved during postoperative recovery. He was ambulatory without assistance and regained full sphincter control on the eighth postoperative week. CONCLUSION CAs of the spinal cord are extremely rare lesions. Typically, they present with low back pain and sciatica, neurological deficits, or as a subarachnoid hemorrhage. These lesions have characteristic features on MRI and should be considered in the differential diagnosis of intradural spinal lesions. Following a thorough literature review of reported cases, the authors propose that for patients presenting with severe preoperative neurological signs, immediate microsurgical tumor excision or decompression increases the chance of neurological improvement.
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Affiliation(s)
- U Er
- Department of Neurosurgery, Diskapi Yildirim Beyazid Training and Research Hospital, Ankara, Turkey
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O'Toole JE, Eichholz KM, Fessler RG. Minimally Invasive Approaches to Vertebral Column and Spinal Cord Tumors. Neurosurg Clin N Am 2006; 17:491-506. [PMID: 17010899 DOI: 10.1016/j.nec.2006.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Minimally invasive approaches to spinal tumors have evolved rapidly over the past 15 to 20 years as clinicians seek to avoid the morbidity and long-term dysfunction associated with traditional open surgical procedures. We review the noninvasive, percutaneous, and minimally invasive surgical techniques currently available for the treatment of spinal column and intradural spinal tumors, including minimal access thoracic corpectomy and minimal access intradural tumor surgery. The various advantages and limitations of these approaches as well as their appropriate indications and uses are also presented here. A measured understanding of surgical objectives and iatrogenic effects on patients' quality of life allows the surgeon to implement such minimally invasive approaches in the design of individualized treatment plans that range from pure palliation to definitive cure.
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Affiliation(s)
- John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, 1725 West Harrison Street, Suite 970, Chicago, IL 60612, USA.
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50
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Safavi-Abbasi S, Feiz-Erfan I, Spetzler RF, Kim L, Dogan S, Porter RW, Sonntag VKH. Hemorrhage of cavernous malformations during pregnancy and in the peripartum period: causal or coincidence? Case report and review of the literature. Neurosurg Focus 2006; 21:e12. [PMID: 16859250 DOI: 10.3171/foc.2006.21.1.13] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is growing evidence to suggest that pregnancy may increase the risk of hemorrhage from cavernous malformations (CMs). In the present case, a 21-year-old primigravida was admitted to the authors' neurosurgical service after a cesarean section. Three weeks before admission she had experienced rapidly progressive bilateral lower-extremity paresthesias. Spinal magnetic resonance (MR) imaging revealed the presence of an intramedullary thoracic lesion. On T2-weighted MR images, heterogeneous signal intensity with a rim of decreased intensity was demonstrated in the spine. The mass was successfully resected, and 1 year later the patient's symptoms had resolved completely. This is the fourth reported case of a spinal intramedullary CM that became symptomatic during pregnancy. The pathogenesis and management of this entity are reviewed.
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Affiliation(s)
- Sam Safavi-Abbasi
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
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