[Intramedullary spinal cord tumors and hydrocephalus: an analysis of the results of surgical treatment in 541 patients]

Upper thoracic spinal schwannoma leading to intracranial hypertension and hydrocephalus: A case report and literature review

RATIONALE

Hydrocephalus is predominantly caused by intracranial hemorrhage, infections, tumors, genetic metabolic disorders, and congenital malformations. Hydrocephalus secondary to spinal cord tumors is exceedingly rare; these tumors are predominantly located in the upper cervical spinal region or near the conus medullaris. Hydrocephalus and elevated intracranial pressure caused by upper thoracic spinal schwannomas have not previously been reported.

PATIENT CONCERNS

We report the first case in a 71-year-old female patient who presented with bilateral lower limb weakness for 6 months, accompanied by headache, dizziness, and urinary incontinence for 1 month.

DIAGNOSES

This patient was diagnosed with schwannomas located in the upper cervical spinal region.

INTERVENTIONS

Based on preoperative examination results, it was difficult to distinguish a schwannoma from a spinal meningioma. Subsequently, a microsurgical operation was performed, and the whole tumor was removed via a posterior approach. Tumor tissue histopathological results revealed a whole capsule; under a light microscope, the tumor mainly consisted of sheath cells, which were arranged in a palisade or swirl shape. Antoni A and Antoni B regions constituted a large part of the whole tumor. Moreover, cytologic atypia and necrosis or mitosis were absent. Immunohistochemical staining revealed strong positivity staining for S-100 and SOX 10. Hence, a histopathological diagnosis of schwannomas was finally confirmed. The patient's symptoms of intracranial hypertension, hydrocephalus, and spinal cord dysfunction were significantly alleviated after the operation.

OUTCOMES

Follow-up magnetic resonance image (1 month after being discharged from the hospital) of the thoracic spine and brain revealed complete resection of the upper thoracic spinal schwannoma, a significant reduction in the size of ventricles, and marked alleviation of periventricular interstitial edema.

LESSONS

The findings emphasize the importance of considering spinal tumors in cases of unexplained hydrocephalus and may guide early microsurgical intervention.

Hydrocephalus in primary intradural spinal cord tumors: a systematic review of the literature in the pediatric population

Hydrocephalus in children with primary intradural spinal cord tumors is exceedingly rare. Herewith, we performed a systematic literature review to address epidemiology, suggested pathophysiological mechanisms, prognostic factors, and treatment of such cases. We performed a systematic review with the best available evidence on cases of pediatric primary intradural tumors of the spinal cord presented with hydrocephalus. The patients were subjected to quantitative analysis on a basis of epidemiological features (age, sex, tumor type and location, clinical presentation, survival, dissemination). The possible pathophysiological theories are discussed in detail. Forty-four studies with a total of 121 patients were included in the study. Astrocytomas were the most frequent tumor (64.5%) type, while most tumors were located in cervical (31.4%) or cervicothoracic region (25.6%). About half of the cases concerned children under 6 years of age. The block of subarachnoid CSF (cerebrospinal fluid) pathways from disseminated tumor cells and the neoplastic inflammation caused by tumor elements advocated to be the major pathogenetic mechanisms. Surgical excision of the tumor and hydrocephalus treatment is usually performed. Primary intradural spinal cord tumors should be considered in children with communicative hydrocephalus of unknown etiology. Onset of hydrocephalus after tumor removal is related to higher mortality.

Cytokine and inflammatory mediator effects on TRPV4 function in choroid plexus epithelial cells

The choroid plexus (CP), composed of capillaries surrounded by a barrier epithelium, is the main producer of cerebrospinal fluid (CSF). The CP epithelium regulates the transport of ions and water between the blood and the ventricles, contributing to CSF production and composition. Several studies suggest a connection between the cation channel transient receptor potential vanilloid-4 (TRPV4) and transepithelial ion movement. TRPV4 is a nonselective, calcium-permeable cation channel present in CP epithelia reported to be activated by cytokines and inflammatory mediators. Utilizing the PCP-R (porcine choroid plexus-Riems) cell line, we investigated the effects of various cytokines and inflammatory mediators on TRPV4-mediated activity. Select proinflammatory cytokines (TNF-α, IL-1β, TGF-β1) had inhibitory effects on TRPV4-stimulated transepithelial ion flux and permeability changes, whereas anti-inflammatory cytokines (IL-10, IL-4, and IL-6) had none. Quantitative mRNA analysis showed that these cytokines had no effect on TRPV4 transcription levels. Inhibition of the transcription factor NF-κB, involved in the production and regulation of several inflammatory cytokines, inhibited TRPV4-mediated activity, suggesting a link between TRPV4 and cytokine production. Contrary to published studies, the proinflammatory mediator arachidonic acid (AA) had inhibitory rather than stimulatory effects on TRPV4-mediated responses. However, inhibition of AA metabolism also caused inhibitory effects on TRPV4, suggesting a complex interaction of AA and its metabolites in the regulation of TRPV4 activity. Together these data imply that TRPV4 activity is involved in the inflammatory response; it is negatively affected by proinflammatory mediators. Furthermore, arachidonic acid metabolites, but not arachidonic acid itself, are positive regulators of TRPV4.

[Neurosurgery in Moscow: clinic - institute - ational center]

In 1929, a surgeon N.N. Burdenko and a neurologist V.V. Kramer founded the first neurosurgical clinic in Moscow, which was reorganized to the Institute of Neurosurgery in 1932. The Institute has come a long way through military and peaceful years, overcoming all sorts of obstacles. It has constantly developed, built, and modernized, and now this is the National Medical Research Center of Neurosurgery. In this article, we describe the history of the Institute/Center and its staff who have had a significant impact on the development of domestic and global neurosurgery.