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Heydar AM, Tanaka M, Prabhu SP, Komatsubara T, Arataki S, Yashiro S, Kanamaru A, Nanba K, Xiang H, Hieu HK. The Impact of Navigation in Lumbar Spine Surgery: A Study of Historical Aspects, Current Techniques and Future Directions. J Clin Med 2024; 13:4663. [PMID: 39200805 PMCID: PMC11354833 DOI: 10.3390/jcm13164663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: We sought to improve accuracy while minimizing radiation hazards, improving surgical outcomes, and preventing potential complications. Despite the increasing popularity of these systems, a limited number of papers have been published addressing the historical evolution, detailing the areas of use, and discussing the advantages and disadvantages, of this increasingly popular system in lumbar spine surgery. Our objective was to offer readers a concise overview of navigation system history in lumbar spine surgeries, the techniques involved, the advantages and disadvantages, and suggestions for future enhancements to the system. Methods: A comprehensive review of the literature was conducted, focusing on the development and implementation of navigation systems in lumbar spine surgeries. Our sources include PubMed-indexed peer-reviewed journals, clinical trial data, and case studies involving technologies such as computer-assisted surgery (CAS), image-guided surgery (IGS), and robotic-assisted systems. Results: To develop more practical, effective, and accurate navigation techniques for spine surgery, consistent advancements have been made over the past four decades. This technological progress began in the late 20th century and has since encompassed image-guided surgery, intraoperative imaging, advanced navigation combined with robotic assistance, and artificial intelligence. These technological advancements have significantly improved the accuracy of implant placement, reducing the risk of misplacement and related complications. Navigation has also been found to be particularly useful in tumor resection and minimally invasive surgery (MIS), where conventional anatomic landmarks are lacking or, in the case of MIS, not visible. Additionally, these innovations have led to shorter operative times, decreased radiation exposure for patients and surgical teams, and lower rates of reoperation. As navigation technology continues to evolve, future innovations are anticipated to further enhance the capabilities and accessibility of these systems, ultimately leading to improved patient outcomes in lumbar spine surgery. Conclusions: The initial limited utilization of navigation system in spine surgery has further expanded to encompass almost all fields of lumbar spine surgeries. As the cost-effectiveness and number of trained surgeons improve, a wider use of the system will be ensured so that the navigation system will be an indispensable tool in lumbar spine surgery. However, continued research and development, along with training programs for surgeons, are essential to fully realize the potential of these technologies in clinical practice.
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Affiliation(s)
- Ahmed Majid Heydar
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Okayama 702-8055, Japan; (A.M.H.); (S.P.P.); (T.K.); (S.A.); (S.Y.); (A.K.); (K.N.); (H.X.); (H.K.H.)
- Orthopedic and Traumatology Clinic, Memorial Bahçelievler Hospital, Bahçelievler Merkez, Adnan Kahveci Blv. No: 227, 34180 İstanbul, Turkey
| | - Masato Tanaka
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Okayama 702-8055, Japan; (A.M.H.); (S.P.P.); (T.K.); (S.A.); (S.Y.); (A.K.); (K.N.); (H.X.); (H.K.H.)
| | - Shrinivas P. Prabhu
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Okayama 702-8055, Japan; (A.M.H.); (S.P.P.); (T.K.); (S.A.); (S.Y.); (A.K.); (K.N.); (H.X.); (H.K.H.)
| | - Tadashi Komatsubara
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Okayama 702-8055, Japan; (A.M.H.); (S.P.P.); (T.K.); (S.A.); (S.Y.); (A.K.); (K.N.); (H.X.); (H.K.H.)
| | - Shinya Arataki
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Okayama 702-8055, Japan; (A.M.H.); (S.P.P.); (T.K.); (S.A.); (S.Y.); (A.K.); (K.N.); (H.X.); (H.K.H.)
| | - Shogo Yashiro
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Okayama 702-8055, Japan; (A.M.H.); (S.P.P.); (T.K.); (S.A.); (S.Y.); (A.K.); (K.N.); (H.X.); (H.K.H.)
| | - Akihiro Kanamaru
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Okayama 702-8055, Japan; (A.M.H.); (S.P.P.); (T.K.); (S.A.); (S.Y.); (A.K.); (K.N.); (H.X.); (H.K.H.)
| | - Kazumasa Nanba
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Okayama 702-8055, Japan; (A.M.H.); (S.P.P.); (T.K.); (S.A.); (S.Y.); (A.K.); (K.N.); (H.X.); (H.K.H.)
| | - Hongfei Xiang
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Okayama 702-8055, Japan; (A.M.H.); (S.P.P.); (T.K.); (S.A.); (S.Y.); (A.K.); (K.N.); (H.X.); (H.K.H.)
| | - Huynh Kim Hieu
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Okayama 702-8055, Japan; (A.M.H.); (S.P.P.); (T.K.); (S.A.); (S.Y.); (A.K.); (K.N.); (H.X.); (H.K.H.)
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Kumawat C, Takahashi T, Date I, Tomita Y, Tanaka M, Arataki S, Komatsubara T, Flores AOP, Yu D, Jain M. State-of-the-Art and New Treatment Approaches for Spinal Cord Tumors. Cancers (Basel) 2024; 16:2360. [PMID: 39001422 PMCID: PMC11240441 DOI: 10.3390/cancers16132360] [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] [Received: 05/21/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024] Open
Abstract
Spinal cord tumors, though rare, present formidable challenges in clinical management due to their intricate nature. Traditional treatment modalities like surgery, radiation therapy, and chemotherapy have been the mainstay for managing these tumors. However, despite significant advancements, challenges persist, including the limitations of surgical resection and the potential side effects associated with radiation therapy. In response to these limitations, a wave of innovative approaches is reshaping the treatment landscape for spinal cord tumors. Advancements in gene therapy, immunotherapy, and targeted therapy are offering groundbreaking possibilities. Gene therapy holds the potential to modify the genes responsible for tumor growth, while immunotherapy harnesses the body's own immune system to fight cancer cells. Targeted therapy aims to strike a specific vulnerability within the tumor cells, offering a more precise and potentially less toxic approach. Additionally, novel surgical adjuncts are being explored to improve visualization and minimize damage to surrounding healthy tissue during tumor removal. These developments pave the way for a future of personalized medicine for spinal cord tumors. By delving deeper into the molecular makeup of individual tumors, doctors can tailor treatment strategies to target specific mutations and vulnerabilities. This personalized approach offers the potential for more effective interventions with fewer side effects, ultimately leading to improved patient outcomes and a better quality of life. This evolving landscape of spinal cord tumor management signifies the crucial integration of established and innovative strategies to create a brighter future for patients battling this complex condition.
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Affiliation(s)
- Chetan Kumawat
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
- Department of Orthopedic Surgery, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060, India
| | - Toshiyuki Takahashi
- Spinal Disorder Center, Fujieda Heisei Memorial Hospital, 123-1 Mizuue Fujieda, Shizuoka 426-8662, Japan
| | - Isao Date
- Department of Neurosurgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Yousuke Tomita
- Department of Neurosurgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Masato Tanaka
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Shinya Arataki
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Tadashi Komatsubara
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Angel O P Flores
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Dongwoo Yu
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Mukul Jain
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
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Spazzapan P, Thompson DNP. Case Report: Two cases of multiples and atypical dermal sinus tracts. Front Pediatr 2024; 12:1346970. [PMID: 38323267 PMCID: PMC10845342 DOI: 10.3389/fped.2024.1346970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024] Open
Abstract
Dermal sinus tracts (DSTs) are congenital lesions that connect the cutaneous ectoderm with the underlying neuroectodermal tissues. They are typically midline, solitary lesions. Multiple, and atypically located DSTs have been only rarely described. We present two cases of multiple and laterally located DSTs. The first presented with bacterial meningitis and two tracts in the right buttock, one of which entered the spinal canal through the S3 neural foramen. The second child had three midline lumbar DSTs, one subcutaneous dermoid cyst and one intradural epidermoid cyst. Complete surgical excision was achieved in both cases with good late follow up. Multiple or atypically located DSTs appear to carry the same risks of infection as the more common, midline, single tracts. Complete surgical excision is recommended to avoid the risks of neurological deterioration, in particular due to infection. Incomplete disjunction is the proposed developmental anomaly for DSTs, however the location of the cases presented here requires an alternative explanation.
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Affiliation(s)
- Peter Spazzapan
- Paediatric Neurosurgery Unit, Clinical Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Dominic N. P. Thompson
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
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Imamura K, Hayashi T, Kawano O, Sakai H, Masuda M, Morishita Y, Maeda T. Surgical treatment for cystic dilation of the ventriculus terminalis: A report of two cases. J Orthop Sci 2024; 29:354-356. [PMID: 35063333 DOI: 10.1016/j.jos.2021.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/19/2021] [Accepted: 12/28/2021] [Indexed: 02/09/2023]
Affiliation(s)
- Kiyoshiro Imamura
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Tetsuo Hayashi
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan; Department of Rehabilitation Medicine, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan.
| | - Osamu Kawano
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Hiroaki Sakai
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Muneaki Masuda
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Yuichiro Morishita
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Takeshi Maeda
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
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Guo X, Jiang C, Zhang Y, Chen Z, Hao D, Zhang H. Spermatogonial stem-cell-derived neural-like cell transplantation enhances the functional recovery of a rat spinal cord injury model: characterization of evoked potentials. Front Neurosci 2023; 17:1289581. [PMID: 37908621 PMCID: PMC10613671 DOI: 10.3389/fnins.2023.1289581] [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] [Received: 09/06/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023] Open
Abstract
Severe spinal cord injuries (SCIs) usually result in the temporary or permanent impairment of strength, sensation or autonomic functions below the sites of injuries. To date, a large number of therapeutic approaches have been used to ameliorate SCIs, and subsequent stem cell transplantation appears to be a promising strategy. The aim of this study was to evaluate the therapeutic effect of stem cells by changes in the evoked potentials at different time points after a transplantation of spermatogonial stem cells (SSCs) to differentiate the source neurons in a rat model with SCIs, as well as through histopathology. A modified Plemel spinal cord lateral compression model was used. The experiment was divided into a blank, a control and a SSC transplantation group. Motor activity scores, sensory evoked potentials (SEPs) and motor evoked potentials (MEPs) were assessed through motor resuscitation as well as histologic evaluation on each experimental group to determine the improvement. Consistent with our results, motor scores and evoked potentials were significantly improved in the SSC transplantation group. In addition, a histologic assessment showed that the transplanted stem cells had a significant restorative effect on the reconstruction of tissue cells. 1 week after the stem cell transplantation, the SSC transplantation group showed improvement in spinal cord functions and spinal cord pathologic injuries. After 2 weeks and beyond, the SSC transplantation group showed significant improvement in spinal cord functions and spinal cord pathology compared to the control group, meanwhile the evoked potentials and motor function of the hind limbs of rats in the SSC transplantation group were significantly improved. Therefore, the therapeutic strategies for spermatogonial stem cells will be an effective program in the study on SCIs, and we suggest the somatosensory evoked potentials as a tool to assess the degree of recovery from SCIs after the transplantation of stem cells.
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Affiliation(s)
- Xinyu Guo
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, China
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi’an, China
| | - Chao Jiang
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Yongjie Zhang
- Department of Electromyography, Hong Hui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Zhe Chen
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, China
- Translational Medicine Center, Hong Hui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Dingjun Hao
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi’an, China
| | - Haihong Zhang
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, China
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Atallah O, Badary A, El-Ghandour NMF, Almealawy YF, Wireko AA, Syrmos N, Umana GE, Al-Barbarawi M, Ergen A, Shrestha P, Chaurasia B. Cystic dilatation of the ventriculus terminalis: A narrative review. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:319-329. [PMID: 38268679 PMCID: PMC10805159 DOI: 10.4103/jcvjs.jcvjs_98_23] [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: 08/20/2023] [Accepted: 10/01/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction The terminal ventricle, also known as the fifth ventricle, is a tiny relic cavity in the conus medullaris of the human spinal cord. Our purpose in bringing attention to this condition is to get the word out about the signs and symptoms, diagnostic hurdles, and therapeutic options available for it. Methods All relevant studies involving patients diagnosed with ventriculus terminalis (VT) were retrieved from PubMed, Google Scholar, and Scopus. Studies published in complete English language reports were included. The terms VT, terminal ventricle, and 5th ventricle. Age, gender, presenting symptoms, magnetic resonance imaging findings, treatment, and outcome of patients with ventriculus terminalis were all included and recorded. Results The average age of the patients was 39 years, and there were 13 men among them (14.4%). Motor deficits and sciatica were the most commonly reported symptoms in 38 and 34 patients (42.2%, 37.7%), respectively. In 48 patients (53.3%), cyst fenestration was performed, and in 25 patients (27.7%), myelotomy was performed. Fifty-eight patients (64.4%) saw a reduction in cyst size after surgery. The majority of patients reported an improvement in their symptoms in 64 cases (51.1%), with only three cases (3.3%) reporting a worsening. Conclusions In cases where the VT is the source of symptoms such as motor, sensory, or bladder dysfunction, surgical intervention is recommended. This review compiles information from the available literature to shed light on the anatomy, clinical presentation, imaging, and treatment options for this variant. It also aims to pinpoint any potential drawbacks or restrictions connected to the surgical techniques.
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Affiliation(s)
- Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Amr Badary
- Department of Neurosurgery, Klinikum Dessau, Dessau-Roßlau, Germany
| | | | - Yasser F. Almealawy
- Department of Neurosurgery, Faculty of Medicine, University of Kufa, Kufa, Iraq
| | - Andrew Awuah Wireko
- Department of Neurosurgery, Faculty of Medicine, Sumy State University, Sumy, Ukraine
| | - Nikolaos Syrmos
- Department of Neurosurgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma Centre, Gamma Knief Centre, Cannizzaro Hospital, Catania, Italy
| | | | - Anil Ergen
- Department of Neurosurgery, Derince Research Hospital, Derince, Kocaeli, Turkey
| | - Prabin Shrestha
- Department of Neurosurgery, Kathmandu Neuro and General Hospital, Kathmandu, Nepal
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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Shigekawa S, Matsui S, Inoue A, Shinohara N, Kunieda T. Usefulness of cyst-subarachnoid shunt using syringo-subarachnoid shunt tube for symptomatic enlarging ventriculus terminalis: A case report and review of the literature. Surg Neurol Int 2023; 14:165. [PMID: 37292402 PMCID: PMC10246340 DOI: 10.25259/sni_120_2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/23/2023] [Indexed: 06/10/2023] Open
Abstract
Background The ventriculus terminalis (VT) is a cystic embryological remnant of the conus medullaris that usually regresses after birth. This structure rarely persists into adulthood and may produce neurological symptoms. We recently encountered three cases of symptomatic enlarging VT. Case Description The three female patients were 78, 64, and 67 years old. Symptoms included pain, numbness, motor weakness, and frequent urination that gradually worsened. Magnetic resonance imaging revealed cystic dilatations of slow growing VT. These patients showed marked improvement after cyst-subarachnoid shunt using a syringo-subarachnoid shunt tube. Conclusion Symptomatic enlarging VT is an extremely rare cause of conus medullaris syndrome and the optimal treatment strategy remains unclear. Surgical management may thus be appropriate for patients with symptomatic enlarging VT.
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Affiliation(s)
- Seiji Shigekawa
- Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan
| | - Seishi Matsui
- Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan
| | - Akihiro Inoue
- Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan
| | - Naoki Shinohara
- Department of Neurosurgery, HITO Hospital, Shikokuchuo, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan
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Menezes AH, Sato Y, Dlouhy BJ, Jones KA, Moore SA. Ventriculus terminalis cyst in an infant: a case report. J Med Case Rep 2023; 17:22. [PMID: 36683067 PMCID: PMC9869499 DOI: 10.1186/s13256-023-03759-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 01/02/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Filar cysts are frequently found on neonatal ultrasound and are physiologically involuting structures with natural resolution. Hence, there has been no previous histologic correlation. Ventriculus terminalis is a focal central canal dilation in the conus medullaris and usually not clinically significant. Extra-axial cyst at the conus-filum junction connected to ventriculus terminalis is extremely rare, especially when associated with tethered lipomatous filum terminale and with progressive cyst enlargement. CASE PRESENTATION A Caucasian female neonate with abnormal gluteal cleft had ventriculus terminalis cyst with an extra-axial cyst at the conus-filar junction and taut lipomatous filum on ultrasound examination and magnetic resonance imaging. This persisted at 6-month follow up imaging. In light of the nonresolving extra-axial mass and thick taut lipomatous filum, the child underwent L1-L3 osteoplastic laminectomies. The extra-axial cyst expanded after bony decompression and furthermore on dural opening; visualized on ultrasound. It communicated with the central canal and was documented with intraoperative photomicrographs. It was excised and filum sectioned. Histological immunostaining of the cyst wall showed neuroglial and axonal elements. The child did well without deficits at 4-year follow up with normal urodynamics. CONCLUSION Progression dilation of ventriculus terminalis and extra-axial conofilar cyst with tethered lipomatous filum will likely progress to clinical significance and require surgical intervention. The embryologic basis for this pathology is discussed, with literature review.
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Affiliation(s)
- Arnold H. Menezes
- grid.412584.e0000 0004 0434 9816Department of Neurosurgery, University of Iowa Hospitals & Clinics and Stead Family Children’s Hospital, Iowa City, IA USA ,grid.412584.e0000 0004 0434 9816Department of Neurosurgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, 1824 JPP, Iowa City, IA 52242 USA
| | - Yutaka Sato
- grid.412584.e0000 0004 0434 9816Department of Radiology, University of Iowa Hospitals & Clinics and Stead Family Children’s Hospital, Iowa City, IA USA
| | - Brian J. Dlouhy
- grid.412584.e0000 0004 0434 9816Department of Neurosurgery, University of Iowa Hospitals & Clinics and Stead Family Children’s Hospital, Iowa City, IA USA
| | - Karra A. Jones
- grid.412584.e0000 0004 0434 9816Department of Pathology, University of Iowa Hospitals & Clinics and Stead Family Children’s Hospital, Iowa City, IA USA
| | - Steven A. Moore
- grid.412584.e0000 0004 0434 9816Department of Pathology, University of Iowa Hospitals & Clinics and Stead Family Children’s Hospital, Iowa City, IA USA
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Dasic D, Signorelli F, Ligarotti GKI, D'Onofrio GF, Rapisarda A, Syrmos N, Chibbaro S, Visocchi M, Ganau M. Cystic Dilatation of the Ventriculus Terminalis: Examining the Relevance of the Revised Operative Classification Through a Systematic Review of the Literature, 2011-2021. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:399-404. [PMID: 38153500 DOI: 10.1007/978-3-031-36084-8_61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
The literature features limited evidence on the natural history of the cystic dilatation of the ventriculus terminalis (CDVT) and its response to treatment. The goal of this study is to ascertain which impact the revised operative classification of CDVT had on the management of patients diagnosed over the past 10 years.Ten new clinical articles presenting a total of 30 cases of CDVT were identified and included for qualitative analysis. Two take-home messages can be identified: (1) Adequate consideration should be given to designing national pathways for referral to tertiary centers with relevant expertise in the management of lesions of the conus medullaris, and (2) we suggest that type Ia should be, at least initially, treated conservatively, whereas we reckon that the signs and symptoms described in types Ib, II, and III seem to benefit, although in some patients only partially, from surgical decompression in the form of cystic fenestration, cyst-subarachnoid shunting, or both.While the level of evidence gathered in this systematic review remains low because the literature on CDVT consists only of retrospective studies based on single-center series (level of evidence 4 according to the Oxford Centre for Evidence-Based Medicine (OCEBM)), the strength of recommendation for adopting the revised operative classification of CDVT is moderate.
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Affiliation(s)
- Davor Dasic
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Francesco Signorelli
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Ginevra Federica D'Onofrio
- Institute of Neurosurgery, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Alessandro Rapisarda
- Institute of Neurosurgery, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Nikolaos Syrmos
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Salvatore Chibbaro
- Division of Neurosurgery, University of Strasbourg, Strasbourg, France
- Department of Neurosurgery, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | | | - Mario Ganau
- Division of Neurosurgery, University of Strasbourg, Strasbourg, France
- Department of Neurosurgery, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
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D'Onofrio GF, Rapisarda A, Signorelli F, Ganau M, Chibbaro S, Montano N, Polli FM, Visocchi M. Toward the End of the Funnel: The Ventriculus Terminalis-The State of Art of an Ancient Entity with a Recent History. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:395-397. [PMID: 38153499 DOI: 10.1007/978-3-031-36084-8_60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
PURPOSE The ventriculus terminalis (VT), also called the fifth ventricle, is a small cavity containing cerebrospinal fluid (CSF) that is in the conus medullaris in continuity with the central canal of the spinal cord. In adults, persistent VT is a very rare entity, and the diagnosis is incidental in most cases. Rarely, VT may become symptomatic for still-uncertain reasons but most often for its cystic dilatation. The management of these selected cases is still controversial and sometimes associated with unsatisfactory outcomes. METHODS We performed a critical review of the existing literature on the management of symptomatic VT in adults. The etiology, pathophysiology, and treatment of VT are presented and discussed, focusing on the best timing for surgery. RESULTS Conservative management, marsupialization, or the placement of a T drain have been reported. The existing classifications describe the most correct approach for each clinical presentation, but scarce importance has been given to the delay from symptoms' onset to surgical treatment. CONCLUSION Although different cases have been described in the literature, this rare pathology remains unknown to most neurosurgeons.
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Affiliation(s)
| | - Alessandro Rapisarda
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
| | - Francesco Signorelli
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Nicola Montano
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Maria Polli
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimiliano Visocchi
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
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11
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Kankam SB, Amini E, Khoshnevisan K, Khoshnevisan A. Investigating acetazolamide effectiveness on CSF leak in adult patients after spinal surgery. NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:293-299. [PMID: 35811251 DOI: 10.1016/j.neucie.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/29/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Despite the use of acetazolamide in the management of CSF leak in most patients after CNS surgeries, there is scant evidence in the literature about the efficacy of this established protocol among adult patients in post-spinal surgery observations. We investigated the potential positive effect of acetazolamide in reducing CSF leak after spine surgery. MATERIALS AND METHODS We conducted a single-center, double-blind, randomized -controlled trial comparing Oral Acetazolamide plus Corrected body (prone) position (CP+A) versus Corrected body (prone) position alone (CP-A) from January 2014 to September 2015 in the Neurosurgery ward of Shariati Teaching Hospital, Tehran University of Medical Sciences, Tehran, Iran. Seventy-two Patients divided into two groups [CP-A group (n = 36, 50%) and CP+A group (n = 36, 50%)] were randomly assigned to this Clinical Trial study. CP+A group (maintained the 3/4 lateral position + dose of acetazolamide 20 mg/kg/day in 3-4 divided doses for 7 days), and CP-A group (Control group) (maintained the 3/4 lateral position for 7 days with no acetazolamide). RESULTS Baseline characteristics between the two groups showed no significant differences: Sex (P < .637), Age (P < .988) and previous CNS operation at other location besides the spine (P < .496). Although we reported post-surgical CSF leak in 2/36 (5.55%) of CP+A group and 4/36 (11.11%) of CP-A (control) group, there was no significant difference observed between the two groups (95%CI, 0.081-2.748; OR = 0.471; P < .402; Adjusted P < .247). Additionally, no significant differences were observed when we examined surgical characteristics, such as the size of the dural opening (P < .489) and type of operation (P < .465). CONCLUSION Acetazolamide has no positive effect in controlling CSF leak after dural opening/dural tear in adult patients who undergo spinal surgery, when we considered alongside the one-week prone position. Therefore, acetazolamide administration may not be essential for postoperative spinal surgery for dural tear. Prospective studies involving a larger sample size may be needed to track long-term acetazolamide complications on patients with CSF leak.
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Affiliation(s)
- Samuel Berchi Kankam
- Department of Neurosurgery, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Amini
- Pharmaceutical Care Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamyar Khoshnevisan
- Biosensor Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khoshnevisan
- Department of Neurosurgery, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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12
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Gao G, Tao B, Chen Y, Yang J, Sun M, Wang H, Hao F, Liu S, Wang M, Shang A. Fetal magnetic resonance imaging in the diagnosis of spinal cord neural tube defects: A prospective study. Front Neurol 2022; 13:944666. [PMID: 36003299 PMCID: PMC9393549 DOI: 10.3389/fneur.2022.944666] [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: 05/15/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to evaluate the value of fetal magnetic resonance imaging (MRI) in the prenatal diagnosis of spinal neural tube defects. Methods From August 2018 to January 2021, 56 fetuses with suspected spinal cord neural tube defects were treated by prenatal ultrasound in the Neurosurgery Department of the First Medical Center of the People's Liberation Army General Hospital. Fetal MRI was performed within 72 h after ultrasound diagnosis. Forty singleton fetuses were selected. Magnetic resonance examination was performed within 1 month after birth, and the diagnostic coincidence rates of prenatal ultrasound and fetal magnetic resonance examination in the prenatal diagnosis of spinal cord neural tube defects were compared and analyzed using postnatal magnetic resonance examination as the standard. Results The coincidence rates of prenatal ultrasound and fetal MRI for the prenatal diagnosis of spina bifida were 71.4% (20/28) and 39.2% (11/28), respectively, and the difference was statistically significant. The coincidence rates of prenatal ultrasound and fetal MRI in the diagnosis of intraspinal lipoma were 52.6% (10/19) and 73.7% (14/19), respectively, and the difference was statistically significant. Conclusion Fetal MRI has an advantage over prenatal ultrasound in detecting intraspinal lipoma. Prenatal ultrasound has an advantage over fetal MRI in detecting spina bifida.
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Affiliation(s)
- Gan Gao
- Department of Neurosurgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Chinese People's Liberation Army (PLA) Medical School, Beijing, China
| | - Benzhang Tao
- Chinese People's Liberation Army (PLA) Medical School, Beijing, China
- Tianjin Medical University, Tianjin, China
| | - Yanyan Chen
- Department of Anesthesiology, The 960th Hospital of the Chinese People's Liberation Army (PLA), Taian, China
| | - Jiaqi Yang
- Department of Neurosurgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Mengchun Sun
- Chinese People's Liberation Army (PLA) Medical School, Beijing, China
| | - Hui Wang
- Chinese People's Liberation Army (PLA) Medical School, Beijing, China
| | - Fangbin Hao
- Department of Neurosurgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Chinese People's Liberation Army (PLA) Medical School, Beijing, China
| | - Simeng Liu
- Department of Neurosurgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Chinese People's Liberation Army (PLA) Medical School, Beijing, China
| | - Minjie Wang
- Department of Neurosurgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Chinese People's Liberation Army (PLA) Medical School, Beijing, China
| | - Aijia Shang
- Department of Neurosurgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Chinese People's Liberation Army (PLA) Medical School, Beijing, China
- *Correspondence: Aijia Shang
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13
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Núñez Báez SG, De Jesus O, Labat EJ, Feliciano CE. Ventriculus terminalis or conus medullaris arachnoid cyst: a diagnostic dilemma. BMJ Case Rep 2022; 15:e250812. [PMID: 35623655 PMCID: PMC9150153 DOI: 10.1136/bcr-2022-250812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sergio G Núñez Báez
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Orlando De Jesus
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Eduardo J Labat
- Department of Radiological Sciences and Diagnostic Radiology, Neuroradiology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Caleb E Feliciano
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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14
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Baig Mirza A, Visagan R, Boardman T, Murphy C, Al-Ali B, Kellett C, Grahovac G. Recurrent terminal ventricle cyst: a case report. J Surg Case Rep 2021; 2021:rjab498. [PMID: 34804483 PMCID: PMC8598984 DOI: 10.1093/jscr/rjab498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
The terminal ventricle (TV) of Krause is a rare cystic dilation of the conus' central canal. Due to limited understanding surrounding its pathophysiology, optimal management remains controversial. We report a 25-year-old female presenting with acute paraparesis. Magnetic resonance imaging spine revealed a cystic conus medullaris lesion in keeping with an incidental TV cyst. However, the patient experienced a rapid resolution of symptoms. We hypothesize that the TV cyst spontaneously ruptured and auto-decompressed. To our knowledge, this is the first reported case of an enlarging symptomatic TV cyst with spontaneous rupture and resolution of symptoms, highlighting the variable natural history of this condition.
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Affiliation(s)
- Asfand Baig Mirza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Ravindran Visagan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Timothy Boardman
- GKT School of Medical Education, King's College London, London, UK
| | - Christopher Murphy
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Bilal Al-Ali
- GKT School of Medical Education, King's College London, London, UK
| | - Christopher Kellett
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Gordan Grahovac
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
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15
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Kankam SB, Amini E, Khoshnevisan K, Khoshnevisan A. Investigating acetazolamide effectiveness on CSF leak in adult patients after spinal surgery. Neurocirugia (Astur) 2021. [DOI: 10.1016/j.neucir.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Kim T, Judy B, Witham T. Intradural cyst: intramedullary or extramedullary? Illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21327. [PMID: 35854914 PMCID: PMC9265220 DOI: 10.3171/case21327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intradural spinal cord cysts are uncommon and generally benign. It can be difficult to determine whether the cyst is intramedullary or extramedullary on preoperative imaging, and the location of the cyst may be determined intraoperatively. This patient presented with intractable back pain associated with imbalance and was found to have a cystic lesion of the ventriculus terminalis (VT). OBSERVATIONS The patient was found to have a cystic lesion of the VT that was intramedullary rather than extramedullary, as initially expected based on preoperative imaging. LESSONS VT is a rare cystic expansion of the conus medullaris that can appear extramedullary on preoperative imaging. Intraoperatively, this lesion was found to be intramedullary and was successfully treated with fenestration.
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Affiliation(s)
- Timothy Kim
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Brendan Judy
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Timothy Witham
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
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Abstract
Ventriculus terminalis (VT) is a cystic embryological remnant within the conus medullaris that normally regresses after birth. In rare cases, it may persist into adulthood and give rise to neurologic symptoms. The pathogenesis remains unclear but is thought to be related to failed embryonic regression with other proposed possible etiologies including vascular disturbances. We present an intriguing case of a slow-growing VT in a woman with progressive neurologic symptoms who experiences symptomatic relief following thoracic laminectomy and fenestration. Our case is the first to present a unique association with polyarteritis nodosa and only the third to report a case of documented enlargement of the VT over time successfully treated with surgical fenestration.
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Affiliation(s)
- Luke J Weisbrod
- Neurological Surgery, University of Nebraska Medical Center, Omaha, USA
| | - Collin Liu
- Neurological Surgery, University of Nebraska Medical Center, Omaha, USA
| | - Daniel Surdell
- Neurological Surgery, University of Nebraska Medical Center, Omaha, USA.,Neurosurgery, University of Nebraska Medical Center, Omaha, USA
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18
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Mukae N, Morioka T, Suzuki SO, Murakami N, Shimogawa T, Kanata A, Tsukamoto H, Mizoguchi M. Two Cases of Large Filar Cyst Associated with Terminal Lipoma: Relationship with Retained Medullary Cord. World Neurosurg 2020; 142:294-298. [PMID: 32668332 DOI: 10.1016/j.wneu.2020.07.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND A small, incidental filar cyst associated with terminal lipoma is thought to be caused by failure of secondary neurulation; however, the precise embryologic background is not fully understood. Retained medullary cord (RMC) also originates from late arrest of secondary neurulation. The central feature of RMC histopathology is a central canal-like ependyma-lined lumen with surrounding neuroglial core. CASE DESCRIPTION We surgically treated 2 patients with a large cyst in the rostral part of the filum and lipoma in the caudal filum. At cord untethering surgery, the filum was severed at the caudal part of the cyst. Histopathologically, the filar cyst was the cystic dilatation of the central canal-like structure at the marginal part of the lipoma. The central canal-like structure was continuous caudally in the lipoma, and its size decreased toward the caudal side. CONCLUSIONS The present findings support the idea raised by Pang et al that entities such as filar cyst, terminal lipomas, and RMC can all be considered consequences of a continuum of regression failure occurring during late secondary neurulation.
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Affiliation(s)
- Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Takato Morioka
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Japan
| | | | - Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Takafumi Shimogawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akiko Kanata
- Department of Neurosurgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Haruhisa Tsukamoto
- Department of Neurosurgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Masahiro Mizoguchi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Tuleasca C, Ducos Y, Knafo S, Levivier M, Aghakhani N, Parker F. Surgery for cyst dilatation of a ventriculus terminalis in adults: Keep it simple! Neurochirurgie 2020; 67:211-213. [PMID: 32504646 DOI: 10.1016/j.neuchi.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 04/11/2020] [Indexed: 12/01/2022]
Affiliation(s)
- C Tuleasca
- Service de neurochirurgie, hôpitaux universitaires Paris Sud, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France; Faculté de médecine, Sorbonné Université, Paris, France; Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculté de biologie et de médecine (FBM), université de Lausanne (Unil), Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.
| | - Y Ducos
- Service de neurochirurgie, hôpitaux universitaires Paris Sud, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - S Knafo
- Service de neurochirurgie, hôpitaux universitaires Paris Sud, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - M Levivier
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculté de biologie et de médecine (FBM), université de Lausanne (Unil), Lausanne, Switzerland
| | - N Aghakhani
- Service de neurochirurgie, hôpitaux universitaires Paris Sud, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - F Parker
- Service de neurochirurgie, hôpitaux universitaires Paris Sud, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
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20
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Kawanishi M, Tanaka H, Yokoyama K, Yamada M. Cystic dilation of the ventriculus terminalis. J Neurosci Rural Pract 2019; 7:581-583. [PMID: 27695242 PMCID: PMC5006474 DOI: 10.4103/0976-3147.185504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The ventriculus terminalis (VT) is a virtual cavity of the conus medullaris that appears during embryonic life. We presented a case with the cystic dilation of the ventriculus terminalis (CDVT) in a symptomatic patient. A 66-year-old female suffered from disturbance while walking evolving for the past 2 years. An MR image revealed a cystic dilatation of ventriculus terminalis. The patient experienced marked improvement of lower extremity strength by a fenestration of cyst and cyst-subarachnoid shunt. Treatment for asymptomatic patients seems to be the best conducted conservatively, whereas patients with focal neurological deficits seem to be best handled surgically.
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Affiliation(s)
| | - Hidekazu Tanaka
- Department of Neurosurgery, Takeda General Hospital, Kyoto, Japan
| | - Kunio Yokoyama
- Department of Neurosurgery, Takeda General Hospital, Kyoto, Japan
| | - Makoto Yamada
- Department of Neurosurgery, Takeda General Hospital, Kyoto, Japan
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21
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Fletcher-Sandersjöö A, Edström E, Bartek J, Elmi-Terander A. Surgical treatment for symptomatic ventriculus terminalis: case series and a literature review. Acta Neurochir (Wien) 2019; 161:1901-1908. [PMID: 31278597 PMCID: PMC6704110 DOI: 10.1007/s00701-019-03996-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/25/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Ventriculus terminalis is a cystic embryological remnant within the conus medullaris that normally regresses after birth. In rare cases, it may persist into adulthood and give rise to neurological symptoms, for which the optimal treatment remains uncertain. The aim of this study was to present our experience from a population-based cohort of patients with ventriculus terminalis and discuss our management strategy as compared to the existing literature. METHODS A retrospective review was conducted of all adult (≥ 15 years) patients with ventriculus terminalis who were referred to the Karolinska University Hospital between 2010 and 2018. RESULTS Fourteen patients were included. All patients were symptomatic at the time of referral, and the most common symptom was lower limb weakness (n = 9). Microsurgical cyst fenestration was offered to all patients and performed in thirteen. Postoperative imaging confirmed cyst size reduction in all surgically treated patients. No surgical complications were reported. Eleven of the surgically treated patients showed clinical improvement at long-term follow-up. One patient declined surgery, with progression of the cyst size and clinical deterioration observed at follow-up. CONCLUSIONS Surgery for ventriculus terminalis seems to be a safe and effective option for relief of symptoms. We propose that surgery should be offered to all patients with symptomatic ventriculus terminalis.
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Affiliation(s)
- Alexander Fletcher-Sandersjöö
- Department of Neurosurgery, Karolinska University Hospital, Solna, Sweden.
- Department of Clinical Neuroscience, Karolinska Institutet, Bioclinicum J5:20, 171 64, Solna, Sweden.
| | - Erik Edström
- Department of Neurosurgery, Karolinska University Hospital, Solna, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Bioclinicum J5:20, 171 64, Solna, Sweden
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, Solna, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Bioclinicum J5:20, 171 64, Solna, Sweden
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Neurosurgery, Karolinska University Hospital, Solna, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Bioclinicum J5:20, 171 64, Solna, Sweden
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22
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Maj E, Wójtowicz K, Aleksandra, Podlecka-Piȩtowska, Prokopienko M, Marchel A, Rowiński O, Bekiesińska-Figatowska M. Intramedullary spinal tumor-like lesions. Acta Radiol 2019; 60:994-1010. [PMID: 30537844 DOI: 10.1177/0284185118809540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The development of magnetic resonance imaging (MRI) has led to an increasingly frequent detection of changes in the spinal cord. The most common intramedullary lesions are: demyelinating; vascular; inflammatory; infectious; and congenital, largely called tumor-like lesions. Spinal cord tumors are relatively rare, as compared with brain tumors. The hardest task is to conclude whether the spinal cord lesion is a tumor or a tumor-like lesion. This review is intended to help evaluate the spinal cord and gives an overview of the tumor-like lesions occurring in the spinal cord along with their characteristic.
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Affiliation(s)
- Edyta Maj
- Second Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Marek Prokopienko
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Olgierd Rowiński
- Second Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
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23
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Hiremath SB, Boto J, Regnaud A, Etienne L, Fitsiori A, Vargas MI. Incidentalomas in Spine and Spinal Cord Imaging. Clin Neuroradiol 2019; 29:191-213. [PMID: 30887091 DOI: 10.1007/s00062-019-00773-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/27/2019] [Indexed: 01/08/2023]
Abstract
Incidentalomas are common in magnetic resonance imaging (MRI) of the spine. These incidental findings (IFs) can be seen involving the spinal cord, nerve root, vertebral body, posterior arch and the extraspinal region. This review article describes the imaging findings, stratifies the IFs similar to the computed tomography (CT) colonography reporting and data system and briefly mentions the current recommendations for further evaluation and management of IFs. Radiologists are the first to detect these lesions, suggest further evaluation and management of IFs. It is therefore mandatory for them to be aware of recommendations in clinical practice in order to avoid increased patient anxiety, excessive healthcare expenditure and inadvertent therapeutic procedures.
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Affiliation(s)
- Shivaprakash B Hiremath
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - José Boto
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - Alice Regnaud
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - Léonard Etienne
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - Aikaterini Fitsiori
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - Maria Isabel Vargas
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland.
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Lotfinia I, Mahdkhah A. The cystic dilation of ventriculus terminalis with neurological symptoms: Three case reports and a literature review. J Spinal Cord Med 2018; 41:741-747. [PMID: 29791269 PMCID: PMC6217512 DOI: 10.1080/10790268.2018.1474680] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
CONTEXT The ventriculus terminalis (VT) is a very small ependymal-lined residual lumen in the conus medullaris. It is normally present in all subjects during fetal development. VT in adults appears as an unusual pathology with an uncertain pathogenesis. FINDINGS In this paper, we described three case reports of symptomatic fifth ventricle cystic dilations. All of them were female and their mean age was 59 years. We treated them surgically and all three patients were improved based on clinical and imaging assessments. CONCLUSION Our cases suggested that surgical decompression was a safe and effective treatment in symptomatic patients and the neurosurgeons should be aware of such rare situations. A complete list of differential diagnosis about other cystic dilations of the conus medullaris should be emphasized to select the correct clinical approach.
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Affiliation(s)
- Iraj Lotfinia
- Professor of Neurosurgery Department of Neurosurgery, Tabriz University of Medical Science, Tabriz, Iran
| | - Ata Mahdkhah
- Assistant Professor of Neurosurgery Department of Neurosurgery, Urmia University of Medical Science, Urmia, Iran
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25
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Ganau M, Syrmos N, Martin AR, Jiang F, Fehlings MG. Intraoperative ultrasound in spine surgery: history, current applications, future developments. Quant Imaging Med Surg 2018; 8:261-267. [PMID: 29774179 DOI: 10.21037/qims.2018.04.02] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Mario Ganau
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Nikolaos Syrmos
- School of Medicine, Aristotle University of Thessaloniki, Macedonia, Greece
| | - Allan R Martin
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Fan Jiang
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Michael G Fehlings
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
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26
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Klekamp J. How Should Syringomyelia be Defined and Diagnosed? World Neurosurg 2018; 111:e729-e745. [DOI: 10.1016/j.wneu.2017.12.156] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/22/2017] [Accepted: 12/26/2017] [Indexed: 11/29/2022]
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27
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Severino R, Severino P. Surgery or not? A case of ventriculus terminalis in an adult patient. JOURNAL OF SPINE SURGERY 2017; 3:475-480. [PMID: 29057360 DOI: 10.21037/jss.2017.06.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The ventriculus terminalis (VT) is an intramedullary cavity containing cerebrospinal fluid (CSF), usually located at the conus, and represents an unsuccessful regression of a normal embryological phase of the development of the neural tube. Symptoms are not univocal and may vary from aspecific signs to sphincter dysfunctions and focal neurological deficits. The correct management of this condition is still an object of debate due to its rarity and its unpredictable behaviour in adult patients. Two different studies have proposed a distinction for patients with cystic dilatation of VT based on their symptoms, suggesting that only those patients with neurological deficits clearly related to the terminal ventricle could benefit from surgery. We describe a case of an adult patient with a progressive dilatation of a diagnosed VT that we treated surgically. A management flowchart for this condition is also proposed based on our experience and a review of the literature.
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Affiliation(s)
- Rocco Severino
- Department of Neurosurgery, Anthea Hospital, Bari, Italy
| | - Paolo Severino
- Department of Neurosurgery, Anthea Hospital, Bari, Italy
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Zeinali M, Safari H, Rasras S, Bahrami R, Arjipour M, Ostadrahimi N. Cystic dilation of a ventriculus terminalis. Case report and review of the literature. Br J Neurosurg 2017; 33:294-298. [PMID: 28618974 DOI: 10.1080/02688697.2017.1340585] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The ventriculus terminalis (VT) is a small ependyma-lined cavity within the conus medullaris that is in direct continuity with the central canal of the spinal cord. Cystic dilatation of the ventriculus terminalis on its own is an extremely rare pathological event in adults whose pathogenesis is uncertain. VT has been described in children as a normal developmental phenomenon. These lesions are often diagnosed incidentally during imaging and are in most cases asymptomatic, especially in children. Symptomatic dilatation of VT in adults is a rare condition with 61cases being reported to date. Symptomatic dilatation of VT in children has not been reported till now. We present a 5 year-old-boy with a sphincteric and walking disorder. The patient was assessed by clinical, electrophysiological and urodynamic investigations as well as magnetic resonance imaging (MRI) of the lumbar-sacral segment with and without gadolinium enhancement. Lumbar-sacral MRI demonstrated the presence of a cystic lesion containing cerebrospinal fluid (CSF), which did not enhance after gadolinium, compatible with the diagnosis of the ventriculus terminalis dilation.The patient underwent laminectomy and the cyst wall was fenestrated with a midline myelotomy. In 6-month of follow-up, urinary problems and gait disturbance improved.
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Affiliation(s)
- Masoud Zeinali
- a Department of Neurosurgery , Ahvaz Jundishapur University Of Medical Sciences , Ahvaz , Iran
| | - Hosein Safari
- a Department of Neurosurgery , Ahvaz Jundishapur University Of Medical Sciences , Ahvaz , Iran
| | - Saleh Rasras
- a Department of Neurosurgery , Ahvaz Jundishapur University Of Medical Sciences , Ahvaz , Iran
| | - Reza Bahrami
- a Department of Neurosurgery , Ahvaz Jundishapur University Of Medical Sciences , Ahvaz , Iran
| | - Mahdi Arjipour
- a Department of Neurosurgery , Ahvaz Jundishapur University Of Medical Sciences , Ahvaz , Iran
| | - Nima Ostadrahimi
- a Department of Neurosurgery , Ahvaz Jundishapur University Of Medical Sciences , Ahvaz , Iran
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Zhang L, Zhang Z, Yang W, Jia W, Xu Y, Yang J. Cystic Dilation of the Ventriculus Terminalis: Report of 6 Surgical Cases Treated with Cyst-Subarachnoid Shunting Using a T-Catheter. World Neurosurg 2017; 104:522-527. [PMID: 28512052 DOI: 10.1016/j.wneu.2017.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/03/2017] [Accepted: 05/04/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cystic dilation of the ventriculus terminalis (CDVT) is a rare anatomic variation that and may become symptomatic. Literature regarding CDVT is limited, and thus the clinical characteristics and management strategy of CDVT are unclear. Here we report 6 cases of CDVT seen in our institution, and provide a review of the current literature. METHODS The study cohort comprised 6 patients with CDVT seen at Beijing Tiantan Hospital between September 2010 and June 2015. All 6 patients were managed surgically. Data on age, sex, clinical presentation, radiologic features, operative methods, and surgical outcomes were reviewed retrospectively. We evaluated the clinical outcomes and postoperative radiologic changes of these patients and compared them with findings of similar previous reports. RESULTS All 6 patients were female, with a median age of 50.0 years (interquartile range [IQR], 25.8-54.0 years). Surgical management of cyst-subarachnoid shunting using T-catheter after myelotomy was successfully performed in all patients. During an average follow-up of 41 months, relief of clinical symptoms, especially low-back pain and sciatica, were observed in all 6 patients. No patients experienced symptom recurrence during follow-up, and postoperative magnetic resonance imaging revealed no regrowth of the lesion. Patients with focal neurologic deficits and sphincter disorders also achieved symptom relief from the procedure. CONCLUSIONS CDVT is an extremely rare cause of conus medullaris syndrome with an unclear treatment strategy. Our successful surgical management of 6 cases through cystic-subarachnoid shunting using a T-catheter for CDVT drainage provides a potential option for treating CDVT.
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Affiliation(s)
- Liang Zhang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University No. 6, Tiantan Xili, Beijing, People's Republic of China
| | - Zhifeng Zhang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University No. 6, Tiantan Xili, Beijing, People's Republic of China
| | - Wuyang Yang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Wenqing Jia
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University No. 6, Tiantan Xili, Beijing, People's Republic of China.
| | - Yulun Xu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University No. 6, Tiantan Xili, Beijing, People's Republic of China
| | - Jun Yang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University No. 6, Tiantan Xili, Beijing, People's Republic of China
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Woodley-Cook J, Konieczny M, Spears J. The Slowly Enlarging Ventriculus Terminalis. Pol J Radiol 2016; 81:529-531. [PMID: 27867442 PMCID: PMC5102252 DOI: 10.12659/pjr.895669] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 04/24/2016] [Indexed: 11/09/2022] Open
Abstract
Background A cerebral spinal fluid (CSF) cavity within the conus medullaris has been described by the term ventriculus terminalis (VT) or the fifth ventricle. The finding of a VT on MRI imaging of the lumbar spine is often incidental but may be found in patients with low back pain or neuromuscular deficits. These lesions, when identified, are thought to regress or remain stable in terms of size, although some have been described to enlarge in the presence of post-traumatic meningeal hemorrhages or deformities of the vertebral canal. Case Report We describe a case of a slowly growing VT in a patient with progressing lower limb weakness without any history or imaging findings of trauma or spinal canal abnormalities. Conclusions We present an intriguing case of a slowly growing VT in a woman with progressive neurological symptoms. Surgical fenestration provided complete symptomatic relief and follow-up imaging two years after surgery demonstrated no evidence of recurrence. This, to our knowledge, is the first described case of a slowly enlarging VT independent of any other imaging findings.
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Affiliation(s)
- Joel Woodley-Cook
- Department of Diagnostic Imaging, The Scarborough Hospital, Scarbrorough, ON, Canada
| | - Magdalena Konieczny
- Department of Diagnostic Imaging, The Scarborough Hospital, Scarbrorough, ON, Canada
| | - Julian Spears
- Department of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
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Intradural Intramedullary Mixed Type Hemangioma: Optimizing the Surgical Management through Intraoperative Neurophysiological Monitoring. Case Rep Surg 2015; 2015:984982. [PMID: 26839729 PMCID: PMC4709661 DOI: 10.1155/2015/984982] [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: 09/01/2015] [Revised: 11/21/2015] [Accepted: 12/10/2015] [Indexed: 11/29/2022] Open
Abstract
Intradural intramedullary mixed type hemangioma is a rare histotype of primary spinal cord tumors, though it can carry a severe clinical burden leading to limb dysfunction or motor and sensory disturbances. Timely intervention with radical resection is the hallmark of treatment but achieving it is not an easy task even for experienced neurosurgeons. We herein present an exemplificative case presenting with sudden paraplegia in which total resection was achieved under intraoperative neurophysiology monitoring. A thorough discussion on the operative technique and the role of neuromonitoring in allowing a safe surgical management of primary spinal cord tumors is presented.
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Schwartz C, Lutz J, Romagna A, Tonn JC, Zausinger S, Schöller K. Microsurgical fenestration of idiopathic intramedullary cysts in adult patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:968-74. [PMID: 24972982 DOI: 10.1007/s00586-014-3437-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 06/21/2014] [Accepted: 06/21/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study is to describe the findings in one of the largest series of microsurgically treated intramedullary cysts investigated by magnetic resonance imaging (MRI), focusing on the peri- and intraoperative setup including detailed neurological and radiological outcome analyses. METHODS Retrospective analysis of patients with intramedullary cyst who had undergone microsurgical fenestration at our department between 2006 and 2011. Preoperative three-dimensional constructive interference of steady-state MRI was conducted to optimize surgical planning. Intraoperative electrophysiological monitoring included motor-evoked potentials, somatosensory-evoked potentials, and electromyogram. Clinical outcome as well as pre-, postoperative and long-term MRI scans were evaluated. RESULTS Eight female patients (median age 58.0 years, range 32-72 years) with a median clinical follow-up of 48.0 months (range 2-69 months) were included. Seven cysts were located in the conus medullaris, one in the cervical spine. Overall, 25.0% (2/8) showed complete remission of preoperative symptoms, 62.5% (5/8) improved, and 12.5% (1/8) asymptomatic patients remained unchanged. Pain syndromes (4/4) as well as motor deficits (2/2) improved in all affected patients and bladder dysfunction (3/4) displayed a high tendency for improvement. Postoperative MRI scans showed permanently decreased cyst volumes by ~80%. CONCLUSION Microsurgical fenestration of intramedullary cysts using preoperative high-resolution imaging and intraoperative electrophysiological monitoring is a safe and effective treatment option for symptomatic patients.
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Affiliation(s)
- Christoph Schwartz
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany,
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Nishimura Y, Hara M, Natsume A, Nakajima Y, Fukuyama R, Wakabayashi T, Ginsberg HJ. Spinal intradural cystic venous angioma originating from a nerve root in the cauda equina. J Neurosurg Spine 2013; 19:716-20. [DOI: 10.3171/2013.8.spine121012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A spinal intradural extramedullary venous angioma is extremely rare and has not been previously reported. In this paper, the authors report on this entity with morphological and immunohistochemical evidence, and discuss the surgical strategy for its treatment. A 54-year-old woman presented to Nagoya University Hospital complaining of left-sided pain in the hip, thigh, and inguinal and perianal regions, with progressive worsening during the previous 2 weeks. Lumbar spine MRI showed an intradural extramedullary cyst at the level of T12–L1, which extended from the conus medullaris to the cauda equina. The cyst wall was not enhanced on T1-weighted MRI with Gd. Intraoperatively, a midline dural opening allowed the authors to easily visualize a dark-reddish cyst behind the spinal nerve rootlets in the cauda equina adjacent to the conus medullaris. The cyst was believed to originate from one of the spinal nerve rootlets in the cauda equina and a cluster of veins was identified on the cyst wall. The cyst was resected with the affected nerve rootlet. The surgery left no detectable neurological deficit. Based on the morphological and immunohistochemical evidence, the lesion was diagnosed as a venous angioma. No tumor recurrence was confirmed based on MRI at the time of the 2-year follow up. This is the first report of an intradural extramedullary cystic venous angioma that was successfully resected.
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Affiliation(s)
- Yusuke Nishimura
- 1Department of Neurosurgery, Nagoya University, Nagoya, Japan
- 3Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Masahito Hara
- 1Department of Neurosurgery, Nagoya University, Nagoya, Japan
| | - Atsushi Natsume
- 1Department of Neurosurgery, Nagoya University, Nagoya, Japan
| | | | | | | | - Howard J. Ginsberg
- 3Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Ontario, Canada
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Bellocchi S, Vidale S, Casiraghi P, Arnaboldi M, Taborelli A. Multilobed cystic dilation of the ventriculus terminalis (CDVT). BMJ Case Rep 2013; 2013:bcr2013008654. [PMID: 23682083 PMCID: PMC3669794 DOI: 10.1136/bcr-2013-008654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The cystic dilation of ventriculus terminalis (CDVT) is a rare anatomical variant in adulthood. In this report we describe a new case of an adult with multilobed CDVT, causing low-back pain and subjective disturbances in walking. A myelotomy with fenestration of the cyst was performed with a good clinical and radiological outcome.
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Affiliation(s)
| | - Simone Vidale
- Department of Neurology, Sant'Anna Hospital, Como, Italy
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