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Wang Y, Mu Q, Sheng M, Chen Y, Jian F, Li R. A Nomogram for Predicting Overall Survival of Patients With Primary Spinal Cord Glioblastoma. Neurospine 2024; 21:676-689. [PMID: 38955537 PMCID: PMC11224756 DOI: 10.14245/ns.2448082.041] [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: 01/15/2024] [Revised: 04/09/2024] [Accepted: 04/17/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE Primary spinal cord glioblastoma (PSCGBM) is a rare malignancy with a poor prognosis. To date, no prognostic nomogram for this rare disease was established. Hence, we aimed to develop a nomogram to predict overall survival (OS) of PSCGBM. METHODS Clinical data of patients with PSCGBM was retrospectively collected from the neurosurgery department of Soochow University Affiliated Second Hospital and the Surveillance Epidemiology and End Results database. Information including age, sex, race, tumor extension, extent of resection, adjuvant treatment, marital status, income, year of diagnosis and months from diagnosis to treatment were recorded. Univariate and multivariate Cox regression analyses were used to identify independent prognostic factors for PSCGBM. A nomogram was constructed to predict 1-year, 1.5-year, and 2-year OS of PSCGBM. RESULTS A total of 132 patients were included. The 1-year, 1.5-year, and 2-year OS were 45.5%, 29.5%, and 18.9%, respectively. Four variables: age groups, tumor extension, extent of resection, and adjuvant therapy, were identified as independent prognostic factors. The nomogram showed robust discrimination with a C-index value for the prediction of 1-year OS, 1.5-year OS, and 2-year of 0.71 (95% confidence interval [CI], 0.61-0.70), 0.72 (95% CI, 0.62-0.70), and 0.70 (95% CI, 0.61-0.70), respectively. The calibration curves exhibited high consistencies between the predicted and observed survival probability in this cohort. CONCLUSION We have developed and internally validated a nomogram for predicting the survival outcome of PSCGBM for the first time. The nomogram has the potential to assist clinicians in making individualized predictions of survival outcome of PSCGBM.
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Affiliation(s)
- Yao Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Qingchun Mu
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Minfeng Sheng
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Yanming Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Rujun Li
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
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2
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Auricchio AM, Pennisi G, Menna G, Olivi A, Gessi M, Gielen GH, Gaudino S, Montano N, Papacci F. H3 K27-Altered Diffuse Glioma of the Spinal Cord in Adult Patients: A Qualitative Systematic Review and Peculiarity of Radiological Findings. J Clin Med 2024; 13:2972. [PMID: 38792513 PMCID: PMC11122636 DOI: 10.3390/jcm13102972] [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: 04/01/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Primary spinal cord diffuse gliomas (SpDG) are rare tumors that may harbor, like diffuse intrinsic pontine gliomas (DIPG), H3K27M mutations. According to the WHO (2021), SpDGs are included in diffuse midline H3K27-altered gliomas, which occur more frequently in adults and show unusual clinical presentation, neuroradiological features, and clinical behavior, which differ from H3 G34-mutant diffuse hemispheric glioma. Currently, homogeneous adult-only case series of SpDG, with complete data and adequate follow-up, are still lacking. Methods: We conducted a qualitative systematic review, focusing exclusively on adult and young adult patients, encompassing all studies reporting cases of primitive, non-metastatic SpDG with H3K27 mutation. We analyzed the type of treatment administered, survival, follow-up duration, and outcomes. Results: We identified 30 eligible articles published between 1990 and 2023, which collectively reported on 62 adult and young adult patients with primitive SpDG. Postoperative outcomes were assessed based on the duration of follow-up, with outcomes categorized as either survival or mortality. Patients who underwent surgery were followed up for a mean duration of 17.37 months, while those who underwent biopsy had a mean follow-up period of 14.65 months. Among patients who were still alive, the mean follow-up duration was 18.77 months. The radiological presentation of SpDG varies widely, indicating its lack of uniformity. Conclusion: Therefore, we presented a descriptive scenario where SpDG was initially suspected to be a meningioma, but was later revealed to be a malignant SpDG with H3K27M mutation.
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Affiliation(s)
- Anna Maria Auricchio
- Department of Neurosurgery, Fondazione Universitaria Policlinico Gemelli, 00168 Rome, Italy; (A.M.A.); (G.M.); (A.O.); (N.M.); (F.P.)
- Department of Neurosurgery, Università Cattolica del Sacro Cuore, 00136 Rome, Italy
| | - Giovanni Pennisi
- Department of Neurosurgery, Fondazione Universitaria Policlinico Gemelli, 00168 Rome, Italy; (A.M.A.); (G.M.); (A.O.); (N.M.); (F.P.)
- Department of Neurosurgery, Università Cattolica del Sacro Cuore, 00136 Rome, Italy
- Department of Neurosurgery, F. Spaziani Hospital, 03100 Frosinone, Italy
| | - Grazia Menna
- Department of Neurosurgery, Fondazione Universitaria Policlinico Gemelli, 00168 Rome, Italy; (A.M.A.); (G.M.); (A.O.); (N.M.); (F.P.)
- Department of Neurosurgery, Università Cattolica del Sacro Cuore, 00136 Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Universitaria Policlinico Gemelli, 00168 Rome, Italy; (A.M.A.); (G.M.); (A.O.); (N.M.); (F.P.)
| | - Marco Gessi
- Department of Pathology, Fondazione Universitaria Policlinico Gemelli, 00168 Rome, Italy;
| | - Gerrit H. Gielen
- Department of Neuropathology, Universitätsklinikum Bonn, 53127 Bonn, Germany;
| | - Simona Gaudino
- Department of Radiology, Fondazione Universitaria Policlinico Gemelli, 00168 Rome, Italy;
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Universitaria Policlinico Gemelli, 00168 Rome, Italy; (A.M.A.); (G.M.); (A.O.); (N.M.); (F.P.)
| | - Fabio Papacci
- Department of Neurosurgery, Fondazione Universitaria Policlinico Gemelli, 00168 Rome, Italy; (A.M.A.); (G.M.); (A.O.); (N.M.); (F.P.)
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3
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Asante SK, Lee JJ, Jenson AV, Bhenderu LS, Patterson JD, Rivera AL, Britz GW. Primary thoracic intramedullary spinal cord tumor with likely metastases of glial origin to the lumbosacral vertebrae: Illustrative case. Surg Neurol Int 2023; 14:333. [PMID: 37810327 PMCID: PMC10559382 DOI: 10.25259/sni_231_2023] [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: 03/13/2023] [Accepted: 08/13/2023] [Indexed: 10/10/2023] Open
Abstract
Background Metastasis of systemic neoplasms to the spine is common; however, the metastasis of primary spinal cord tumors to other regions in the body is an infrequent occurrence. A few case reports have described the metastasis of primary spinal cord tumors, and in most cases, patients were younger than 30 years of age. Case Description We present an illustrative case of a 47-year-old female with metastatic lesions to the lumbosacral vertebrae years after the initial diagnosis of an intradural, intramedullary spinal cord tumor (IMSCT). Although the surgical biopsy of the IMSCT was nondiagnostic, the patient was not found to have a separate primary neoplastic source, and the specimens of the metastatic lesions from the lumbar vertebral body were of glial origin. Conclusion Metastasis from primary IMSCTs is extremely rare. Distant vertebral body and intracranial metastasis are even rarer yet possible. The clinical course is highly aggressive and responds poorly to current standard treatment.
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Affiliation(s)
- Samuel K. Asante
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
| | - Jonathan J. Lee
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
| | - Amanda V. Jenson
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
| | - Lokeshwar S. Bhenderu
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
| | - John D. Patterson
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
| | - Andreana L. Rivera
- Department of Pathology, Houston Methodist Hospital, Houston, Texas, United States
| | - Gavin W. Britz
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
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4
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Aftahy AK, Butenschoen VM, Hoenikl L, Liesche-Starnecker F, Wiestler B, Schmidt-Graf F, Meyer B, Gempt J. A rare case of H3K27-altered diffuse midline glioma with multiple osseous and spinal metastases at the time of diagnosis. BMC Neurol 2023; 23:87. [PMID: 36855102 PMCID: PMC9972747 DOI: 10.1186/s12883-023-03135-4] [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: 10/24/2022] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND H3K27-altered diffuse midline gliomas are uncommon central nervous system tumors with extremely poor prognoses. CASE PRESENTATION We report the case of a 24-year-old man patient with multiple, inter alia osseous metastases who presented with back pain, hemi-hypoesthesia, and hemi-hyperhidrosis. The patient underwent combined radio-chemotherapy and demonstrated temporary improvement before deteriorating. CONCLUSIONS H3K27-altered diffuse midline glioma presents an infrequent but crucial differential diagnosis and should be considered in cases with rapid neurological deterioration and multiple intracranial and intramedullary tumor lesions in children and young adults. Combined radio-chemotherapy delayed the neurological deterioration, but unfortunately, progression occurred three months after the diagnosis.
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Affiliation(s)
- A. Kaywan Aftahy
- grid.6936.a0000000123222966Department of Neurosurgery, School of Medicine, Medical Faculty, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Vicki M. Butenschoen
- grid.6936.a0000000123222966Department of Neurosurgery, School of Medicine, Medical Faculty, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Lisa Hoenikl
- grid.6936.a0000000123222966Department of Neurosurgery, School of Medicine, Medical Faculty, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Friederike Liesche-Starnecker
- grid.6936.a0000000123222966Department of Neuropathology, School of Medicine, Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Benedikt Wiestler
- grid.6936.a0000000123222966Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Friederike Schmidt-Graf
- grid.6936.a0000000123222966Neurological Department, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Meyer
- grid.6936.a0000000123222966Department of Neurosurgery, School of Medicine, Medical Faculty, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Jens Gempt
- grid.6936.a0000000123222966Department of Neurosurgery, School of Medicine, Medical Faculty, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
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5
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Muacevic A, Adler JR. Primary Spinal Glioblastoma Mimicking Neuroschistosomiasis: A Case Report. Cureus 2022; 14:e30248. [PMID: 36381781 PMCID: PMC9652719 DOI: 10.7759/cureus.30248] [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: 09/27/2022] [Accepted: 10/12/2022] [Indexed: 12/05/2022] Open
Abstract
Primary glioblastoma of the spinal cord (sGB) is a rare and challenging diagnosis. In the diagnostic algorithm, reversible causes should be considered while the diagnosis of sGB is under evaluation. We present a case of cervical sGB mimicking neuroschistosomiasis. A 21-year-old Somali man presented with neck pain, sensory disturbances, and spastic tetraplegia. Cervical spine magnetic resonance imaging with contrast showed a heterogeneously enhancing intramedullary mass spanning from the level of the C1 to T3 vertebrae. Cerebrospinal fluid analysis showed a lymphocytic predominance and elevated protein. Due to the patient's history of poorly treated schistosomiasis, praziquantel and dexamethasone were initiated while the diagnostic work-up was completed. Three days after the patient was discharged to a rehabilitation facility where he experienced worsened motor function with radiographic progression of the lesion and increased cord edema. The patient underwent a surgical biopsy which confirmed a diagnosis of primary sGB. sGB is an unusual diagnosis that can masquerade as a non-neoplastic lesion. However, the diagnosis of sGB should be considered in patients with an intramedullary spinal cord lesion who exhibit rapid radiographic and clinical progression.
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6
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Alharbi B, Alammar H, Alkhaibary A, Alharbi A, Khairy S, Alassiri AH, AlSufiani F, Aloraidi A, Alkhani A. Primary spinal cord glioblastoma: A rare cause of paraplegia. Surg Neurol Int 2022; 13:160. [PMID: 35509569 PMCID: PMC9062964 DOI: 10.25259/sni_135_2022] [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: 02/01/2022] [Accepted: 03/27/2022] [Indexed: 12/11/2022] Open
Abstract
Background: Primary spinal glioblastomas are extremely rare neoplasms and account for only 0.2% of glioblastoma cases. Due to the rare incidence of spinal cord glioblastoma in the literature, its natural history/ outcome remains undetermined. The present article describes the clinical presentation, radiological/pathological characteristics, and outcome of the primary spinal cord glioblastoma. Case Description: Two young patients initially presented with paresis that rapidly progressed to paraplegia. Nondermatomal sensory deficits were also noted, mainly affecting the lower limbs. Neuroradiological imaging revealed an extensive intramedullary spinal cord lesion, with no evidence of concurrent intracranial space-occupying lesions. Thoracic laminectomy, followed by tumor debulking and/or biopsy, was performed. The histomorphology was suggestive of glioblastoma, the World Health Organization grade 4 (Isocitrate Dehydrogenase-wild type). They were discharged in stable condition and were started on chemoradiotherapy, with clinicoradiological follow-up. One patient passed away after 9 months of initial presentation. The other patient was alive at 6-month follow-up. Conclusion: Primary spinal glioblastoma is a rare and challenging tumor. Patients commonly present with a progressive paresis, resulting in paraplegia, regardless of the surgical resection extent, and received adjuvant chemotherapy. Therefore, primary spinal cord glioblastoma should be considered in patients reporting a rapid lower limb weakness with neuroradiological evidence of extensive, exophytic intramedullary lesion of the spine. A biopsy-proven histopathological diagnosis is of indisputable importance to establish the final diagnosis and plan treatment options.
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Affiliation(s)
- Bashaer Alharbi
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hajar Alammar
- Saudi Ministry of Health, Third Healthcare Cluster, Riyadh, Saudi Arabia
| | - Ali Alkhaibary
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ahoud Alharbi
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sami Khairy
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ali H. Alassiri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia
| | - Fahd AlSufiani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Aloraidi
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ahmed Alkhani
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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7
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Yabuno S, Kawauchi S, Umakoshi M, Uneda A, Fujii K, Ishida J, Otani Y, Hattori Y, Tsuboi N, Kohno S, Noujima M, Toji T, Yanai H, Yasuhara T, Date I. Spinal Cord Diffuse Midline Glioma, H3K27M- mutant Effectively Treated with Bevacizumab: A Report of Two Cases. NMC Case Rep J 2022; 8:505-511. [PMID: 35079510 PMCID: PMC8769434 DOI: 10.2176/nmccrj.cr.2021-0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/01/2021] [Indexed: 11/23/2022] Open
Abstract
“Diffuse midline glioma (DMG), H3K27M-mutant” was newly classified in the revised World Health Organization (WHO) 2016 classification of central nervous system tumors. Spinal cord DMG, H3K27M-mutant is relatively rare, with poor prognosis, and there are no effective treatment protocols. In this study, we report two cases of spinal cord DMG, H3K27M-mutant treated with bevacizumab. The two patients were women in their 40s who initially presented with sensory impairment. MRI showed spinal intramedullary tumors, and each patient underwent laminectomy/laminoplasty and biopsy of the tumors. Histological examination initially suggested low-grade astrocytoma in case 1 and glioblastoma in case 2. Upon further immunohistochemical examination in case 1 and molecular examination in case 2, however, both cases were diagnosed as DMG, H3K27M-mutant. Case 1 was treated with radiation therapy and temozolomide (TMZ) chemotherapy, which induced a transient improvement of symptoms; 3 months after surgery, however, the patient’s symptoms rapidly deteriorated. MRI showed tumor enlargement with edema to the medulla. Triweekly administration of bevacizumab improved her symptoms for the following 12 months. Case 2 was treated with bevacizumab from the beginning because of acute deterioration of breathing. After bevacizumab administration, both cases showed tumor regression on MRI and drastic improvement of symptoms within a few days. Although spinal cord DMG, H3K27M-mutant has an aggressive clinical course and poor prognosis, bevacizumab administration may offer the significant clinical benefit of alleviating edema, which improves patient’s capacity for activities of daily life.
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Affiliation(s)
- Satoru Yabuno
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Satoshi Kawauchi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Michiari Umakoshi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Atsuhito Uneda
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Kentaro Fujii
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Joji Ishida
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Yoshihiro Otani
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Yasuhiko Hattori
- Department of Neurological Surgery, Sumitomo Besshi Hospital, Niihama, Ehime, Japan
| | - Nobushige Tsuboi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Shohei Kohno
- Department of Neurosurgery, Japanese Red Cross Society Himeji Hospital, Himeji, Hyogo, Japan
| | - Mai Noujima
- Department of Diagnostic Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Tomohiro Toji
- Department of Diagnostic Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Hiroyuki Yanai
- Department of Diagnostic Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
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8
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Upadhyay R, Khose S, Pokhylevych H, Paulino AC, McAleer MF, Ghia A, Li J, Yeboa DN, Loghin M, Harrison R, O’Brien B, Kamiya-Matsuoka C, De Groot J, Puduvalli VK, Tatsui C, Alvarez-Breckenridge C, Prabhu S, Rhines L, Zaky W, Lin F, Weinberg JS, Fuller G, Sandberg DI, Johnson JM, McGovern SL. Patterns of failure after radiation therapy in primary spinal high-grade gliomas: A single institutional analysis. Neurooncol Adv 2022; 4:vdac129. [PMID: 36128585 PMCID: PMC9476222 DOI: 10.1093/noajnl/vdac129] [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] [Indexed: 12/01/2022] Open
Abstract
Background Primary spinal high-grade gliomas (S-HGG) are rare aggressive tumors; radiation therapy (RT) often plays a dominant role in management. We conducted a single-institution retrospective review to study the clinicopathological features and management of S-HGGs. Methods Patients with biopsy-proven S-HGG who received RT from 2001 to 2020 were analyzed for patient, tumor, and treatment characteristics. Kaplan–Meier estimates were used for survival analyses. Results Twenty-nine patients were identified with a median age of 25.9 years (range 1–74 y). Four patients had GTR while 25 underwent subtotal resection or biopsy. All patients were IDH wildtype and MGMT-promoter unmethylated, where available. H3K27M mutation was present in 5 out of 10 patients tested, while one patient harbored p53 mutation. Median RT dose was 50.4 Gy (range 39.6–54 Gy) and 65% received concurrent chemotherapy, most commonly temozolomide. Twenty-three (79%) of patients had documented recurrence. Overall, 16 patients relapsed locally, 10 relapsed in the brain and 8 developed leptomeningeal disease; only 8 had isolated local relapse. Median OS from diagnosis was 21.3 months and median PFS was 9.7 months. On univariate analysis, age, gender, GTR, grade, RT modality, RT dose and concurrent chemotherapy did not predict for survival. Patients with H3K27M mutation had a poorer PFS compared to those without mutation (10.1 m vs 45.1 m) but the difference did not reach statistical significance (P = .26). Conclusions The prognosis of patients with spinal HGGs remains poor with two-thirds of the patients developing distant recurrence despite chemoradiation. Survival outcomes were similar in patients ≤ 29 years compared to adults > 29 years. A better understanding of the molecular drivers of spinal HGGs is needed to develop more effective treatment options.
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Affiliation(s)
- Rituraj Upadhyay
- Department of Radiation Oncology, The James Cancer Centre, Ohio State University , Columbus, Ohio , USA
| | - Swapnil Khose
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Halyna Pokhylevych
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Amol Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Debra Nana Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Monica Loghin
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Rebecca Harrison
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Barbara O’Brien
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Carlos Kamiya-Matsuoka
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - John De Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Vinay K Puduvalli
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Claudio Tatsui
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | | | - Sujit Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Larry Rhines
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Wafik Zaky
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Frank Lin
- Texas Children’s Cancer Center, Baylor College of Medicine , Houston, Texas , USA
| | - Jeffery S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Gregory Fuller
- Department of Neuro-pathology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA (G.F.)
| | - David I Sandberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Jason Michael Johnson
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
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9
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Nagarajan A, Ravichandar R. Glioblastoma multiforme of spinal cord - Case series in a tertiary cancer centre. J Clin Transl Res 2021; 7:792-796. [PMID: 34988331 PMCID: PMC8710352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/03/2021] [Accepted: 11/12/2021] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND AND AIM Primary spinal cord glioblastoma multiforme (GBM) is a rare clinical condition and is often associated with a dismal prognosis. The standard treatment is maximal safe surgery followed by adjuvant radiotherapy and chemotherapy. Despite such aggressive treatments, the median survival is estimated to be around 15 months in several studies. We report three patients with primary spinal GBM who received treatment in our institute from 2012 to 2019. Among the three, one patient is on long-term follow-up with no evidence of disease, another patient succumbed to the illness and the third patient is having stable disease. RELEVANCE FOR PATIENTS Although primary spinal GBM is usually associated with a dismal prognosis, our case series shows a subset of patients will have a favorable outcome with the protocol treatment.
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Affiliation(s)
- Aswin Nagarajan
- 1Department of Radiation Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India,Corresponding author: Aswin Nagarajan Department of Radiation Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India E-mail:
| | - Ramya Ravichandar
- 2Department of Pharmacology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
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10
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Primary and metastatic glioblastoma of the spine in the pediatric population: a systematic review. Childs Nerv Syst 2021; 37:1849-1858. [PMID: 33675391 DOI: 10.1007/s00381-021-05098-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 01/15/2023]
Abstract
Pediatric glioblastoma multiforme (GBM) involving the spine is an aggressive tumor with a poor quality of life for patients. Despite this, there is only a limited number of reports describing the outcomes of pediatric spinal GBMs, both as primary spinal GBMs and metastases from an intracranial tumor. Here, we performed an individual patient meta-analysis to characterize factors affecting prognosis of pediatric spinal GBM. MEDLINE, Embase, and the Cochrane databases were searched for published studies on GBMs involving the spine in pediatric patients (age ≤ 21 years old). Factors associated with the survival were assessed with multi-factor ANOVAs, Cox hazard regression, and Kaplan-Meier analyses. We extracted data on 61 patients with spinal GBM from 40 studies that met inclusion criteria. Median survival was significantly longer in the primary spinal GBM compared that those with metastatic GBM (11 vs 3 months, p < 0.001). However, median survival of metastatic GBM patients was 10 months following diagnosis of their primary brain tumor, which was not different from that of primary spinal GBM patients (p = 0.457). Among primary spinal GBM patients, chemotherapy (hazard ratio (HR) = 0.255 [0.106-0.615], p = 0.013) and extent of resection (HR = 0.582 [0.374-0.905], p = 0.016) conferred a significant survival benefit. Younger age (less than 14 years) was associated with longer survival in patients treated with chemotherapy than those who did not undergo chemotherapy (β = - 1.12, 95% CI [- 2.20, - 0.03], p < 0.05). In conclusion, survival after presentation of metastases from intracranial GBM is poor in the pediatric population. In patients with metastatic GBM, chemotherapy may have provided the most benefit in young patients, and its efficacy might have an association with extent of surgical resection.
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11
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Farzin M, Hajiabadi M, Rahmani M, Kolahdouzan K. Mixed malignant glioblastoma and schwannoma in spinal cord with metachronous ependymoma: A case report. Clin Case Rep 2021; 9:e04162. [PMID: 34194761 PMCID: PMC8222762 DOI: 10.1002/ccr3.4162] [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: 01/06/2021] [Accepted: 03/31/2021] [Indexed: 11/17/2022] Open
Abstract
Here, we report a very rare case of mixed spinal tumor comprising of malignant glioblastoma and schwannoma, who was initially treated with tumor resection and adjuvant chemoradiation, but relapsed three years later with grade 3 ependymoma.
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Affiliation(s)
- Mostafa Farzin
- Brain and Spinal Cord Injury Research CenterNeuroscience InstituteTehran University of Medical SciencesTehranIran
- Radiation Oncology Research CenterCancer InstituteTehran University of Medical SciencesTehranIran
| | - Mohamadreza Hajiabadi
- Brain and Spinal Cord Injury Research CenterNeuroscience InstituteTehran University of Medical SciencesTehranIran
| | - Mohammad Rahmani
- Department of NeurosurgerySina HospitalTehran University of Medical SciencesTehranIran
| | - Kasra Kolahdouzan
- Radiation Oncology Research CenterCancer InstituteTehran University of Medical SciencesTehranIran
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12
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Jokovic M, Somma T, Ilic R, Guizzardi G, Stanimirovic A, Raicevic S, Milicevic M, Grujicic D, Solari D. Primary spinal glioblastoma multiforme. Single center experience and literature review. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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13
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Kashyap S, Brazdzionis J, Savla P, Berry JA, Farr S, Patchana T, Majeed G, Ghanchi H, Bowen I, Wacker MR, Miulli DE. Osteopathic Manipulative Treatment to Optimize the Glymphatic Environment in Severe Traumatic Brain Injury Measured With Optic Nerve Sheath Diameter, Intracranial Pressure Monitoring, and Neurological Pupil Index. Cureus 2021; 13:e13823. [PMID: 33859888 PMCID: PMC8038899 DOI: 10.7759/cureus.13823] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Traumatic brain injury (TBI) has a complex pathophysiology that has historically been poorly understood. New evidence on the pathophysiology, molecular biology, and diagnostic studies involved in TBI have shed new light on optimizing rehabilitation and recovery. The goal of this study was to assess the effect of osteopathic manipulative treatment (OMT) on peripheral and central glial lymphatics in patients with severe TBI, brain edema, and elevated intracranial pressure (ICP) by measuring changes in several parameters regularly used in management. Methodology This was a retrospective study at a level II trauma center that occurred in 2018. The study enrolled patients with TBI, increased ICP, or brain edema who had an external ventricular drain placed. Patients previously underwent a 51-minute treatment with OMT with an established protocol. Patients received 51 minutes of OMT to the head, neck, and peripheral lymphatics. The ICP, cerebrospinal fluid (CSF) drainage, optic nerve sheath diameter (ONSD) measured by ultrasonography, and Neurological Pupil Index (NPi) measured by pupillometer were recorded before, during, and after receiving OMT. Results A total of 11 patients were included in the study, and 21 points of data were collected from the patients meeting inclusion criteria who received OMT. There was a mean decrease in the ONSD of 0.62 mm from 6.24 mm to 5.62 mm (P = 0.0001). The mean increase in NPi was 0.18 (P = 0.01). The mean decrease in ICP was 3.33 mmHg (P= 0.0001). There was a significant decrease in CSF output after treatment (P = 0.0001). Each measurement of ICP, ONSD, and NPi demonstrated a decrease in overall CSF volume and pressure after OMT compared to CSF output and ICP prior to OMT. Conclusions This study demonstrates that OMT may help optimize glial lymphatic clearance of CSF and improve brain edema, interstitial waste product removal, NPi, ICP, CSF volume, and ONSD. A holistic approach including OMT may be considered to enhance management in TBI patients. As TBI is a spectrum of disease, utilizing similar techniques may be considered for all forms of TBI including concussions and other diseases with brain edema. The results of this study can better inform future trials to specifically study the effectiveness of OMT in post-concussive treatment and in those with mild-to-moderate TBI.
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Affiliation(s)
- Samir Kashyap
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - James Brazdzionis
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Paras Savla
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - James A Berry
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Saman Farr
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Tye Patchana
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Gohar Majeed
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Hammad Ghanchi
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Ira Bowen
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | | | - Dan E Miulli
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
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14
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Spinal cord glioblastoma during pregnancy: Case report. Neurochirurgie 2020; 67:201-204. [PMID: 33232712 DOI: 10.1016/j.neuchi.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/17/2020] [Accepted: 11/14/2020] [Indexed: 11/20/2022]
Abstract
Spinal Cord Glioblastoma Multiforme (SCGBM) is a very rare, debilitating and often fatal tumor. Cases of intracranial GBM during pregnancy have been reported, and as other tumor occurring in this setting, it harbors a great dilemma to attending physicians and families. We report the first case of a SCGBM diagnosed during pregnancy and discuss its management and treatment.
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15
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Vadhan JD, Eichberg DG, Di L, Manzano G, Ivan M, Komotar RJ. Primary Low-Grade Astrocytoma of the Spine With Secondary Cerebral Metastasis: A Case Report and Comprehensive Review of the Literature. Cureus 2020; 12:e10030. [PMID: 32983723 PMCID: PMC7515806 DOI: 10.7759/cureus.10030] [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] [Indexed: 11/23/2022] Open
Abstract
An astrocytoma is a subclassification of glioma, with primary spinal manifestations accounting for less than 10% of all spinal cord tumors, with the majority encompassing low-grade features. It is even more uncommon for such lesions to demonstrate intracerebral metastasis. We report such an occurrence in a 39-year-old female who initially presented with an intramedullary and intradural mass from T10-L1, as well as secondary metastasis to the mesial right temporal lobe and cerebellum upon clinical follow-up. Surgical resection of the spine and subsequent temporal lobe biopsy confirmed high-grade glioma. Given the rarity and poor prognosis of spinal gliomas with cerebral metastasis, we also summarize all previously reported cases to date. We recommend that physicians maintain an index of suspicion for spinal gliomas in young patients with cord compression related symptoms outside the event of traumatic injury.
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Affiliation(s)
- Jason D Vadhan
- Osteopathic Medicine, Nova Southeastern University, Miami, USA
| | - Daniel G Eichberg
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Long Di
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Glen Manzano
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Michael Ivan
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Ricardo J Komotar
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
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16
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Yi S, Choi S, Shin DA, Kim DS, Choi J, Ha Y, Kim KN, Suh CO, Chang JH, Kim SH, Yoon DH. Impact of H3.3 K27M Mutation on Prognosis and Survival of Grade IV Spinal Cord Glioma on the Basis of New 2016 World Health Organization Classification of the Central Nervous System. Neurosurgery 2020; 84:1072-1081. [PMID: 29718432 DOI: 10.1093/neuros/nyy150] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 03/25/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Spinal cord glioma grade IV is a rare, diffuse midline glioma. H3 K27M-mutant was classified in a different entity in the 2016 World Health Organization (WHO) classification recently. No reports about prognosis of spinal cord glioma grade IV are available yet. OBJECTIVE To analyze the prognostic factors for spinal cord glioma grade IV. METHODS Twenty-five patients with spinal cord glioma of grade IV who underwent surgery in a single institute were selected. All grade IV spinal cord glioma histologically confirmed as glioblastoma or "diffuse midline glioma with H3 K27M-mutant" by the 2016 WHO classification of the central nervous system were included. Basic demographics, treatment modalities, and pathological tumor molecular profiles were investigated for prognosis. RESULTS Mean age was 39.1 yr; male to female ratio was 18 : 7. Tumor was located in thoracic cord (53.3%), cervical cord (40%), and lumbar area (6.7%). Median overall survival was 37.1 mo; median disease-free survival was 18.5 mo. Treatment modality showed no statistical difference. Only K27M profile showed significant prognostic value, 20 patients (80%) showed K27M mutation positive, K27M mutation patients showed longer overall survival (40.07 mo) than K27M negative patients (11.63 mo, P < .0001), and disease-free survival (20.85 vs 8.72 mo, P = .0241). CONCLUSION This study is the first and largest report of the prognosis of primary spinal cord grade IV glioma using the new WHO classification. This study reported survival analysis and prognostic factors, and revealed that H3.3 K27M mutation is not a major poor prognostic factor. Further studies to explore K27M mutations needed for risk stratification and therapy optimization.
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Affiliation(s)
- Seong Yi
- Department of Neurosurgery; Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sunkyu Choi
- Department of Neurosurgery; Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Ah Shin
- Department of Neurosurgery; Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Du Su Kim
- Department of Neurosurgery; Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Junjeong Choi
- College of Pharmacy, Yonsei University, Incheon, Korea
| | - Yoon Ha
- Department of Neurosurgery; Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Keung Nyun Kim
- Department of Neurosurgery; Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology; Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Do Heum Yoon
- Department of Neurosurgery; Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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17
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Peters K, Pratt D, Koschmann C, Leung D. Prolonged survival in a patient with a cervical spine H3K27M-mutant diffuse midline glioma. BMJ Case Rep 2019; 12:12/10/e231424. [PMID: 31628092 DOI: 10.1136/bcr-2019-231424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We report a case of prolonged survival in a patient with known cervical intramedullary H3K27M-mutant diffuse midline glioma. A 39-year-old man presented for evaluation with several months of progressive upper extremity pain and weakness. MRI of the cervical spine revealed an intramedullary ring-enhancing lesion centred at C3-C4. Following subtotal surgical resection, a diagnosis of glioblastoma (GBM) was confirmed. Subsequent testing at a later date revealed an H3K27M mutation. He was initially treated with radiation and concomitant and adjuvant temozolomide. He had multiply recurrent disease and was treated with various regimens, including the histone deacetylase inhibitor valproic acid. The patient passed away 31 months (~2.5 years) after diagnosis. Our case is one of few reported adult spinal cord GBMs possessing the H3K27M mutation, and one with the longest reported overall survival in the literature to date.
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Affiliation(s)
- Kelsey Peters
- Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Drew Pratt
- Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Carl Koschmann
- Paediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Denise Leung
- Neurology, University of Michigan, Ann Arbor, Michigan, USA
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19
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Chanchotisatien A, Xiong J, Yu J, Chu S. Exophytic Primary Intramedullary Spinal Cord Glioblastoma: Case Report and Critical Review of Literature. World Neurosurg 2018; 122:573-576. [PMID: 30476666 DOI: 10.1016/j.wneu.2018.11.113] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Primary intramedullary spinal cord (IMSC) glioblastoma (GBM) is an extremely rare entity; we report the first case of primary IMSC GBM presenting with exophytic involvement. The prognosis of glioblastoma remains poor due to the aggressive nature of the disease and lack of effective treatment. CASE DESCRIPTION A 27-year-old Asian female presented to our hospital with a 1-month history of dysuria, incomplete bladder emptying, progressive numbness, and weakness of both lower limbs, as well as a 1-year history of back pain. Spinal magnetic resonance imaging (MRI) revealed an intramedullary lesion and exophytic growth in the T4-T12 and T5-12 regions, respectively. The patient's MRI findings were atypical of spinal glioblastoma. The diagnosis was made on the basis of immunohistochemical and pathologic analyses of tissue samples obtained from an open biopsy. The patient received a standard course of glioblastoma radiotherapy and adjuvant temozolomide chemotherapy, which improved her symptoms in the absence of an apparent reduction in tumor size. CONCLUSIONS Although MRI is of indisputable importance in the diagnosis of spinal cord lesions, immunohistochemical and histopathologic studies are often required to establish a definitive diagnosis. It remains unclear how the unusual involvement of exophytic growth will affect the prognosis of primary IMSC GBM.
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Affiliation(s)
| | - Jie Xiong
- Department of Pathology, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China
| | - Jintai Yu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Shuguang Chu
- Department of Radiology, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China.
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20
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Caro-Osorio E, Herrera-Castro JC, Barbosa-Quintana A, Benvenutti-Regato M. Primary Spinal Cord Small-Cell Glioblastoma: Case Report and Literature Review. World Neurosurg 2018; 118:69-70. [PMID: 30017760 DOI: 10.1016/j.wneu.2018.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Approximately 2%-10% of all central nervous system tumors are primary spinal cord tumors (SCTs). Spinal cord glioblastoma is a rare tumor type accounting for 1%-3% of all SCTs and 7.5% of all spinal cord gliomas. Notably, the small-cell variant of spinal cord glioblastoma is even rarer with only 2 previously reported cases. CASE DESCRIPTION We present herein a case report of a rare primary spinal cord glioblastoma in a 48-year-old patient with a 2-month history of numbness in the left arm and mild cervical pain radiating to the occipital zone. Clinical examination revealed hypoalgesia and thermal dissociation of the left arm and the ipsilateral superior part of the trunk treated through subtotal surgical resection followed by adjuvant chemotherapy and radiotherapy. Histologic examination of the surgical tumor specimen revealed features of the small-cell spinal cord glioblastoma. CONCLUSIONS To the best of our knowledge, this is only the third reported case of small-cell spinal cord glioblastoma. The aggressive nature of this tumor variant reduces overall survival rate regardless of the treatment.
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Affiliation(s)
- Enrique Caro-Osorio
- Department of Neurosurgery, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico.
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21
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Mansha MA, Khan AMH, Abbasi ANN, Tariq MUU, Mushtaq N, Tariq M, Waheed A. Glioblastoma Multiforme Involving Conus Medullaris in a Child. Cureus 2018; 10:e2863. [PMID: 30148015 PMCID: PMC6107034 DOI: 10.7759/cureus.2863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 06/22/2018] [Indexed: 11/05/2022] Open
Abstract
Primary spinal cord glioblastoma multiforme involving the conus medullaris is an uncommon entity with poor outcomes. An aggressive multimodality treatment approach has been used, but prognosis remains same. There are no guidelines for the treatment of patients with spinal glioblastoma multiforme (GBM). We highlight the case of a child diagnosed with conal GBM. He was treated with definitive surgery followed by adjuvant concurrent chemoradiation. After completion of treatment, he showed a temporary symptomatic improvement, but later on his condition deteriorated. We elaborate the stepwise treatment approach employed in this patient.
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Affiliation(s)
| | | | | | | | | | - Maria Tariq
- Pediatrics, Aga Khan University, Karachi, PAK
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22
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Liu J, Zheng M, Yang W, Lo SFL, Huang J. Impact of surgery and radiation therapy on spinal high-grade gliomas: a population-based study. J Neurooncol 2018; 139:609-616. [DOI: 10.1007/s11060-018-2904-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/14/2018] [Indexed: 11/28/2022]
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Purkayastha A, Sharma N, Sridhar MS, Abhishek D. Intramedullary Glioblastoma Multiforme of Spine with Intracranial Supratentorial Metastasis: Progressive Disease with a Multifocal Picture. Asian J Neurosurg 2018; 13:1209-1212. [PMID: 30459896 PMCID: PMC6208206 DOI: 10.4103/ajns.ajns_67_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Primary spinal glioblastoma multiforme (GBM) is very uncommon while an intramedullary spinal GBM with intracranial metastasis is rarely heard of. A 23-year-old male presented with bilateral paraplegia associated with bowel and bladder incontinence. Craniospinal radiograph showed an intramedullary spinal mass lesion, for which he underwent laminectomy and histopathology revealed GBM. He received local radiotherapy (RT) with temozolomide (TMZ). While on adjuvant TMZ, he developed severe headache and recurrent episodes of vomiting. Brain and spine imaging showed intracranial mass lesions associated with expansion of the entire cord. Biopsy from the intracranial lesion was confirmed as GBM on immunohistopathology. He was treated with palliative RT to the brain and was put on metronomic TMZ; however, he succumbed to his illness. Review of literature reveals that our case may be the fourth such case in the world and probably the first case reported in India where the intracranial metastatic GBM again presented with a reverse spinal dissemination.
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Affiliation(s)
- Abhishek Purkayastha
- Department of Radiation Oncology, Army Hospital Research and Referral, New Delhi, India
| | - Neelam Sharma
- Department of Radiation Oncology, Army Hospital Research and Referral, New Delhi, India
| | | | - Dwivedi Abhishek
- Department of Radiology, Army Hospital Research and Referral, New Delhi, India
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Inoue T, Endo T, Nakamura T, Shibahara I, Endo H, Tominaga T. Expression of CD133 as a Putative Prognostic Biomarker to Predict Intracranial Dissemination of Primary Spinal Cord Astrocytoma. World Neurosurg 2017; 110:e715-e726. [PMID: 29180077 DOI: 10.1016/j.wneu.2017.11.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/15/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Spinal cord astrocytoma with intracranial dissemination carries a poor prognosis. The mechanisms leading to dissemination remain to be elucidated. A stem cell marker, CD133, was reported to predict recurrence patterns in intracranial glioblastoma. We evaluated the significance of CD133 as a putative prognostic biomarker to predict intracranial dissemination in spinal cord astrocytoma. METHODS This study included 14 consecutive patients with primary spinal cord astrocytoma treated from 1998 to 2014. Six of the patients were women and the patients' ages ranged from 12 to 75 years. Seven and 6 patients underwent open biopsy and partial resection of the tumors, respectively. After confirmation of the histologic diagnoses, all patients were treated with postoperative radiotherapy, chemotherapy, or a combination of both. To identify factors predictive of intracranial dissemination, we analyzed their clinical data including Ki-67 labeling index, and CD133 expression. RESULTS Intracranial dissemination was observed in 6 of 14 patients. All 6 patients died during the follow-up period. Of the 8 patients without intracranial dissemination, 5 survived (P = 0.02). Median survival for the patients with intracranial dissemination was 22.7 months. CD133 expression was significantly higher in patients with intracranial dissemination (P = 0.04), whereas other variables did not indicate the dissemination. CONCLUSIONS The expression of CD133 can be an efficient biomarker to predict intracranial dissemination in spinal cord astrocytoma. Recognition of high CD133 expression in surgical specimens and early detection of intracranial dissemination is important for the clinical management of spinal cord astrocytoma.
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Affiliation(s)
- Tomoo Inoue
- Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan.
| | - Taigen Nakamura
- Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Ichiyo Shibahara
- Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Miyagi, Japan
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25
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Fayçal L, Mouna B, Najia EA. Rare case of conus medullaris glioblastoma multiforme in a teenager. Surg Neurol Int 2017; 8:234. [PMID: 29026670 PMCID: PMC5629838 DOI: 10.4103/sni.sni_21_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 07/28/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Primary intramedullary spinal glioblastoma multiforme (GBM) lesions are very rare comprising only 1.5% of all spinal cord tumors. These lesions typically result in rapid neurological deterioration and are associated with a very poor prognosis. CASE DESCRIPTION A 16-year-old male exhibited a slowly progressive paraparesis with urinary incontinence, ultimately resulting in paraplegia. On magnetic resonance (MR), he was diagnosed with an intramedullary GBM of the spinal cord extending from the T9 level through the conus medullaris. Ten months following decompression/partial surgical resection of the intramedullary mass, he remained paraplegic. CONCLUSION GBM of the spinal cord are rare in the pediatric age group. A 16-year-old male presented with a flaccid paraplegia attributed to an MR-documented GBM of the distal thoracic cord extending from the T9 level through the conus medullaris. Despite partial intramedullary tumor resection, 10 months postoperatively, he remained paraplegic.
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Affiliation(s)
- Lakhdar Fayçal
- Department of Neurosurgery, Hassan II Hospital, University Sidi Mohamed Ben Abdellah, Fes, Morocco
| | - Bougrine Mouna
- Department of Neurosurgery, Cheikh Zaid Hospital, Rabat, Morocco
| | - El Abbadi Najia
- Department of Neurosurgery, Cheikh Zaid Hospital, Rabat, Morocco
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26
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Cheng X, Lou S, Huang S, Chen H, Liu J. Primary Spinal Cord Glioblastoma Multiforme: A Retrospective Study of Patients at a Single Institution. World Neurosurg 2017; 106:113-119. [PMID: 28377242 DOI: 10.1016/j.wneu.2017.03.120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/24/2017] [Accepted: 03/25/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Primary spinal cord (PSC) glioblastoma multiforme (GBM) is extremely rare and accounts for only 1.5% of all spinal cord tumors. Therefore, its treatment is still ill defined. To elucidate prognostic factors, we performed a single-institutional retrospective review of the largest series to date of patients with PSC GBM who underwent surgical resection in West China Hospital between 2008 and 2014. A total of 14 patients with PSC GBM were reviewed. METHODS Demographic, operative, and postoperative factors were recorded. Overall survival (OS) and progression-free survival (PFS) were calculated and compared with the Kaplan-Meier method. RESULTS Eight males (57%) and 6 females (43%) were involved in the study. Their median age was 28 years (range, 14-56 years). Median Karnofsky Performance Status score was 60 (range, 20-90). Four patients (28.6%) received gross total resection, 5 (35.7%) partial resection, and the remaining 5 (35.7%) biopsy only. Nine patients (64.3%) received postoperative radiotherapy and chemotherapy, 3 (21.4%) chemotherapy only, and 2 (14.3%) neither. Median follow-up period was 15 months (range, 5-26 months). One-year and 2-year survival was 78.5% (11/14) and 7.1% (1/14), respectively. Median OS was 15 months, and median PFS 8 months. Univariate log-rank analysis showed that OS and PFS were significantly associated with patients' age (P = 0.007 and P = 0.04, respectively) and postoperative radiotherapy (P = 0.001 and P = 0.002, respectively). However, preoperative Karnofsky Performance Status score affected only OS and did not affect PFS (P = 0.033 and P = 0.106, respectively). CONCLUSIONS According to our study, the combination of postoperative radiotherapy and temozolomide chemotherapy can improve prognosis and may serve as a feasible postoperative adjuvant treatment of PSC GBM.
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Affiliation(s)
- Xing Cheng
- Department of Neurosurgery, Chongqing Cancer Hospital, Chongqing, China; Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Silong Lou
- Department of Neurosurgery, Chongqing Cancer Hospital, Chongqing, China
| | - Siqing Huang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Haifeng Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jiagang Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Elsharkawy AE, Salem S, Abuamona R, Bergmann M. Primary spinal glioblastoma multiforme presenting with leptomeningeal gliomatosis and subarachnoid hemorrhage: A case report. INTERDISCIPLINARY NEUROSURGERY 2016. [DOI: 10.1016/j.inat.2016.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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28
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Yanamadala V, Koffie RM, Shankar GM, Kumar JI, Buchlak QD, Puthenpura V, Frosch MP, Gudewicz TM, Borges LF, Shin JH. Spinal cord glioblastoma: 25years of experience from a single institution. J Clin Neurosci 2016; 27:138-41. [DOI: 10.1016/j.jocn.2015.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 11/21/2015] [Indexed: 10/22/2022]
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29
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Predictive Factors Determining the Overall Outcome of Primary Spinal Glioblastoma Multiforme: An Integrative Survival Analysis. World Neurosurg 2016; 86:341-8.e1-3. [DOI: 10.1016/j.wneu.2015.08.078] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 08/21/2015] [Accepted: 08/22/2015] [Indexed: 11/17/2022]
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30
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Primary spinal cord glioblastoma multiforme treated with temozolomide. J Clin Neurosci 2015; 22:1877-82. [DOI: 10.1016/j.jocn.2015.04.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 03/30/2015] [Accepted: 04/05/2015] [Indexed: 11/22/2022]
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31
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Kuo KL, Lieu AS, Tsai FJ, Chen YT, Liang PI. Intramedullary spinal glioblastoma metastasis from anaplastic astrocytoma of cerebellum: A case report and review of the literature. Asian J Neurosurg 2015; 10:268-71. [PMID: 26396627 PMCID: PMC4553752 DOI: 10.4103/1793-5482.161170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cerebellar anaplastic astrocytoma is infrequently encountered even nowadays, and drop metastasis with progression into spinal glioblastoma is not reported in the English literature. We report a case of cerebellar anaplastic astrocytoma receiving operation and subsequent concurrent chemoradiotherapy. One year later, progressive weakness of both lower limbs and unsteady gait occurred. Spine magnetic resonance imaging showed cervical and thoracic spine intramedullary tumor. We then performed laminectomy and tumor biopsy. The histopathological report demonstrated primary spinal cord glioblastoma multiforme with positive glial fibrillary acidic protein, high MIB-1 labeling index and negative staining of isocitrate dehydrogenase-1 mutation. After reviewing the English literature to date, most metastatic spinal glioblastoma resulted from previous intracranial glioblastoma, and there are few studies mentioning spinal glioblastoma originating from intracranial low-grade gliomas. Over time, improvement in local control of the primary tumor has raised patient risk of the possibility of spinal metastasis, and clinical physicians should be aware of this aspect so that quicker diagnosis and management will be accomplished, even in patients with lower grade of intracranial gliomas.
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Affiliation(s)
- Keng-Liang Kuo
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ann-Shung Lieu
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Feng-Ji Tsai
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ting Chen
- Department of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peir-In Liang
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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32
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Current Management and Treatment Modalities for Intramedullary Spinal Cord Tumors. Curr Treat Options Oncol 2015; 16:39. [DOI: 10.1007/s11864-015-0358-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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33
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Liu A, Sankey EW, Bettegowda C, Burger PC, Jallo GI, Groves ML. Poor prognosis despite aggressive treatment in adults with intramedullary spinal cord glioblastoma. J Clin Neurosci 2015; 22:1628-31. [PMID: 26142051 DOI: 10.1016/j.jocn.2015.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/06/2015] [Indexed: 11/16/2022]
Abstract
We report our institution's experience with adult patients who underwent surgery for intramedullary spinal cord glioblastoma. Spine involvement of glioblastoma is rare, representing 7.5% of all intramedullary gliomas and 1-3% of all spinal cord tumors. We performed a retrospective review of five male patients with intramedullary spinal cord glioblastoma who underwent surgical resection from 1990 to 2014. Demographic, operative, and postoperative factors were recorded. The median age at treatment was 31 years (range: 18-61) and all men presented with motor or sensory dysfunction. Two had prior surgical resection of an intramedullary World Health Organization Grade III anaplastic astrocytoma lesion with adjuvant chemoradiation. All tumors were present in the cervical (n=2; 40%) or thoracic (n=3; 60%) spine, spanning a median of three levels (range: 2-4). Gross total resection was achieved in three men (60%), and there were no intraoperative mortalities or complications. Although one had improvement in his neurological status postoperatively, all five men died with a median time to death of 20 months (range: 2-31). Adult intramedullary spinal cord glioblastoma is rare, and despite aggressive treatment, prognosis is poor, with a median survival in our series of only 20 months. New treatment strategies are necessary to improve survival in this patient population.
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Affiliation(s)
- Ann Liu
- Department of Neurosurgery, Johns Hopkins Hospital, Phipps, Room 118, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Eric W Sankey
- Department of Neurosurgery, Johns Hopkins Hospital, Phipps, Room 118, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins Hospital, Phipps, Room 118, 600 North Wolfe Street, Baltimore, MD 21287, USA.
| | - Peter C Burger
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - George I Jallo
- Department of Neurosurgery, Johns Hopkins Hospital, Phipps, Room 118, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Mari L Groves
- Department of Neurosurgery, Johns Hopkins Hospital, Phipps, Room 118, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Linsenmann T, Westermaier T, Vince GH, Monoranu CM, Löhr M, Ernestus RI, Stetter C. Primary Spinal Glioblastoma Multiforme with Secondary Manifestation as a Cerebral "Angioglioma." Literature Review and Case Report. J Neurol Surg Rep 2015; 76:e128-34. [PMID: 26251789 PMCID: PMC4520969 DOI: 10.1055/s-0035-1549227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 02/04/2015] [Indexed: 11/05/2022] Open
Abstract
Primary intramedullary spinal glioblastoma multiforme (sGBM) with a secondary cerebral manifestation is a very rare entity with a poor outcome. Case studies show a mean average of survival of 10 months after diagnosis. These tumors tend to develop at a young age. A combination with an arteriovenous malformation in the same location has never been published before. Vascular malformations in association with cerebral glioblastomas have only been reported in five cases so far. Proangiogenic factors are assumed to be involved in the appearance of both entities. We present a case study and a review of the literature.
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Affiliation(s)
- Thomas Linsenmann
- Department of Neurosurgery, Julius-Maximilians-University, Würzburg, Germany
| | - Thomas Westermaier
- Department of Neurosurgery, Julius-Maximilians-University, Würzburg, Germany
| | | | | | - Mario Löhr
- Department of Neurosurgery, Julius-Maximilians-University, Würzburg, Germany
| | - Ralf-Ingo Ernestus
- Department of Neurosurgery, Julius-Maximilians-University, Würzburg, Germany
| | - Christian Stetter
- Department of Neurosurgery, Julius-Maximilians-University, Würzburg, Germany
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35
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Baruah D, Chandra T, Bajaj M, Sonowal P, Klein A, Maheshwari M, Guleria S. A simplified algorithm for diagnosis of spinal cord lesions. Curr Probl Diagn Radiol 2015; 44:256-66. [PMID: 25801464 DOI: 10.1067/j.cpradiol.2014.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/07/2014] [Accepted: 12/29/2014] [Indexed: 11/22/2022]
Abstract
Neuroimaging is indispensable for evaluation of Myelopathy not only for localization but also for etiologic determination. MRI is the preferred examination for further characterization of the majority of these conditions. These include traumatic, inflammatory, infections, compressive and neoplastic conditions. This article provides an overview of a variety of pathologies that afflict the spinal cord in an easy to understand format. Their respective imaging manifestations on MRI and differential diagnoses are focused in this review. Early diagnosis and treatment of Myelopathy is critical in preventing or arresting neurological morbidity.
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Affiliation(s)
- Dhiraj Baruah
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI.
| | - Tushar Chandra
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Manish Bajaj
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Purabi Sonowal
- Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Andrew Klein
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Mohit Maheshwari
- Department of Radiology, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Saurabh Guleria
- Department of Pediatric Radiology, University of Alabama, Birmingham, AL
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36
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Ljevak J, Poljaković Z, Adamec I, Habek M. Glioblastoma multiforme presenting as Froin's syndrome: a new face of an old foe. Acta Neurol Belg 2014; 114:319-20. [PMID: 24652664 DOI: 10.1007/s13760-014-0289-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 03/07/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Josip Ljevak
- University Department of Neurology, Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
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37
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Warade AG, Misra BK. Dorsally exophytic cervicomedullary glioblastoma. J Clin Neurosci 2014; 21:1823-4. [PMID: 24842321 DOI: 10.1016/j.jocn.2014.01.014] [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] [Received: 12/25/2013] [Accepted: 01/01/2014] [Indexed: 11/16/2022]
Abstract
Spinal glioblastoma multiforme is a rare entity comprising 1.5% of all spinal cord tumors. We report a 57-year-old man presenting with a 1.5 month history of left sided radiculopathy, lower cranial nerve weakness and difficulty in walking. MRI of the brain and spine showed an exophytic intramedullary lesion extending from the cervicomedullary junction to the lower margin of C4. To our knowledge, we report the first patient with dorsally exophytic cervicomedullary and cervical intramedullary glioblastoma multiforme.
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Affiliation(s)
- Abhijit G Warade
- Department of Neurosurgery & Gamma Knife Radiosurgery, P.D. Hinduja Hospital & Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai 400016, Maharashtra, India
| | - Basant K Misra
- Department of Neurosurgery & Gamma Knife Radiosurgery, P.D. Hinduja Hospital & Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai 400016, Maharashtra, India.
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