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Puac-Polanco P, Guarnizo A, Cruz JP, Rodriguez FR, Torres CH. Intradural Extramedullary Tumors and Associated Syndromes. Neuroimaging Clin N Am 2023; 33:407-422. [PMID: 37356859 DOI: 10.1016/j.nic.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Most intradural tumors are located within the intradural extramedullary compartment, and the most common tumors are schwannomas and meningiomas. Other less common neoplasms include neurofibroma, solitary fibrous tumor, myxopapillary ependymoma, lymphoma, metastatic leptomeningeal disease, malignant peripheral nerve sheath tumor, and paraganglioma. Patients usually present with gait ataxia, radicular pain, and motor and sensory deficits due to chronic compressive myelopathy or radiculopathy. MRI is the modality of choice for detecting and evaluating intradural extramedullary spinal tumors. This imaging technique helps narrow the differential diagnosis and therefore decide treatment.
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Affiliation(s)
- Paulo Puac-Polanco
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Box 232, General Campus Room 1466e, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Angela Guarnizo
- Radiology- Department of Diagnostic Imaging, Hospital Universitario Fundación Santa Fe de Bogota, Carrera 7 # 117-15, 220246 Bogotá-Colombia
| | - Juan Pablo Cruz
- Instituto de Neurocirugía Dr. Asenjo, Servicio de Neurorradiología Diagnóstica y Terapéutica, José Manuel Infante 553, Santiago, Providencia, Región Metropolitana, Chile
| | - Francisco Rivas Rodriguez
- Radiology, Division of Neuroradiology, University of Michigan, Michigan Medicine, C.S. Mott Children's Hospital, 1540 E Hospital Drive Rm 3-227, Ann Arbor, MI 48109-4252, USA
| | - Carlos H Torres
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Box 232, General Campus Room 1466e, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
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Noureldine MHA, Shimony N, Jallo GI. Malignant Spinal Tumors. Adv Exp Med Biol 2023; 1405:565-581. [PMID: 37452954 DOI: 10.1007/978-3-031-23705-8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Malignant spinal tumors constitute around 22% of all primary spinal tumors. The most common location of metastases to the spinal region is the extradural compartment. The molecular and genetic characterization of these tumors was the basis for the updated WHO classification of CNS tumors in 2016, where many CNS tumors are now diagnosed according to their genetic profile rather than relying solely on the histopathological appearance. Magnetic resonance imaging (MRI) is the current gold standard for the initial evaluation and subsequent follow-up on intradural spinal cord tumors, and the imaging sequences must include T2-weighted images (WI), short time inversion recovery (STIR), and pre- and post-contrast T1-WI in the axial, sagittal, and coronal planes. The clinical presentation is highly variable and depends on the tumor size, growth rate, type, infiltrative, necrotic and hemorrhagic potential as well as the exact location within the spinal compartment. Surgical intervention remains the mainstay of management of symptomatic and radiographically enlarging spinal tumors, where the goal is to achieve maximal safe resection. Tumor recurrences are managed with repeat surgical resection (preferred whenever possible and safe), radiotherapy, chemotherapy, or any combination of these therapies.
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Affiliation(s)
- Mohammad Hassan A Noureldine
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Johns Hopkins University School of Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Nir Shimony
- Johns Hopkins University School of Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Geisinger Medical Center, Institute of Neuroscience, Geisinger Commonwealth School of Medicine, Danville, PA, USA
| | - George I Jallo
- Institute for Brain Protections Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA.
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Kangabam B, Amataleima T, Amitkumar M, Umesh T. Intradural extramedullary tuberculoma of the thoracic spine - A rare case report of paraparesis. Surg Neurol Int 2021; 12:136. [PMID: 33948307 PMCID: PMC8088537 DOI: 10.25259/sni_197_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Intradural extramedullary tuberculoma of the spinal cord (IETSC) is an extremely rare form of spinal tuberculosis (TB) that is believed to be due to a host’s immune reaction against the Mycobacterium protein derivatives. Case Description: A 25-year-old male with human immunodeficiency virus, hepatitis C virus, and disseminated TB on antitubercular therapy for the past 8 months, presented with paraplegia of 2 months duration. When the MRI spine revealed multiple peripheral rim enhancing intradural extramedullary lesions from T6 to T8 and dorsally from T10 to T11, the patient was diagnosed with IETSC. At surgery, we countered cystic lesions adherent to the dura and the spinal cord, containing a whitish material. Postoperatively, the patient showed clinical improvement in motor power and sensation. Conclusion: Intradural extramedullary spinal tuberculomas in patients with a history of TB and spinal cord compression, although rare, should be considered among the differential diagnoses.
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Affiliation(s)
- Boris Kangabam
- Department of Surgery, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India
| | - Thokchom Amataleima
- Department of Surgery, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India
| | - Mayanglambam Amitkumar
- Department of Neurosurgery, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India
| | - Takhelmayum Umesh
- Department of Orthopaedics, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India
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Abstract
BACKGROUND Despite technological advances in medical treatment, the prognosis of the rarely reported spinal subdural abscesses (SSAs) has remained a serious entity largely unaffected, especially when they are diagnosed late. In this study, the authors aimed to present the surgical outcomes of 3 consecutive pediatric patients with SSA. MATERIALS AND METHODS We retrospectively reviewed the medical records of pediatric patients with spinal lesions who underwent surgery at 2 neurosurgical centers spanning 7 years, from 2012 to 2019. All pediatric patients who were diagnosed with SSA (n = 3) were selected as the core sample for this study. RESULTS Three pediatric patients (2 females and 1 male) with SSA were surgically treated. Holocord SSA was observed in 1 patient. The mean age was 7.1 ± 7.7 years. The most common presenting symptoms were gait disturbance and weakness of lower extremities (100%). The mean preoperative course was 5.7 ± 4.0 weeks. The causative pathogens were Escherichia coli (E. coli) and M. tuberculosis. In the 2nd case, the pathogen was non-tuberculosis mycobacterium in the extramedullary abscess. In the 44th postoperative month, she underwent surgery for intramedullary abscess. The causative pathogen was E. coli. Except for 1 male adolescent who presented with severe clinical status (paraplegic), the improvement was observed in all patients at their last follow-up after 50.3 ± 43.5 months of average. CONCLUSIONS Drainage followed by appropriate antibiotics is the optimal treatment for SSAs. Early diagnosis and urgent surgical treatment are essential for a good prognosis. All surgically treated SSA patients with neurological deficits were rehabilitated with physical therapy postoperatively.
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Affiliation(s)
- Anas Abdallah
- Department of Neurosurgery, Special Bahçelievler Aile Hospital, Istanbul, Turkey,
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Rotter J, Mueller K, MacConnell A, McGowan J, Spitz S. Isolated cervical extraosseous intradural chordoma attached to the C5 nerve root: a case report. Chin Neurosurg J 2020; 5:22. [PMID: 32922921 PMCID: PMC7398216 DOI: 10.1186/s41016-019-0170-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/13/2019] [Indexed: 11/23/2022] Open
Abstract
Background As chordomas are slow growing and locally invasive with high recurrence rates, initial recommendations include complete surgical resection with or without radiation therapy. A large proportion of recurrences occur years after initial resection necessitating lengthy follow-up. The novel biomarker brachyury and the repurposing of pharmaceutical products have the potential to substantially impact long-term recurrence rates. Case presentation A 43-year-old woman presented with an isolated, cervical extraosseous intradural extramedullary chordoma attached to a nerve root underwent a C3-5 laminectomy, C3-5 lateral mass screw instrumentation, and mass resection. All symptoms resolved by the 12-month postoperative follow-up visit. Conclusions This is the first report of an isolated, cervical extraosseous intradural extramedullary chordoma attached to a nerve root, and this case adds to the previous six Type IV chordomas in the literature. Unfortunately, the very rare form of extraosseous intradural chordoma is poorly understood: the lack of detailed knowledge in how they are differentiated from other forms of chordoma confounds the development of optimal treatment strategies and follow-up guidelines.
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Affiliation(s)
- Juliana Rotter
- Georgetown University School of Medicine, 3700 Reservoir Rd, Washington, DC 20007 USA
| | - Kyle Mueller
- Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd, Washington, DC 20007 USA
| | - Ashley MacConnell
- Georgetown University School of Medicine, 3700 Reservoir Rd, Washington, DC 20007 USA
| | - Jason McGowan
- Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St. Ste B400, Pittsburg, PA 15213 USA
| | - Steven Spitz
- Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd, Washington, DC 20007 USA
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Kaur H, Mittal GK, Singhdev J. Intradural extramedullary tuberculoma of the spinal cord in patient of tubercular meningitis - an uncommon scenario. Indian J Tuberc 2020; 67:426-429. [PMID: 32825887 DOI: 10.1016/j.ijtb.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
Intradural extramedullary tuberculoma of the spinal cord (IETSC) is a rare and unanticipated manifestation of CNS tuberculosis. A 28 years old female diagnosed case of tubercular meningitis (TBM), already on antitubercular therapy (ATT) for last nine months, developed sensory and motor weakness in lower limbs along with saddle anaesthesia. Magnetic resonance imaging (MRI) with contrast of the spine revealed the presence of multiple space occupying lesions in dorsal spinal cord. She received oral steroid therapy for six weeks with escalation of ATT after which neurological functions improved remarkably.
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Affiliation(s)
- Harleen Kaur
- Department of Neurology, St Stephen's Hospital, Delhi, 110054, India
| | | | - Jennifer Singhdev
- Department of Neurology, St Stephen's Hospital, Delhi, 110054, India
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Akgun MY, Isler C, Ulu MO. C6-T1 Intradural Extramedullary Ventral Meningeal Melanocytoma Resected Via Anterior Corpectomy with Reconstruction. World Neurosurg 2020; 138:457-460. [PMID: 32251820 DOI: 10.1016/j.wneu.2020.03.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Melanocytic lesions of the nervous system are thought to arise from leptomeningeal melanocytes, which are derived from neural crest and include diffuse melanocytosis, melanocytomas, and malignant melanomas. Meningeal melanocytomas are extremely rare benign lesions. The usual treatment of intradural extramedullary melanocytomas involves surgical removal through a posterior approach using a laminectomy or laminotomy. CASE DESCRIPTION We present a 30-year-old female harboring a C6-T1 ventrally located intradural extramedullary lesion compressing the cord anteriorly. The lesion was totally resected via an anterior approach with oblique corpectomy even if the usual treatment involves surgical removal through a posterior approach using a laminectomy or laminotomy. CONCLUSIONS There is no evidence of recurrence at 4-year follow-up records of the patient. We discuss the surgical approach of these rare lesions.
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Affiliation(s)
- Mehmet Yigit Akgun
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, Turkey.
| | - Cihan Isler
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, Turkey
| | - Mustafa Onur Ulu
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, Turkey
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Cho KT, Yang JJ, Lee K. Intradural Extramedullary Metastatic Conjunctival Malignant Melanoma. World Neurosurg 2020; 138:444-448. [PMID: 32217182 DOI: 10.1016/j.wneu.2020.03.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Intradural extramedullary (IDEM) metastatic spine tumors of nonneurogenic origin, excluding leptomeningeal seeding, are very rare. Most patients with IDEM metastatic spine tumors of nonneurogenic origin have coexisting brain metastasis. We report a case of IDEM metastatic malignant melanoma without antecedent or coexisting brain metastasis. CASE DESCRIPTION A 52-year-old man presented with back pain, numbness in the lower extremities, paraparesis, and residual urine sensation after voiding. The patient had a history of conjunctival melanoma in the left eye and underwent surgical removal 3 years 6 months ago. Whole-spine magnetic resonance imaging showed an IDEM tumor at the T11 and T12 level, with compression of the spinal cord. Total laminectomy and resection of the tumor was performed. Pathology confirmed a malignant melanoma. Postoperatively, adjuvant chemotherapy was performed. Pain and neurologic deficit gradually improved, but complete recovery was not achieved. CONCLUSIONS Although rare, even without brain metastasis, malignant melanoma can cause IDEM metastatic malignant melanoma. For neurologic recovery and maintaining quality of life of the patient, surgical treatment for decompression of the spinal cord and postoperative adjuvant treatment for IDEM metastatic malignant melanoma should be considered unless multiple lesions are present in different parts within the spinal column.
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Affiliation(s)
- Keun-Tae Cho
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Goyang, South Korea.
| | - Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Kyuho Lee
- Department of Pathology, Dongguk University Ilsan Hospital, Goyang, South Korea
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Kumar R, Debbarma I, Boruah T, Sareen A, Patralekh MK, Dagar A, Kareem SA. Flipped Reposition Laminoplasty for Excision of Intradural Extramedullary Tumors in the Thoracolumbar Spine: A Case Series of 14 Patients. Asian Spine J 2020; 14:327-335. [PMID: 31906618 PMCID: PMC7280918 DOI: 10.31616/asj.2019.0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 08/06/2019] [Indexed: 12/15/2022] Open
Abstract
STUDY DESIGN A retrospective study was done to assess the outcome of the new technique of flipped reposition laminoplasty for excision of intradural extramedullary (IDEM) spinal tumors of the thoracolumbar region. PURPOSE To describe flipped reposition laminoplasty technique and evaluate its outcomes. OVERVIEW OF LITERATURE Laminectomy has been the conventional approach for the surgical excision of IDEM spinal tumors, but it has potential postoperative complications. Laminoplasty maintains the posterior arch of the spine and avoids complications seen in Laminectomy, such as instability, epidural scarring, and kyphotic deformity. METHODS Fourteen patients (nine females and five males) diagnosed with IDEM tumors of the thoracolumbar region operated between 2016 and 2018 were included in this study. Pathologically, five cases were schwannomas; four cases were meningiomas; two cases were ependymomas; and one case each was lymphoma, neurofibroma, and teratoma. All patients had their neurological deficits documented using the American Spinal Injury Association (ASIA) impairment scale. After completion of all preanesthetic formalities, the patients were operated upon by a single surgeon using the flipped reposition laminoplasty technique. Follow-up was done at 1, 3, 6, and 12 months post operation and yearly thereafter. RESULTS The mean age of the patients was 35.28 years (14-65 years), and the mean follow-up duration was 17 months (6-26 months). Two patients were assessed with ASIA grade A neurology, one patient improved to ASIA grade B, whereas the other did not improve. Two patients improved from ASIA grade B to ASIA grade D, and seven patients with ASIA grades C and D improved to ASIA grade E. Fusion at the osteotomy site was seen in 92.85% (13 out of 14) cases on one side within 6 months post operation. Fusion was seen in all the cases within 1 year post operation. CONCLUSIONS Flipped reposition laminoplasty is an excellent technique providing adequate exposure and additional stability postoperatively.
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Affiliation(s)
- Ramesh Kumar
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ijack Debbarma
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Tankeshwar Boruah
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Atul Sareen
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Mohit Kumar Patralekh
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ashish Dagar
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Shaffaf Abdul Kareem
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Khalighinejad F, Hajizadeh M, Mokhtari A, Rakhshan R, Hajizadeh M, Rezvani M. Spinal Intradural Extramedullary Dermoid Cyst. World Neurosurg 2019; 134:448-451. [PMID: 31759148 DOI: 10.1016/j.wneu.2019.11.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Dermoid cysts are benign congenital tumors that develop early in life. These tumors are classified by the presence of all 3 germ layers. Spinal intradural extramedullary teratoma is a rare disease, which is more common in children under 5 years of age than in adults. CASE DESCRIPTION A 12-year-old girl with a dermoid cyst at the lower lumbar level presented with 2-month low back pain and intermittent lower extremity radicular symptoms on the right side. Magnetic resonance imaging scan of the spine revealed an intradural extramedullary mass lesion at L4-5. Surgical excision of the cyst was successfully performed. Surgical and histopathologic findings confirmed extramedullary ruptured matured teratoma. Postoperatively, the patient had remarkable clinical improvement. CONCLUSIONS Although dermoid cysts are uncommon, they should be considered in the differential diagnosis of spinal lesions in patients with lower back pain. It can be successfully treated with surgical excision.
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Affiliation(s)
| | - Mahsa Hajizadeh
- Isfahan Research Committee of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Ali Mokhtari
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Rakhshan
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Hajizadeh
- Department of Radiology, Abadan University of medical sciences, Abadan, Iran
| | - Majid Rezvani
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran
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Jung GS, Lee YM, Kim YZ, Kim JS. Intratumoral Hemorrhage of the Cervical Spinal Schwannoma Presenting: Acute Quadriparesis. Brain Tumor Res Treat 2019; 7:160-163. [PMID: 31686450 PMCID: PMC6829079 DOI: 10.14791/btrt.2019.7.e34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/03/2019] [Accepted: 07/23/2019] [Indexed: 12/27/2022] Open
Abstract
Schwannomas are the most common extramedullary spinal tumors, with chronic progressive symptoms being the most common presenting features. The acute hemorrhagic onset of a spinal schwannoma is a rare occurrence. Here, we report the case of a 37-year-old male who presented with complaint of neck pain and an acute onset of quadriparesis. MRI of his cervical spine revealed an intradural extramedullary lesion in the C2 to C3 cervical segment, with features of acute hemorrhage but mild enhancement. He was operated in emergency and complete microsurgical resection of tumor was achieved. Histopathology revealed features of an ancient schwannoma with hemorrhage. Postoperatively, the patient showed significant improvement.
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Affiliation(s)
- Gyu Seo Jung
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Young Min Lee
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
| | - Young Zoon Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Joon Soo Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Kumar S, Maheshwari V, Mukherjee A, Raman DK. Primary Neuroendocrine Tumor of the Lumbar Spine: Rare Tumor Mimicking Nerve Sheath Tumor of the Spine. Asian J Neurosurg 2019; 14:894-896. [PMID: 31497122 PMCID: PMC6702991 DOI: 10.4103/ajns.ajns_276_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Neuroendocrine tumors (Carcinoid tumors) generally arise from enterochromaffin cells of gut and bronchi. Primary carcinoid tumors of spine are extremely rare and have been described in sacrum and coccyx. Primary carcinoid tumors involving the spinal cord are still rarer, and review of literature revealed only two cases reported. Our patient a 39-year-old male had diagnosed as a case of nerve sheath tumor (intradural extramedullary) at LV4 region on neuroimaging. However, postoperatively, the tumor turned out to be a rare primary spinal carcinoid tumor on histopathological examination and immunohistochemical staining. Work up to rule out any other site in the body was negative. To the best of our knowledge, this is the first case of primary carcinoid tumor of the lumbar spine.
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Affiliation(s)
- Sanjay Kumar
- Department of Neurosurgery, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Vikas Maheshwari
- Department of Neurosurgery, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Aishik Mukherjee
- Department of Neurosurgery, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Deep Kumar Raman
- Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
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Chotai S, Zuckerman SL, Parker SL, Wick JB, Stonko DP, Hale AT, McGirt MJ, Cheng JS, Devin CJ. Healthcare Resource Utilization and Patient-Reported Outcomes Following Elective Surgery for Intradural Extramedullary Spinal Tumors. Neurosurgery 2018; 81:613-619. [PMID: 28498938 DOI: 10.1093/neuros/nyw126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 04/28/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Healthcare resource utilization and patient-reported outcomes (PROs) for intradural extramedullary (IDEM) spine tumors are not well reported. OBJECTIVE To analyze the PROs, costs, and resource utilization 1 year following surgical resection of IDEM tumors. METHODS Patients undergoing elective spine surgery for IDEM tumors and enrolled in a single-center, prospective, longitudinal registry were analyzed. Baseline and postoperative 1-year PROs were recorded. One-year spine-related direct and indirect healthcare resource utilization was assessed. One-year resource use was multiplied by unit costs based on Medicare national payment amounts (direct cost). Patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). RESULTS A total of 38 IDEM tumor patients were included in this analysis. There was significant improvement in quality of life (EuroQol-5D), disability (Oswestry and Neck Disability Indices), pain (Numeric rating scale pain scores for back/neck pain and leg/arm pain), and general physical and mental health (Short-form-12 health survey, physical and mental component scores) in both groups 1 year after surgery (P < .0001). Eighty-seven percent (n = 33) of patients were satisfied with surgery. The 1-year postdischarge resource utilization including healthcare visits, medication, and diagnostic cost was $4111 ± $3596. The mean total direct cost was $23 717 ± $7412 and indirect cost was $5544 ± $4336, resulting in total 1-year cost $29 177 ± $9314. CONCLUSION Surgical resection of the IDEM provides improvement in patient-reported quality of life, disability, pain, general health, and satisfaction at 1 year following surgery. Furthermore, we report the granular costs of surgical resection and healthcare resource utilization in this population.
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Affiliation(s)
- Silky Chotai
- Department of Orthopedics Surgery and Department of Neurological surgery, Spinal Column Surgical Quality and Out-comes Research Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott L Zuckerman
- Department of Orthopedics Surgery and Department of Neurological surgery, Spinal Column Surgical Quality and Out-comes Research Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott L Parker
- Department of Orthopedics Surgery and Department of Neurological surgery, Spinal Column Surgical Quality and Out-comes Research Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph B Wick
- Department of Orthopedics Surgery and Department of Neurological surgery, Spinal Column Surgical Quality and Out-comes Research Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David P Stonko
- Department of Orthopedics Surgery and Department of Neurological surgery, Spinal Column Surgical Quality and Out-comes Research Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew T Hale
- Department of Orthopedics Surgery and Department of Neurological surgery, Spinal Column Surgical Quality and Out-comes Research Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew J McGirt
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Joseph S Cheng
- Department of Orthopedics Surgery and Department of Neurological surgery, Spinal Column Surgical Quality and Out-comes Research Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Clinton J Devin
- Department of Orthopedics Surgery and Department of Neurological surgery, Spinal Column Surgical Quality and Out-comes Research Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
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Lee JH, Jeon I, Kim SW. Intradural Extramedullary Capillary Hemangioma In the Upper Thoracic Spine with Simultaneous Extensive Arachnoiditis. Korean J Spine 2017; 14:57-60. [PMID: 28704911 PMCID: PMC5518430 DOI: 10.14245/kjs.2017.14.2.57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/25/2017] [Accepted: 04/24/2017] [Indexed: 11/30/2022]
Abstract
Capillary hemangiomas are common benign vascular tumors on skin and soft tissues, but developing as an intradural and extramedullary (IDEM) tumor in spine is extremely rare. In this report, we present IDEM tumor compressing thoracic cord in T2–3 level with extensive arachnoiditis below the tumor level in a 60-year-old man. The lesion was removed and histological diagnosis was capillary hemangioma. Prompt diagnosis and resection are important to avoid neurological deterioration from acute hemorrhagic condition. Simultaneous arachnoiditis may be originated from old subarachnoid hemorrhage associated tumor before diagnosis, and we suggest it as a helpful diagnostic feature to suspect vascular tumors such as capillary hemangioma.
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Affiliation(s)
- Jae Ho Lee
- Department of Neurosurgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Ikchan Jeon
- Department of Neurosurgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Sang Woo Kim
- Department of Neurosurgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
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Lozupone E, Martucci M, Rigante L, Gaudino S, Di Lella GM, Colosimo C. Magnetic resonance image findings of primary intradural Ewing sarcoma of the cauda equina: case report and review of the literature. Spine J 2014; 14:e7-e11. [PMID: 24314762 DOI: 10.1016/j.spinee.2013.09.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/11/2013] [Accepted: 09/19/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Involvement of the cauda equina in Ewing sarcoma (ES) is extremely rare, and only few cases are reported in literature. However, ES of cauda equina shares some neuroradiological features with other neoplasms that can involve the intradural space. Therefore, differential diagnosis with other tumors of cauda equina should be considered by neuroradiologists and neurosurgeons to provide appropriate treatment. PURPOSE To present a rare case of intradural extramedullary primary ES. STUDY DESIGN Case report. METHODS We report a case of a 44-year-old woman presenting with the rapid onset of cauda equina syndrome. Radiological analysis showed multiple intradural masses, extending from L1 to S3 level. After radical surgery, lesions were histologically defined as ES. We present a literature review, analyzing magnetic resonance image (MRI) features of primary intradural ES of the cauda equina. RESULTS Four cases of primitive ES arising from the cauda equina have been reported in the literature. CONCLUSIONS Because of the low number of reported cases, it is not possible to describe pathognomonic MRI findings for intradural ES of the cauda equina. However, few tumors show similar MRI features. Therefore, despite its rarity, intradural ES should be taken into account in the differential diagnosis of spinal tumors involving cauda equina.
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Affiliation(s)
- Emilio Lozupone
- Department of Bioimaging and Radiological Sciences, Catholic University School of Medicine, L.go A. Gemelli 8, 000168 Rome, Italy.
| | - Matia Martucci
- Department of Bioimaging and Radiological Sciences, Catholic University School of Medicine, L.go A. Gemelli 8, 000168 Rome, Italy
| | - Luigi Rigante
- Institute of Neurosurgery, Catholic University School of Medicine, L.go A. Gemelli 8, 000168 Rome, Italy
| | - Simona Gaudino
- Department of Bioimaging and Radiological Sciences, Catholic University School of Medicine, L.go A. Gemelli 8, 000168 Rome, Italy
| | - Giuseppe Maria Di Lella
- Department of Bioimaging and Radiological Sciences, Catholic University School of Medicine, L.go A. Gemelli 8, 000168 Rome, Italy
| | - Cesare Colosimo
- Department of Bioimaging and Radiological Sciences, Catholic University School of Medicine, L.go A. Gemelli 8, 000168 Rome, Italy
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Kim BS, Kim SW, Kwak KW, Choi JH. Extra and intramedullary anaplastic ependymoma in thoracic spinal cord. Korean J Spine 2013; 10:177-80. [PMID: 24757483 PMCID: PMC3941770 DOI: 10.14245/kjs.2013.10.3.177] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/20/2013] [Accepted: 07/22/2013] [Indexed: 11/19/2022]
Abstract
Spinal ependymoma occupies 40-60% of primary spinal cord tumors and has a feature of intramedullary tumor. The tumor most commonly arises from the central canal of the spinal cord, the conus medullaris or the filum terminale and its pathological features are usually benign. Unlike above characteristics, intra and extramedullary ependymomas are reported very rarely and have wide variety of histological features. We present a rare case of spinal anaplastic ependymoma with an accompanied exophytic lesions extramedullary as well. The tumor was poorly delineated between a spinal cord and the extramedullary components in operative view. After we had confirmed the frozen biopsy as anaplastic ependymoma, the remnant mass embedded in the spinal cord was remained because of its unclear resection margin and the risk of neurological deterioration. She underwent radiotherapy with 50.4 Gy, and there were newly developed mass lesions at the lumbosacral region on the MRI, 14 months postoperatively.
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Affiliation(s)
- Byung Soo Kim
- Department of Neurosurgery, Yeungnam University, College of Medicine, Daegu, Korea
| | - Sang Woo Kim
- Department of Neurosurgery, Yeungnam University, College of Medicine, Daegu, Korea
| | - Kyung-Woo Kwak
- Department of Neurosurgery, Yeungnam University, College of Medicine, Daegu, Korea
| | - Jun Huck Choi
- Department of Pathology, Yeungnam University, College of Medicine, Daegu, Korea
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Lee CH, Kim KJ, Hyun SJ, Jahng TA, Kim HJ. Intradural extramedullary metastasis of small cell lung cancer: a case report. Korean J Spine 2012; 9:293-6. [PMID: 25983836 PMCID: PMC4431023 DOI: 10.14245/kjs.2012.9.3.293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 09/04/2012] [Accepted: 09/26/2012] [Indexed: 11/19/2022]
Abstract
A 60-year-old man presented with para-anesthesia and a tingling sensation in the saddle area. Intradural extramedullary (IDEM) tumors in conus medullaris were observed by radiologic studies. The patient underwent laminoplastic laminotomy at the T12-L2 level and subtotal removal of the tumor because of the ill-defined margin. Postoperatively, hypesthesia was improved up to 50%. The IDEM tumor revealed a metastatic cancer originated from small cell lung cancer (SCLC) by histologic examination, and additional studies showed multiple metastases including adrenal gland, brain, and bone. Clinicians need to consider IDEM metastasis when SCLC patients were complained of neurologic symptoms mimic paraneoplastic syndrome. The pathophysioloigy of IDEM metastasis may be not only tertiary drop metastasis, but also faster mechanisms such as direct invasion.
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Affiliation(s)
- Chang-Hyun Lee
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Tae-Ahn Jahng
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun-Jib Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Sohn S, Jin YJ, Kim KJ, Kim HJ. Long-term Sequela of Intradural Extramedullary Tuberculoma in the Thoracic Dorsal Spinal Cord: Case Report and Review of the Literature. Korean J Spine 2011; 8:295-9. [PMID: 26064149 PMCID: PMC4461743 DOI: 10.14245/kjs.2011.8.4.295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 12/18/2011] [Accepted: 01/06/2012] [Indexed: 11/19/2022]
Abstract
A 45-year old man, who had tuberculosis five years ago presented with paresthesia, decreased proprioception, and gait disturbance in the lower extremity which were aggravated for a month. Magnetic resonance imaging revealed the T3-7 intradural extramedullary fibrotic mass with dark signal intensity on T2-weighted images. The yellowish material in the thick fibrous mass was confirmed as caseous necrosis. Two days after the operation, the symptoms improved. Although quite rare, intradural extramedullary tuberculoma should be considered as a chronic sequel of the previous medical history of pulmonary tuberculosis or tuberculous meningitis.
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Affiliation(s)
- Seil Sohn
- Department of Neurosurgery, Seoul National University College of Medicine, Bundang Hospital, Seongnam-si, Korea
| | - Yong Jun Jin
- Department of Neurosurgery, Seoul Paik Hospital, Inje University, Seoul, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Bundang Hospital, Seongnam-si, Korea
| | - Hyun-Jib Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Bundang Hospital, Seongnam-si, Korea
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Son DW, Song GS, Han IH, Choi BK. Primary extramedullary ependymoma of the cervical spine : case report and review of the literature. J Korean Neurosurg Soc 2011; 50:57-9. [PMID: 21892408 DOI: 10.3340/jkns.2011.50.1.57] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 12/14/2010] [Accepted: 07/11/2011] [Indexed: 11/27/2022] Open
Abstract
Intradural extramedullary (IDEM) ependymomas occur very rarely and little has been reported about their clinical characteristics. The authors present a case of a 57-year-old woman with an IDEM ependymoma. She was referred for the evaluation of a 4-month history of increasing neck pain and muscular weakness of the left extremities. Magnetic resonance imaging (MRI) of the cervical spine demonstrated an IDEM tumor with spinal cord compression. At the time of surgery, an encapsulated IDEM tumor without a dural attachment or medullary infiltration was noted, but the tumor capsule adherent to the spinal cord and root was left in place to minimize the risk of neurological sequelae. Histologic examination revealed a benign classic ependymoma. The post-operative course was uneventful and radiotherapy was performed. The patient showed an excellent clinical recovery, with no recurrence after 5 years of follow-up.
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Affiliation(s)
- Dong Wuk Son
- Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
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Kim SB, Kim HS, Jang JS, Lee SH. Mobility of intradural extramedullary schwannoma at spine : report of three cases with literature review. J Korean Neurosurg Soc 2010; 47:64-7. [PMID: 20157382 DOI: 10.3340/jkns.2010.47.1.64] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 04/06/2009] [Accepted: 11/30/2009] [Indexed: 11/27/2022] Open
Abstract
Although very rare, a few cases of intradural extramedullary (IDEM) spinal tumor migration have been reported since Tomimatsu first reported a mobile schwannoma of the cervical cord in 1974. Schwannoma is a neurogenic tumor which originates from nerve sheath that it is relatively well-marginated tumor with little attachment or adhesion to surrounding tissue. Mobility of tumor in spinal canal sometimes can result in negative exploration at the expected area. We found three interesting cases in which different tumor locations observed in repeated magnetic resonance image (MRI) findings. All tumors were intradural and extramedullary schwannoma. We reviewed the literature about moving tumor in the spine through PUBMED search.
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Affiliation(s)
- Soo-Beom Kim
- Department of Orthopedic Surgery, Seoul Wooridul Hospital, Seoul, Korea
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