Intradural extramedullary spinal choristoma: A case report

RATIONALE

A choristoma is a rare and benign neoplasm characterized by the presence of normal tissue in an anomalous anatomical location. In contrast, choristoma tend to occur in other body regions rather than within the spinal canal. Before our findings, only 4 cases of intraspinal choristoma had been recorded. Because its composition is complex and very rare, routine examinations, such as magnetic resonance imaging, are difficult to diagnose, and the possibility of its occurrence is often missed in clinical diagnosis. If there is no specificity in its components, such as in this case, even pathological examinations can only confirm the diagnosis as choristoma after eliminating other possibilities. Therefore, in clinical practice, when encountering patients with intraspinal tumors, it is essential to consider the possibility of choristoma. In this case, the choristoma lack of specific constituent composition sets it apart from previously reported intraspinal choristoma, significantly raising the diagnostic challenge, which offers valuable insights for clinical diagnosis.

PATIENT CONCERNS

A female patient aged 48 years was admitted to our medical center due to experiencing persistent lower back pain accompanied by radiating pain in both legs for 5 months. Based on the findings from the neurological physical examination and magnetic resonance imaging, the patient was diagnosed with an intradural space-occupying lesion located at the level of the first lumbar vertebral body. We performed an enhanced magnetic resonance neurography examination to further determine the positional relationship between the occupation and nerves in preparation for surgery. Postoperative pathological biopsy showed that the mass was an intraspinal choristoma.

DIAGNOSIS

Intradural extramedullary spinal choristoma.

INTERVENTION

Occupied lesion is removed surgically.

OUTCOMES

After surgery, all symptoms were significantly relieved, and when the patient was discharged, all symptoms disappeared completely. There was no sign of recurrence after 1 year of follow-up.

LESSONS

Intraspinal choristomas are not specific and need to be diagnosed by pathologic examination. Early detection of and intervention for intraspinal tumors can mitigate nerve dysfunction.

Transient spinal cord dysfunction after surgery for intraspinal tumors: A case report

RATIONALE

Limb dysfunction is not uncommon clinically after intramural tumor surgery. However, there are no relevant literature reports on the recovery of unilateral motor function caused by spinal cord dysfunction after short-term observation and treatment. The report of such cases is of great value for improving the cognition of postoperative complications of meningioma reducing misdiagnosis and providing reference for clinical treatment.

PATIENT CONCERNS

A 73-year-old female patient with numbness and weakness in both lower limbs accompanied by unstable walking for 2 months. Combined with imaging data and postoperative pathological diagnosis, it was diagnosed as thoracic spinal meningioma. The patient experienced transient unilateral limb dysfunction after surgery.

DIAGNOSES

Magnetic resonance imaging and its enhanced magnetic resonance imaging suggest a space occupying lesion on the left side of the spinal canal at the level of the thoracic 3 to 4 vertebral body, possibly a meningioma. The postoperative pathology was grade I meningioma.

INTERVENTION

Administer 10 mL of dexamethasone, 1 g of methylprednisolone, and 250 mL of mannitol for treatment.

OUTCOMES

After 3 hours, the patient's muscle strength gradually recovered, and after 12 hours, it was better than the preoperative level.

CONCLUSION

Spinal cord dysfunction may occur after surgery for intraspinal meningioma in the upper thoracic spine. Unlike spinal cord dysfunction caused by spinal cord injury, this dysfunction is short-term and transient. The use of hormones and diuretics is a feasible solution that can quickly restore patient limb function.

[Treatment of intraspinal benign tumors in upper cervical vertebrae by modified recapping laminoplasty]

Objective

To evaluate the effectiveness of modified recapping laminoplasty preserving the continuity of supraspinous ligament in the treatment of intraspinal benign tumors in upper cervical vertebrae and its influence on the stability of the cervical vertebrae.

Methods

The clinical data of 13 patients with intraspinal benign tumors in upper cervical vertebrae treated between January 2012 and January 2021 were retrospectively analyzed. There were 5 males and 8 females, the age ranged from 21 to 78 years, with an average of 47.3 years. The disease duration ranged from 6 to 53 months, with an average of 32.5 months. The tumors located between C ₁ and C ₂. Postoperative pathology showed 6 cases of schwannoma, 3 cases of meningioma, 1 case of gangliocytoma, 2 cases of neurofibroma, and 1 case of hemangioblastoma. During operation the continuity of the supraspinal ligament were retained, the lamina ligament complex was lifted to expose the spinal canal via the approach of the outer edge of the bilateral lamina, and the lamina was fixed after the resection of the intraspinal tumors. Before and after operation, the atlantodental interval (ADI) was measured on three-dimensional CT; the effectiveness was evaluated by Japanese Orthopaedic Association (JOA) score, the neck dysfunction index (NDI) was used to evaluate the cervical function, and the total rotation of the cervical spine was recorded.

Results

The operation time was 117-226 minutes (mean, 127.3 minutes); the intraoperative blood loss was 190-890 mL (mean, 227.8 mL). The tumors were completely removed in all patients. There was no vertebral artery injury, aggravation of neurological dysfunction, epidural hematoma, infection, or other related complications. Two patients occurred cerebrospinal fluid leakage after operation, which were healed through electrolyte supplement and local pressure treatment of incision. All the patients were followed up 14-37 months, with an average of 16.9 months. Imaging examination showed no recurrence of tumor, displacement of vertebral lamina, loosening and displacement of internal fixator, and secondary reduction of vertebral canal volume. At last follow-up, JOA score significantly improved when compared with preoperative scores ( P<0.05). Among them, 8 cases were excellent, 3 cases were good, and 2 cases were medium, with an excellent and good rate was 84.6%. There was no significant difference in ADI, total rotation of the cervical spine, and NDI between pre- and post-operation ( P>0.05).

Conclusion

The treatment of intraspinal benign tumors in upper cervical vertebrae with modified recapping laminoplasty preserving the continuity of the supraspinous ligament can restore the normal anatomical structure of the spinal canal and maintain the stability of the cervical spine.

Spinal Epidermoid Tumor: A Case Report

Spinal epidermoid tumors are rare tumors with typical symptoms including low back pain, radiculopathy, weakness, sensory disturbances, and bowel/bladder dysfunction. Here we present a rare case of a spinal epidermoid tumor in a 44-year-old female patient with a previous surgical history of epidural anesthesia with two cesarean sections. Our report aims to highlight the rare development of this type of tumor following epidural anesthesia, a routine part of labor management.

[Reversible Paraplegia - Favorable Outcome After Delayed Diagnosis]

Reversible Paraplegia - Favorable Outcome After Delayed Diagnosis Abstract. A 74-year-old woman was referred for progressive gait disturbances. On presentation, she had a complete paraplegia (wheelchair-bound for 19 months) and bladder sphincter dyssynergia with sensory sacral sparing. Magnetic resonance imaging studies revealed a 24 × 13 × 17 mm intradural mass with compression of the spinal cord and myelomalacia between C6 and Th1. We performed unilateral laminectomies of C6-Th1 and microsurgical resection of a meningioma. Under intensive rehabilitation, the patient regained independent walking ability and recovery of bladder function and continence within six months postoperatively.

Spinal chordoid meningioma in a child: A case report and review of the literature

As an uncommon subtype of meningioma, chordoid meningioma (CM) of the spinal canal is extremely rare. There have been only two reported cases of intraspinal CM in the literature, and this lesion has not been previously reported in the pediatric age group. To the best of our knowledge, the present study reports the first case of spinal chordoid meningioma in a pediatric patient. A 12-year-old female presented with a 3-month history of progressive numbness and weakness in the right-side limbs, and intermittent pain in the neck and right shoulder. Spinal magnetic resonance imaging (MRI) revealed an intraspinal lesion at the C2-3 level with irregularly heterogeneous enhancement. The patient underwent a C2-3 laminotomy. Due to adhesion to the dura and proximity to the vertebral artery, the tumor was partially removed intraoperatively. The post-operative course was uneventful and the symptoms were apparently relieved. The patient experienced recurrence 5 years subsequent to surgery. MRI revealed an extradural regrown tumor at the C2-5 level. Partial removal combined with radiotherapy was performed. However, the patient experienced progression of tetraplegia and succumbed to severe pneumonia and respiratory failure 5 months subsequent to the second surgery. In the present study, the clinicoradiological findings and treatment outcome of this rare entity are discussed, in addition to a review of the relevant literature. Spinal CMs should be included in the differential diagnosis of intraspinal tumors of the pediatric spine. Multidisciplinary treatment, consisting of total surgical removal and adjuvant radiotherapy, should be considered due to the aggressive nature of this abnormality and the risk of long-term recurrence.

Radiation-Induced Intraspinal Chondrosarcoma: A Case Report

Study Design Case report and review of the literature. Objective To report a unique case of an intraspinal chondrosarcoma that was diagnosed 18 years after radiotherapy for a cervical carcinoma and its remarkably unusual clinical presentation. Methods A retrospective case description of an intraspinal mass lesion that occurred 6 weeks after previous spinal surgery. Results Within ∼9 weeks, the tumor had infiltrated the peritoneal cavity and reached the lumbar subcutaneous tissue. Conclusion Radiation-induced sarcomas are rare, are highly aggressive, and may be difficult to diagnose. Furthermore, the only means of achieving long-term survival is through early and extensive surgery.

Treatment results in different surgical approaches for intraspinal tumor in 51 patients

To investigate the treatment results for the different surgical approaches for intraspinal tumor in lumbar spine. We retrospectively reviewed data for 51 patients with intraspinal tumors who were treated with surgery. We used the navigation system (group A) or traditional method (group B) to guide the surgery. Through the comparison of group A (22 patients) and group B (29 patients), we found some differences between the two groups, such as their total resection rate, the placement of pedicle screws, the mean operating time, intraoperative operation loss, JOA scores. In group A, the total resection rate was 95.45%. One hundred and ten pedicle screws were implanted, and no screw injured the nerve tissues or blood vessel; the placement of 94.55% of the pedicle screws was excellent. In group B, the total resection rate was 86.28%. A total of 134 pedicle screws were implanted, including five screws that injured nerve tissues or blood vessels; the placement of 87.31% of the pedicle screws was excellent. The postoperative symptoms were significantly improved in the two groups, and there were no deaths. The operation times were significantly lower in group A than in group B (P < 0.05), and the intraoperative operation loss was significantly lower in group A than in group B (P < 0.01). Additionally, the postoperative improvement in percent evaluated by Japan Orthopaedic Association (JOA) back pain evaluation questionnaire was significantly higher in group A than in group B (P < 0.05). The navigation system can provide crucial help in the treatment of spinal operation as an assisted method, which has great potential to improve the accuracy and safety.

Triad of Intraspinal Meningioma, Schwannoma, and Ependymoma: Report of an Extremely Rare Case

Mixed tumors composed of schwannoma and meningioma are extremely rare and are usually associated with neurofibromatosis type 2. So far, all the cases reported have involved the cerebellopontine angle. Only 3 reported cases did not have a clear association with neurofibromatosis type 2. We report a mixed tumor comprising schwannoma admixed with meningioma and ependymoma in the cervical spinal cord of a 22-year-old male.

Ependymomas of the filum terminale: The role of surgery and radiotherapy

Background:

Ependymomas of the filum terminale (EFT) form a specific and relatively uncommon subtype of spinal cord ependymomas. Most series in the literature are small, spanning a large time period. Up to date no consensus has been reached about the optimal treatment of these lesions. Some authors promote postoperative radiotherapy for all cases, others advocate postoperative radiotherapy only when a subtotal resection is performed or when metastasis are apparent.

Methods:

We performed a retrospective analysis of 22 patients with an EFT (mean age at diagnosis of 35.6 years).

Results:

In all patients (9/22) with lesions smaller than 4.5 cm no metastases were present and a complete resection could be obtained. No adjuvant radiotherapy was performed and at latest follow they had an excellent outcome. In our series, these initial tumor characteristics were more important regarding prognosis than either histology or treatment-related factors. For the larger tumors, total resection was obtained less frequently, more dissemination was diagnosed and a worse outcome was scored. Radiotherapy if indicated did lead to an acceptable disease control.

Conclusion:

In every case of EFT, an individual treatment protocol has to be outlined, but if an EFT is relatively small and can be resected completely, we would advocate to withhold radiotherapy.

Tight hamstring syndrome and extra- or intraspinal diseases in childhood: a multicenter study

Tight hamstrings syndrome (THS) has been attributed to a number of disorders. Most authors argue that tight hamstring syndrome is determined in the majority of cases by a protruding or slipped vertebral disc. The term "disc related tight hamstring syndrome" is usually used to describe the condition. However, tight hamstring syndrome in childhood can also be an initial symptom of a usually severe disease. We reviewed retrospectively 102 children who had presented to our clinics with tight hamstring syndrome in the past 22 years (between 1980 and 2001). To our knowledge, this study includes the largest number of patients with tight hamstring syndrome analysed so far. Seventy four children (73%) suffered from severe underlying diseases. In more than one-third of all THS cases (38 of 102 cases; 37%), we observed intra- or extraspinal tumorous alterations. In 15% of the cases (15 of 102), osteomyelitis or spondylodiscitis was diagnosed. Only in 27% of the cases (28 of 102), disc protrusion, one of the commonly known underlying diagnoses (14 cases), or higher-grade spondylolisthesis/spondyloptosis (14 cases) were the inciters. Our results suggest that tight hamstring syndrome in childhood can be an initial symptom of an associated, usually severe disease. We conclude that therefore further diagnostic evaluation is required when tight hamstring syndrome is observed. A rapid initiation of an adequate primary therapy could be indicated.