Case report: An epidural cavernous hemangioma mimicking a dumbbell-shaped neuroma.

INTRODUCTION AND IMPORTANCE: Spinal epidural cavernous hemangiomas are a rare occurrence. This particular case is made even more distinctive by the fact that the lesion mimicked a dumbbell-shaped neuroma. Moreover, it had a very unique localization (wholly epidural, at cervical-thoracic -C7-D1- level). The importance of this case is linked not only to its remarkable rarity, but also to the diagnostic avenues explored. The surgery was carried out by Prof. Riccardo Caruso, Head of the Neurosurgical Department of the Military Hospital of Rome and Professor of Neurosurgery of Sapienza University of Rome, assisted by Dr. Luigi Marrocco, Senior Neurosurgeon of the Military Hospital of Rome. Postsurgical recovery was managed by Dr. Venceslao Wierzbicki, Senior Neurosurgeon of the Military Hospital of Rome. CASE PRESENTATION: In 2020, a 71 year-old man, suffering from intense pain in the left scapular region and in the ulnar area of the left forearm, underwent surgery for the removal of a spinal epidural cavernous hemangioma involving the left C7-D1 foramen. Prior to surgery, the lesion had been misdiagnosed as a neuroma by a radiologist. CLINICAL DISCUSSION: In the Literature there are other, rare cases of hemangiomas partly located in the spinal canal, and partly located intra and extra foramen. In the case here presented, differential diagnosis as well as a potential Schwannoma, suggested by the dumbbell shape of the lesion, should have considered also the possibility of a meningioma. Two teams of radiologists examined the images, the radiologists of our team, Dr. Valentina Martines and Dr. Emanuele Piccione, thanks to a close inspection of the features of the lesion, postulated the extra-dural position. Other aspects of the scans were then analyzed to help guide future diagnosis of similar lesions. CONCLUSION: With a spinal tumor affecting the foramen, a close examination of the images allows for accurate presurgical differential diagnosis, differentiating between the more frequent neuroma and other rarer tumors, such as a hemangioma.

Assessing the real benefits of surgery for degenerative lumbar spinal stenosis without instability and spondylolisthesis: a single surgeon experience with a mean 8-year follow-up.

BACKGROUND: The degenerative lumbar spinal stenosis is one of the most commonly treated spinal disorders in older adults; despite its increasing frequency, it is not yet clear what the most effective therapy might be. The aim of this study is to investigate the very long term results of a homogenized cohort of patients suffering from lumbar spinal stenosis: the first subset of patients operated on with laminectomy and the second subset of patients was also advised to undergo laminectomy but never operated on. METHODS: Patients from both subgroups were advised to undergo surgery, according to the same criteria, in the period between 2000 and 2010 and were re-evaluated in the period between January and December 2016. RESULTS: Comparing the two subsets of patients, both suffering from clinically relevant LSS, the first subset returns a statistically significant clinical improvement at follow-up. The rate of excellent results decreases over years. Iatrogenic spinal instability incidence was found to be 3.8% in the present cohort. CONCLUSIONS: Although the improvement of the first postoperative years decreases over time and despite the lack of general consensus, the lack of established shared guidelines and the limitations of this research, the results support the utilisation of surgery for the management of this condition. LEVEL OF EVIDENCE: 3.

A primary intraosseous cystic meningioma: Case report.

INTRODUCTION: This is a very rare case of intraosseous cystic meningioma. There have been no reports of similar cases in the last 30 years. PRESENTATION OF CASE: A 62-year-old man, suffering from a swelling of the lateral wall of the left orbit was admitted to our hospital. MRI and CT scan showed a large intradiploic lesion involving the lateral wall of the orbit and the greater wing of the sphenoid. The lesion was cystic with a mural nodule. We operated the patient and removed completely the mural nodule and the fibrous wall of cyst. Histological examination showed that the mural nodule was a benign meningothelial meningioma. DISCUSSION: Primary intraosseous meningiomas represent a subtype of primary extradural meningiomas; they comprise about 2% of all meningiomas and are therefore rare entities. Cystic meningiomas are rare, their incidence compared to all other types of meningiomas is of 2-4%. The presence of a meningioma with both characteristics: cystic and intraosseous, like in our case, is an exceptional occurrence. CONCLUSION: The surgical management of tumor was easy; its rarity means that the case is interesting.

Adjacent segment pathology: natural history or effect of anterior cervical discectomy and fusion? A 10-year follow-up radiological multicenter study using an evaluation scale of the ageing spine.

PURPOSE: Aim of this study is to compare late degenerative MRI changes in a subset of patients operated on with ACDF to a second subset of patients presenting indication to ACDF but never operated on. METHODS: Patients from both subgroups received surgical indication according to the same criteria. Both subgroups underwent a cervical spine MRI in 2004-2005 and 10 years later in 2015. These MRI scans were retrospectively evaluated with a cervical spine ageing scale. RESULTS: Comparing the two subset of patients both suffering from clinically relevant single-level disease returns no statistically significant difference in the degenerative condition of posterior ligaments, presence of degenerative spondylolisthesis, foraminal stenosis, diameter of the spinal canal, Modic alteration, and intervertebral discs degeneration at 10-year follow-up. CONCLUSIONS: The adjacent segment degeneration represents, in the present cohort, a result of the natural history of cervical spondylosis rather than a consequence of fusion.

A Blast of Mistakes: Undiagnosed Cervical Spondylolisthesis Following a Bomb Explosion.

BACKGROUND A case of spinal trauma had an unusual clinical course due to medical mistakes, from which we can learn some important lessons. CASE REPORT We report a case of spondylolisthesis following a bomb explosion, which went undiagnosed for a long time because of a series of mistakes that are highlighted in this article. What makes this case unique is that the spondylolisthesis developed during hospital stay, but the patient had no loss of mobility, strength, or sensitivity. CONCLUSIONS This case shows that establishing the conditions of an organ or a body part upon admission to hospital may not be enough when a patient has suffered extensive and serious trauma, and that it is necessary to carry out more checkups over time, especially if there are new clues and symptoms.

Cerebellar hemisphere herniation in the neck: Case report of a very rare complication following a posterior fossa craniectomy.

This article presents a very rare late complication of surgery to the posterior fossa involving a craniectomy: cerebellar hemisphere herniation in the neck, through the craniectomy site. Here we also analyse the possible causes of such complication.

Surgical Approach to the Cavernous Sinus for a Trigeminal Schwannoma Resection: Technical Note and Case Report.

We report a rare case of schwannoma of the lateral wall of the cavernous sinus, an exceedingly rare lesion affecting this anatomical district, and discuss salient aspects of the surgical approach to the cavernous sinus, which are traditionally considered technically challenging due to the high risk of postoperative morbidity and mortality related to the presence of the cranial nerves and internal carotid artery.

Ancient Schwannoma of the Cauda Equina: Our Experience and Review of the Literature.

Ancient schwannomas (AS) are exceedingly rare variant of common schwannomas (CS). Only two cases involving the cauda equina region have been previously reported in literature. AS are typically associated with a higher histological degree of degenerative changes (Antoni B areas). It is of peculiar importance, according to our opinion, to outline that, because of their extremely slow growth (which explains the increase of the degenerative changes in respect to the CS) and their typical soft consistency in respect to their standard counterparts, AS usually imply an even better prognosis.

A Poorly Known Cerebrospinal Fluid Shunt Complication: Miyazaki Syndrome.

We studied a poorly known form of cerebrospinal fluid hypotension characterized by cervical myelopathy, a considerable growth in volume of the venous plexus of the cervical spine, and absence of headache. This form was first described by Miyazaki. We reported a case brought to our attention, reviewed the literature, and formulated etiopathogenic theories that might explain all the various clinical aspects of this pathology.

How old is your cervical spine? Cervical spine biological age: a new evaluation scale.

PURPOSE: This article aims at presenting a scale that, through the analysis of MRI images, clearly charts the various degenerative stages of the cervical spine and establishes its biological age. We have created this scale by summing together various scores linked to a selection of parameters according to which MRI images are analyzed. METHOD: We examined 423 cervical spine MRI scans, belonging to patients who had been admitted to the Medical Imaging Service of the Military Hospital of Rome between January 2010 and July 2011. We selected 6 parameters for the analysis of the MRI scans of the cervical spine: (1) the degeneration of the intervertebral discs, (2) the degeneration of the yellow ligaments, (3) the degeneration of the vertebral bodies, (4) the possible presence of spondylolistheses, (5) the presence or absence of foraminal stenosis, and (6) the diameter of the spinal canal. We assigned to each parameter a score system based on a graduated scale. The cervical spine physiological age can be determined by summing up the scores obtained for each parameter. RESULTS: We submitted the data obtained from the study to a statistical enquiry. The results of the enquiry confirmed the suitability of the parameters selected for the evaluation of the aging process of the cervical spine. CONCLUSIONS: The effectiveness of the various treatments for cervical spine degenerative disorders is influenced by the overall anatomical conditions of the cervical spine. Up until now there has been no objective criterion for the evaluation of these anatomical conditions. We believe that this scale will be a useful tool to homogenize retrospective studies and to correctly set up prospective studies on the degenerative conditions of the cervical spine and relative treatments.