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1.
Zhonghua Yi Xue Za Zhi ; 100(39): 3093-3098, 2020 Oct 27.
Artigo em Chinês | MEDLINE | ID: mdl-33105961

RESUMO

Objective: To compare the safety and outcomes between keyhole surgery and total laminectomy for resection of intradural extramedullary spinal cord tumors. Methods: Retrospectively collected the clinical data of 102 patients with intradural extramedullary spinal cord tumors(≤3 cm) treated by surgery in Department of Orthopedics in Fujian Provincial Hospital from January 2014 to January 2017. Fifty cases underwent the keyhole surgery and the other 52 received total laminectomy. The operation time, volume of intraoperative bleeding, the leaving bed time, the length of postoperative hospital stay, drainage, postoperative complications, intraoperative neuroelectrophysiological monitoring (IONM), preoperative and postoperative visual analogue score (VAS), neck disability index (NDI), Oswestry disability index (ODI), McCormick spinal cord function grading were analyzed and compared between the two groups to evaluate the safety and clinical outcomes. The data of two groups were compared by t, χ(2) or rank sum test. Results: The keyhole group was followed up for (30±15) months and the total laminectomy group was followed up for (45±15) months. All the tumors were completely resected. All the incision healed well and no cerebrospinal fluid leakage occurred. There was no statistically significant differences in baseline data, operation time, the results of IONM, preoperative and 3 months, 6 months, 12 months postoperative VAS, NDI (cervical tumors), ODI (thoracic and lumbar tumors), McCormick spinal cord function grading, tumor recurrence between the two groups (all P>0.05). The keyhole group had less intraoperative bleeding than that in the total laminectomy group ((73±24) ml vs (136±26) ml, t=-12.610, P<0.05), earlier postoperative leaving bed time ((1.4±0.6) d vs (6.5±1.0) d, t=-31.822, P<0.05), and the postoperative hospital stay was shorter ((4.3±0.8) d vs (11.2±2.0) d, t=-22.319, P<0.05), and it was more advantageous in terms of drainage. The VAS, NDI and ODI in the keyhole group improved significantly compared with those in the total laminectomy group 2 weeks post operation (all P<0.05). Conclusion: Compared with the total laminectomy, keyhole surgery is suitable for the treatment of intradural extramedullary spinal cord tumors with small size and limited location, and it is equivalently safe with faster functional recovery.


Assuntos
Laminectomia , Neoplasias da Medula Espinal , Humanos , Recidiva Local de Neoplasia , Estudos Retrospectivos , Neoplasias da Medula Espinal/cirurgia , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(40): e21433, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019381

RESUMO

INTRODUCTION: Intradural schwannomas can occur at any level of the spine. According to the literature, approximately 8% of intradural schwannomas occur in the atlantoaxial spine, and these tumors are usually located in the posterolateral or lateral spinal cord. In contrast, tumors in the ventral midline of the spinal cord are relatively rare. PATIENT CONCERNS: A 47-year-old female presented with progressively worsening neck pain and paresthesias in both upper and lower limbs for the past 5 years. DIAGNOSIS: Based on Magnetic Resonance Imaging and histopathological findings, she was diagnosed with ventral midline primary schwannoma of the cervical spinal cord. INTERVENTIONS: The patient was treated with surgical resection. OUTCOMES: Follow-up visit at 2 years after the surgery showed that the patient is neurologically intact and free of disease. CONLUSION: In summary, for the tumors in the ventral midline of the atlantoaxial spinal cord, the preferred treatment is complete surgical resection by the posterior approach compared to the anterior approach, which often improves clinical symptoms or achieves a healing effect.


Assuntos
Neurilemoma/patologia , Neoplasias da Medula Espinal/patologia , Medula Cervical/diagnóstico por imagem , Medula Cervical/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia
4.
Niger J Clin Pract ; 23(8): 1167-1171, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32788497

RESUMO

Background: Spine tumors could affect the bony elements and/or its neural contents. Clinical manifestations are underlined by their biological behaviors. Aim: This study aims to identify the pattern of presentation and surgical management of spine tumors in southeast Nigeria over a 10-year period. Patients and Methods: A retrospective analysis of patients who were managed surgically for the spine and spinal cord neoplastic lesions over a 10-year period. All patients had pre-and post-operative magnetic resonance imaging (MRI) and histological diagnosis. Relevant clinical, radiological, and histological data were extracted and analyzed using Statistical Package for the Social Sciences (SPSS) for windows version 21. Results: Four hundred and seventy-two spine procedures performed within the study period, 39 cases of histologically proven primary spinal cord tumors (PSCT) and non-PSCT were identified. These represented 8.3% of spine procedures. Seventeen were PSCT (3.6% of spine procedures), while 22 (4.7%) had non-PSCT, mean age for the PSCT group was 45 yrs and non-PSCT 59.5 years. A total of 56.5% of tumors are involved in the thoracic region, 43.7% in the cervical region. PSCT was likely to affect the cervical spine; while bony spine tumors, thoracic spine [odds ratio (OR) 4.9, P value 0.019]. A total of 84.6% of non-PSCT affected the bony spine, mainly the vertebral body. The histological result showed metastatic adenocarcinoma to be the most common tumor (33.3%). PSCT was likely to be benign than non-PSCT (P value < 0.00001). Gross total resection (GTR) was done in 100% of PSCT, and 50% in non-PSCT. Thirteen (40.6%) patients improved and 11 (34.4%) patients remained the same. Conclusions: Metastatic adenocarcinoma was the most common tumor of the spine. There was restricted ability at a GTR for non-PSCT compared to PSCT. Grossly 75% had improved/same neurological status, as such adjudged as a good outcome.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/cirurgia , Coluna Vertebral/diagnóstico por imagem , Adenocarcinoma/patologia , Adolescente , Adulto , Vértebras Cervicais/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/patologia , Procedimentos Neurocirúrgicos/métodos , Nigéria , Estudos Retrospectivos , Doenças da Medula Espinal , Neoplasias da Medula Espinal/patologia , Neoplasias da Coluna Vertebral/patologia , Resultado do Tratamento , Adulto Jovem
5.
Artigo em Russo | MEDLINE | ID: mdl-32759927

RESUMO

Spinal cord metastases of brain gliomas are rare. However, incidence of these tumors has been increasing recently. The vast majority of neurosurgeons and oncologists recognize spinal cord metastasis of malignant brain glioma followed by symptoms of transverse spinal cord lesion as non-curable terminal stage of malignant process. In this paper, we report a rare clinical case of metastatic spinal cord lesion in a patient after previous surgery for anaplastic oligodendroglioma of the right frontal lobe. There were no signs of local recurrence of the primary tumor. Active surgical strategy followed by radio- and chemotherapy significantly improved the patient's quality of life. Postoperative follow-up is 6 months by the moment of writing the manuscript, no clinical signs of progression are observed.


Assuntos
Astrocitoma , Neoplasias Encefálicas/cirurgia , Oligodendroglioma/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Humanos , Recidiva Local de Neoplasia , Qualidade de Vida
6.
J Clin Neurosci ; 78: 411-413, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32600971

RESUMO

Classic type intradural extramedullary (IDEM) ependymomas of the lumbar spine are rare entities. Only two such cases have previously been reported in the literature. Here the authors report a new case and describe radiological, surgical and histological findings as well as review the literature. Unlike previously encountered lumbar IDEM ependymomas, this case was an incidental finding and surgically managed on the grounds of radiological progression over 8 years.


Assuntos
Ependimoma/diagnóstico por imagem , Vértebras Lombares/patologia , Neoplasias da Medula Espinal/diagnóstico por imagem , Ependimoma/cirurgia , Feminino , Humanos , Achados Incidentais , Região Lombossacral/patologia , Imagem por Ressonância Magnética , Neoplasias da Medula Espinal/cirurgia
7.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(3): 119-131, mayo-jun. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192416

RESUMO

El objetivo principal del tratamiento en las metástasis espinales es el control local de la enfermedad, el alivio del dolor y el mantenimiento de la deambulación. Clásicamente, se ha recomendado una resección quirúrgica del tumor lo más amplia posible seguida de radioterapia o quimioterapia adyuvante. En la actualidad, la radioterapia estereotáxica corporal (SBRT) en dosis única o hipofraccionada proporciona tasas globales de control local al año superiores al 95% con mínima morbilidad, incluso en histologías que suelen considerarse radiorresistentes. Por otro lado, mediante cirugía de descompresión circunferencial posterolateral y estabilización de la columna es factible crear un espacio de 2-3 mm entre el borde tumoral y la duramadre (separation surgery) suficiente para permitir administrar de forma segura SBRT a dosis ablativas. Dado que con frecuencia se trata de pacientes frágiles, dicha cirugía puede realizarse mediante técnicas mínimamente invasivas, que reducen la agresividad quirúrgica y ayudan a minimizar el retraso de eventuales tratamientos sistémicos


The main goal of treatment in spinal metastatic patients is local control of the disease, pain relief and the maintenance of ambulation. Traditionally, wide surgical resection of the tumour followed by adjuvant radiation and/or chemotherapy has been recommended. Currently, single-fraction or hypofractionated stereotactic body radiation therapy (SBRT) yields a one-year local control rate of over 95% with minimum morbidity, even for tumours previously considered radioresistant. In addition, by posterolateral and circumferential decompression and stabilisation of the spinal cord, it is feasible to create a 2 to 3 mm epidural margin between the dura mater and the tumour (separation surgery), enough to deliver safe and ablative doses of SBRT to the vertebrae. As these patients tend to be frail, such interventions should ideally be minimally invasive, thereby reducing surgical aggressiveness and helping to minimise the delay of any systemic therapies


Assuntos
Humanos , Feminino , Adulto , Idoso , Técnicas Estereotáxicas/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neoplasias da Medula Espinal/cirurgia , Metástase Neoplásica , Manejo da Dor , Transtornos Neurológicos da Marcha/terapia , Qualidade de Vida , Algoritmos , Radiocirurgia/efeitos adversos , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Cifose/diagnóstico por imagem , Imunoterapia
9.
Medicine (Baltimore) ; 99(25): e20814, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569229

RESUMO

RATIONALE: Spinal meningioma is the second most common spinal neoplasm that commonly occurs in middle-aged women. As a rare histological variation of meningioma, completely ossified meningioma (OSM) and its standard surgical strategies have been reported. However, the surgical outcomes of elderly OSM cases (age >70) are less investigated. Herein, we intend to present an elderly OSM case and review the elderly OSM cases in published literatures. PATIENT CONCERNS: An 85-year-old female presented with 10-year history of back pain and developed radiating pain on her left lower extremity within the last 2 weeks. DIAGNOSES: A magnetic resonance imaging scan revealed an intradural tumor at the T11 level. A computed tomography scan demonstrated that the mass was completely ossified and had distinct borders (D-F). In a dynamic contrast-enhanced magnetic resonance imaging scan, the mass presented as a lateral intradural extramedullary tumor with abundant blood supply (). INTERVENTIONS: The patient underwent en bloc intradural tumorectomy via posterior approach. OUTCOMES: After surgery, the patient's pain was relieved. However, the patient spent another 3 weeks in hospital due to a series of post-surgery complications, including hypostatic pneumonia, pulmonary heart failure, hydrothorax in both thoracic cavities, hypoproteinemia, and deep venous thrombosis on both of her legs. The complications recovered after 3-weeks treatment. In 1-year follow up, no additional symptom was found and the patient was recurrence free. LESSONS: Our report indicated that the surgical outcome can be satisfying in elderly OSM patients, while the post-operative complications frequently occur due to the poor physical condition of elderly patients. As a result, treatment of peri-operative complications of elderly OSM patients also deserves greater attention along with surgical resection.


Assuntos
Meningioma/diagnóstico , Neoplasias da Medula Espinal/diagnóstico , Idoso de 80 Anos ou mais , Feminino , Humanos , Imagem por Ressonância Magnética , Meningioma/diagnóstico por imagem , Meningioma/patologia , Meningioma/cirurgia , Ossificação Heterotópica/diagnóstico , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/patologia , Ossificação Heterotópica/cirurgia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia , Vértebras Torácicas , Tomografia Computadorizada por Raios X
10.
World Neurosurg ; 140: 162-165, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32389872

RESUMO

BACKGROUND: Paraplegia after lumbar spinal surgery has been previously described. It was generally provoked by a missed thoracic compression because of degenerative processes, arachnoid cyst, and spinal cord tumor such as meningioma. We describe here a case of a patient with neurofibromatosis type 2 (NF-2) with multiple spinal meningiomas that developed postoperative paraplegia because of decompensation of spinal cord compression below and far from the operated level. CASE DESCRIPTION: A 54-year-old woman with NF-2 was followed-up for multiple spinal meningiomas (C7-T1, T6-7, T9-10 levels). Surgery for the symptomatic and larger lesion (C7-T1) was scheduled. Postoperatively, the patient was found to have paraplegia with sensor anesthesia below the level of the T6 vertebra. An urgent spinal magnetic resonance imaging (MRI) scan was performed revealing the absence of complication at the operated level (C7-T1) but the appearance of a marked intramedullary hyperintensity at the T6-7 level. An urgent T6-7 laminectomy and removal of the meningioma was performed. The postoperative phase was marked by a poor recuperation. Spinal MRI scan at 3 months clearly showed a severely injured spinal cord at the T6-7 level consistent with the neurologic status of the patient. CONCLUSIONS: We report here the first case of acute neurologic deterioration after decompensation of a spinal cord compression below the operated level in spinal intradural surgery. Neurosurgeons must be aware of this possible complication when treating patients with multiple spinal meningiomas.


Assuntos
Meningioma/cirurgia , Neurofibromatose 2/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Paraplegia/etiologia , Compressão da Medula Espinal/etiologia , Neoplasias da Medula Espinal/cirurgia , Feminino , Humanos , Laminectomia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Paraplegia/diagnóstico por imagem , Paraplegia/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia
11.
Medicine (Baltimore) ; 99(18): e20107, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358400

RESUMO

BACKGROUND: Intramedullary cervical spinal cord teratomas (ICTs) are extremely rare, and diagnosis and treatment are challenging. We conducted a systematic review of the literature on the diagnosis and treatment of ICT. METHOD: The presentation, imaging manifestations, diagnosis, management, surgery findings, prognosis and histology were reviewed following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. English-language studies and case reports published from inception to 2018 were retrieved. Data on presentation, imaging characteristics, diagnosis, management, surgery findings, outcomes, and histopathology were extracted. RESULTS: Ten articles involving 10 patients were selected. The lesions were located in the upper cervical vertebrae in 4 cases, whereas in the lower cervical vertebrae in the remaining 6 cases. In 5 cases, the lesions were located on the dorsal side of the spinal cord, and in the center of the spinal cord in the remaining 5 cases. Quadriparesis (60%), paraplegia (30%), monoplegia (10%), and neck pain (50%) were the main presentations. The lesion appeared as a intramedullary heterogeneous signal during an MRI scan, and the lesion signal would be partially enhanced after the contrast medium was applied. All patients underwent surgical intervention through a posterior approach. Neurological function improved postoperatively in all patients. Two patients with pathology confirmed to be immature teratomas experienced recurrence. CONCLUSION: ICTs are extremely rare entities that are mainly located in the center or dorsal part of the spinal cord which mainly manifest as quadriplegia and neck pain. MRI is a useful modality that provides diagnostic clues. Surgery from a posterior approach is the primary treatment, and the effect of adjuvant therapy remains uncertain. The prognosis is mainly related to the pathological nature of the tumor and not the method of resection.


Assuntos
Vértebras Cervicais/patologia , Neoplasias da Medula Espinal/patologia , Teratoma/patologia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Teratoma/diagnóstico por imagem , Teratoma/cirurgia
12.
J Clin Neurosci ; 77: 237-239, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32446808

RESUMO

Myxopapillary ependymomas are low grade neoplasms, which originate mostly from the medullary conus, cauda equina and the filum terminale. To date the principal treatment is surgical, total- or subtotal removal (GTR or STR), which can be associated with adjuvant radiotherapy. We report a patient with two tumor locations, one larger tumor at the L3 to S1 level and a smaller S2-S3 localized lesion. The patient was treated successfully with a combined approach of GTR of L3-S1 lesion and radiosurgical treatment of S2-S3 lesion.


Assuntos
Ependimoma/patologia , Ependimoma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia , Adulto , Feminino , Humanos , Neoplasias Primárias Múltiplas/patologia , Procedimentos Neurocirúrgicos/métodos , Radiocirurgia/métodos
13.
J Ayub Med Coll Abbottabad ; 32(1): 87-90, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32468763

RESUMO

BACKGROUND: This study was conducted to determine the short-term outcome of surgical procedure in patients having spinal intradural tumours. METHODS: This cross-sectional study was conducted from 26 April 2016 to 25 March 2019 on 56 patients after approval from hospitals ethical and research committee. MRI spine were studied in detail for all patients to know about the site, size, shape, extent and nature of the tumour. History, examination, pre-operative MRI findings, post-operative findings were documented in patient's pro forma. Short term as well as long term post-operative results were documented after surgery, during stay at hospital and followup visits till 6 months. RESULTS: In this study, 56 patients with spinal intradural tumours were observed. Male to female ratio was 1.33:1. Age ranged from 5-65 years (32.5±14.6). Paraparesis, hypesthesia, sphincter dysfunction were the presenting symptoms in most of the patients. 47% (21) patients improved according to MRC Grading system 46% (20) patients remained static 7% (3) patients deteriorated. Wound infection was found in 7 (12.5%) patients, followed by Neurological Deficit in 5 (8.9%) cases, Meningitis was found in 2 (3.57%), CSF leak was noted in 4 (7.14%) patients and mortality in 1 (1.7%) of the case. CONCLUSIONS: Surgery of the intradural spinal tumours carry good neurological outcome with acceptable complication rates.


Assuntos
Procedimentos Neurocirúrgicos , Neoplasias da Medula Espinal/cirurgia , Coluna Vertebral/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/mortalidade , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Adulto Jovem
14.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(2): 76-86, mar.-abr. 2020. ilus, grab, tab
Artigo em Inglês | IBECS | ID: ibc-190375

RESUMO

INTRODUCTION AND OBJECTIVES: Angiolipomas of the spinal canal are a rare condition of unknown origin. They are considered histologically benign; however, some have the potential to infiltrate adjacent structures. The aim of this systematic review was to suggest a potential mechanism for the pathogenesis of spinal angiolipomas, along with a useful approach for their preoperative management. MATERIALS AND METHODS: A literature review of cases of spinal angiolipoma was performed. In addition, two of the cases encountered in our practice are presented. The first case refers to a 35-year-old male patient with a history of spinal fusion because of a T9 fracture, while the second concerns a 46-year-old male patient with an epidural mass extending outside the spinal canal, who underwent fine needle biopsy and embolisation of its feeding vessel. RESULTS: From the review of the literature performed, we were unable to identify any correlation between the infiltrative potential and the patients' demographic and tumour characteristics. CONCLUSIONS: Angiolipomas are considered to be sporadic, yet theories concerning their pathogenesis include reaction to harmful stimuli and congenital malformation of the adipose tissue. Fine needle biopsy may be mistakenly considered non-diagnostic, due to the presence of well-differentiated adipocytes


INTRODUCCIÓN Y OBJETIVOS: Los angiolipomas del canal vertebral son una enfermedad rara de origen desconocido. Se consideran histológicamente benignos, aunque en algunos casos existe la posibilidad de que se infiltren en estructuras adyacentes. El objetivo de esta revisión sistemática es sugerir un posible mecanismo para la patogenia de los angiolipomas espinales, junto con un enfoque útil para su tratamiento preoperatorio. Materiales y métodos: Se realizó una búsqueda bibliográfica de los casos de angiolipomas espinales. Además, se presentan 2 de los casos encontrados en nuestra práctica clínica. El primer caso corresponde a un paciente varón de 35 años con antecedentes de artrodesis vertebral debido a una fractura en T9, mientras que el segundo corresponde a un paciente varón de 46 años con una masa epidural que se extendía fuera del canal vertebral, al que se realizó una biopsia con aguja fina y una embolización del vaso nutricio. RESULTADOS: A partir de la revisión bibliográfica realizada, no pudimos identificar ninguna correlación entre el potencial de infiltración, los datos demográficos y las características de los tumores de los pacientes. CONCLUSIONES: Los angiolipomas se consideran esporádicos, existiendo, no obstante, teorías referentes a su patogenia que incluyen la reacción a estímulos nocivos y la malformación congénita del tejido adiposo. La biopsia con aguja fina puede considerarse erróneamente como no diagnóstica, debido a la presencia de adipocitos bien diferenciados


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Angiolipoma/cirurgia , Medula Espinal/cirurgia , Neoplasias da Medula Espinal/cirurgia , Angiolipoma/diagnóstico por imagem , Biópsia , Embolização Terapêutica , Tomografia Computadorizada por Raios X , Espectroscopia de Ressonância Magnética , Meios de Contraste , Fotomicrografia , Medula Espinal/patologia , Diagnóstico Diferencial , Neoplasias da Medula Espinal/diagnóstico por imagem
15.
World Neurosurg ; 139: 266-267, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32289505

RESUMO

A 39-year-old man with a history of recurrent pituitary tumor, Cushing disease, and Nelson syndrome presented with neck stiffness. He previously had bilateral adrenalectomy and hypophysectomy 27 years ago. He subsequently had repeat pituitary surgery, stereotactic radiosurgery, and chemotherapy for recurrent pituitary tumor. During follow-up, he was noted to have rising basal adrenocorticotrophin (ACTH) level. On examination, he was neurologically intact with no signs of myelopathy. Magnetic resonance imaging of the spine showed a large intradural extramedullary lesion causing cord compression at the C2-3 level. He underwent a cervical laminectomy and debulking of the lesion under continuous monitoring of motor-evoked and somatosensory-evoked potentials. He remained neurologically intact postoperatively. Histologic analysis revealed a tumor of pituitary origin with synaptophysin and ACTH expression. Pituitary drop metastasis is a rare entity and should raise a high index of suspicion given this clinical presentation. The radiologic appearance can mimic benign lesions such as meningioma or schwannoma.


Assuntos
Carcinoma/secundário , Neoplasias Hipofisárias/patologia , Compressão da Medula Espinal/etiologia , Neoplasias da Medula Espinal/secundário , Adulto , Carcinoma/cirurgia , Descompressão Cirúrgica , Humanos , Laminectomia , Masculino , Compressão da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/cirurgia
16.
World Neurosurg ; 139: 20-22, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32251824

RESUMO

BACKGROUND: Ten-segment intramedullary tumors are rare lesions in adults. CASE DESCRIPTION: In this report, we describe the case of a 30-year-old woman who presented with a 2-year history of right lower limb numbness. Spinal magnetic resonance imaging showed an expansive 10-segment intramedullary lesion and syringomyelia. The final pathologic tests confirmed World Health Organization grade II ependymoma. She received a successful gross total tumorectomy with no obvious surgical-related complications. CONCLUSIONS: The postoperative recovery is far beyond our expectations.


Assuntos
Vértebras Cervicais/cirurgia , Craniotomia , Ependimoma/cirurgia , Laminectomia , Neoplasias da Medula Espinal/cirurgia , Siringomielia/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Adulto , Ependimoma/complicações , Ependimoma/diagnóstico por imagem , Ependimoma/patologia , Feminino , Forame Magno , Humanos , Hipestesia/etiologia , Imagem por Ressonância Magnética , Debilidade Muscular/etiologia , Reabilitação Neurológica , Procedimentos Neurocirúrgicos , Recuperação de Função Fisiológica , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Siringomielia/etiologia , Resultado do Tratamento
17.
World Neurosurg ; 139: 136-141, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32283320

RESUMO

BACKGROUND: Granular cell tumors (GCT) are rare soft tissue neoplasms with a nerve sheath origin, most often found in female adult populations. When these tumors arise in the central nervous system, they most commonly appear intradurally in the thoracic or lumbar spine. GCT malignancy rates vary and recurrence rates can be relatively high, thereby necessitating complete resection. CASE DESCRIPTION: We present an exceedingly rare case of an intradural, extramedullary GCT originating in the anterior cervical spine of a male pediatric patient who presented with progressive neck pain and gait instability. CONCLUSIONS: The patient underwent an anterior C7 corpectomy for resection of the tumor, followed by stabilization and fusion, and recovered without neurologic deficit. A literature review of spinal GCTs is provided.


Assuntos
Vértebras Cervicais/cirurgia , Tumor de Células Granulares/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias da Medula Espinal/cirurgia , Adolescente , Tumor de Células Granulares/complicações , Tumor de Células Granulares/diagnóstico por imagem , Tumor de Células Granulares/patologia , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Cervicalgia/etiologia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Fusão Vertebral
18.
World Neurosurg ; 139: 39-50, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32298825

RESUMO

BACKGROUND: Epidermoid cysts are rare benign neoplasms within the neuroaxis and account for <1% of all intraspinal tumors. They can be congenital or acquired. Being a slow-growing tumor, the clinical presentation is widely variable depending on the location, size, or age of the patient. OBJECTIVES: Because of the rarity of this entity, the diagnosis and treatment are often delayed. We wanted to offer an updated overall view on spinal epidermoid cysts to facilitate diagnosis and treatment decisions. METHODS: We present the case of a patient with thoracic intramedullary epidermoid cyst and we conduct a review of reported cases in the literature using PubMed database. RESULTS: From 1962 to September 2019, we gathered 91 articles with a total of 139 cases (ours included). There is a slightly female predominance and a bimodal age distribution. Acquired cysts are seen in 38.1% of patients. The most frequent symptom was pain, followed by motor deficit, sensitive deficits, and sphincter deficiencies. The mean time delay to diagnosis is 26.36 ± 53.29 months. The most common localization was in the lumbar area and one third of the tumors were intramedullary. A good outcome was achieved in most of the treated cases. CONCLUSIONS: To achieve a good outcome, an early recognition of this disease is essential. The management consists in most cases of surgical resection. Although recurrence is low, it can significantly alter the quality of life of our patients, and, therefore, gross total resection should be our goal.


Assuntos
Cisto Epidérmico/cirurgia , Neoplasias da Medula Espinal/cirurgia , Dor nas Costas/etiologia , Cisto Epidérmico/complicações , Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paraparesia Espástica/etiologia , Recuperação de Função Fisiológica , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/fisiopatologia , Vértebras Torácicas
19.
World Neurosurg ; 139: 355-360, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32344144

RESUMO

BACKGROUND: Pancreatic neuroendocrine tumors (pNETs) are known to frequently metastasize to the liver and lymphatics; however, metastasis to the spine is exceedingly rare. We report the first case of an intradural, extramedullary pNET metastasis to the upper cervical spine. CASE DESCRIPTION: A 75-year-old Hispanic male patient with history of stage IV pNET with metastasis to the liver and lymph nodes and new-onset lymphadenopathy seen on CT of the chest was found on positron emission tomography scan to have a lesion in the cervical spine. The patient was neurologically intact on physical examination, yet given the patient's medical history, magnetic resonance imaging of the cervical spine was performed, revealing a right-sided intradural, extramedullary mass at the C1-C2 level with associated mass effect on the spinal cord, likely representing a schwannoma. Due to the tumor size, mass effect, and the need for definitive tissue diagnosis, a partial C1-C2 laminectomy with intradural resection of the tumor was performed. The histology was consistent with the patient's known pNET. CONCLUSIONS: As treatment for pNETs has evolved, there has been a surge in unique presentations of systemic well-differentiated pNETs being reported. It is vital that patients diagnosed with pNET be monitored for metastases, and when discovered, treated promptly.


Assuntos
Tumores Neuroendócrinos/secundário , Neoplasias Pancreáticas/patologia , Neoplasias da Medula Espinal/secundário , Idoso , Vértebras Cervicais , Humanos , Laminectomia , Masculino , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/cirurgia , Neoplasias da Medula Espinal/cirurgia
20.
World Neurosurg ; 138: 440-443, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32251817

RESUMO

BACKGROUND: Spinal schwannomas are benign nerve sheath neoplasms that constitute about 30% of extramedullary spinal cord tumors. They are usually small, well-encapsulated tumors with low mitotic activity and concurrently carry a low risk of recurrence. Here, we report a case of atypical histologic variant of spinal schwannoma that had higher cellular density, nuclear atypia, and lack of encapsulation. To our best knowledge, no such cases of this atypical variant with regards to lumbar spine have been reported in the literature. CASE DESCRIPTION: A 66-year-old male had an incidental left-sided paraspinal mass discovered while undergoing workup for cholecystitis. On examination, the patient was neurologically intact. Imaging revealed the presence of a contrast-enhanced, partially cystic mass arising from the L3-4 intervertebral foramen and causing left psoas muscle displacement. A minimally invasive left L3-4 posterior extracavitary resection was done. Histopathologic examination revealed a partly unencapsulated tumor with higher than usual cellular density and nuclear atypia, resulting in a diagnosis of "atypical schwannoma." Imaging at 6 months' follow-up showed stable postsurgical changes and residual tumor with no evidence of progression/recurrence. CONCLUSIONS: Atypical schwannoma has higher cellular density and nuclear atypia and lacks encapsulation. A review of the literature suggests an increased risk of recurrence when compared with typical variants, and complete tumor removal should be attempted.


Assuntos
Vértebras Lombares/patologia , Neurilemoma/patologia , Neoplasias da Medula Espinal/patologia , Idoso , Colecistite/complicações , Colecistite/diagnóstico por imagem , Forame Magno/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Masculino , Neoplasias da Bainha Neural/patologia , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Resultado do Tratamento
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