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1.
World Neurosurg ; 133: 185-187, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606509

RESUMO

We report a rare case of bony diastematomyelia associated with intraspinal teratoma. The patient was surgically treated with bony diastematomyelia and intradural teratoma resection, followed by lumbar duroplasty, and posterior fusion from L2-L4 in order to maintain the spinal stability of the approached segments. Despite the risks, it was necessary to perform early surgical treatment because of rapid neurologic deterioration. The patient had a good postoperative outcome.


Assuntos
Vértebras Lombares/cirurgia , Defeitos do Tubo Neural/cirurgia , Neoplasias da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Teratoma/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Humanos , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Defeitos do Tubo Neural/complicações , Defeitos do Tubo Neural/diagnóstico por imagem , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Teratoma/complicações , Teratoma/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
S Afr J Surg ; 57(3): 58, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392870

RESUMO

BACKGROUND: Intradural extramedullary (IDEM) spinal masses are common lesions with varying histological diagnoses often associated with significant neurological deficits. This study aimed to describe the epidemiology, management and perioperative outcome of IDEM tumours seen at the teaching hospitals of the University of the Witwatersrand, Johannesburg, between 2014 and 2017. RESULTS: 92 patients were included in the study. The ages ranged from 21 to 87 years, sex ratio was M:F 1:1.4, and duration of symptoms prior to diagnosis ranged between 3 days to 18 months. Local and radicular type pain as well as motor weakness were the commonest symptoms. 67% had severe neurological deficit McCormick Grade III and IV. Schwannoma (26) Neurofibromas (21) and Meningiomas (16) and were the most frequent tumour types. Meningiomas predominantly occurred at the cranio-cervical and thoracic levels. Nerve sheath tumours were mostly found at the cervical and lumbar levels while filum terminale ependymomas occurred at the thoracolumbar area. Laminectomy was the commonest surgical approach employed, and the extent of resection varied, with total excision in half the cases. Neurological function was regained in 3 patients, deteriorated in two and was unchanged in the remainder. CONCLUSION: IDEM tumours are an important subset of spinal cord compressive lesions Presentation with severe neurological deficit is common and though resection is feasible neurological deficit remains in the vast majority. Earlier detection should improve the results of surgery.


Assuntos
Meningioma/cirurgia , Neurilemoma/cirurgia , Neurofibroma/cirurgia , Neoplasias da Medula Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/etiologia , Feminino , Hospitais de Ensino , Humanos , Laminectomia , Masculino , Meningioma/complicações , Meningioma/epidemiologia , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Neurilemoma/complicações , Neurilemoma/epidemiologia , Neurofibroma/complicações , Neurofibroma/epidemiologia , Radiculopatia/etiologia , África do Sul/epidemiologia , Compressão da Medula Espinal/etiologia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/epidemiologia , Adulto Jovem
4.
BMC Neurol ; 19(1): 189, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395022

RESUMO

BACKGROUND: Lumbosacral lipomas (LLs) may remain asymptomatic or lead to progressive neurological deterioration. However, sudden neurological deterioration is a rare and severe event. Herein, we report rare occurrences of sudden clinical deterioration in two previously asymptomatic children harbouring intradural LLs without dermal sinus tracts or signs of occult dysraphism. A review of the pertinent literature is also included. CASE PRESENTATION: One child exhibited acute deterioration because of an epidural abscess associated with a filar lipoma without a sinus tract (probably caused by haematogenous spreading from a respiratory tract multiple infection), and the other child exhibited acute deterioration because of a very large, holocord syringomyelia-like cyst associated with a small conus lipoma. Both patients were 4 years old. In case #2, a previously undetected, severe tethered cord (conus at the S3-S4 level) was also present. A complete recovery was attained after an urgent surgical operation in both cases (in addition to targeted antibiotic therapy in case #1). All cases of deterioration in the literature were caused by abscess formation in dermal sinus tracts. CONCLUSIONS: Prophylactic surgery may be indicated even in asymptomatic children that have tethered cord and surgically favourable LLs (small dorsal and filar LLs), especially if the conditions are associated with progressive syringomyelia. Similarly, intradural dermal sinus tracts should be regarded as surgery-indicated, even if the conus is in its normal position and the patient is asymptomatic because there is a consistent risk of severe, infection-related complications. Finally, asymptomatic patients with filar LLs and a normally located conus can be candidates for surgery or an accurate clinical and radiological follow-up.


Assuntos
Lipoma/patologia , Neoplasias da Medula Espinal/patologia , Pré-Escolar , Humanos , Lipoma/complicações , Imagem por Ressonância Magnética , Masculino , Espinha Bífida Oculta/complicações , Neoplasias da Medula Espinal/complicações , Siringomielia/complicações
5.
J Clin Neurosci ; 69: 272-276, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31439491

RESUMO

Mobile or migratory intradural extramedullary schwannoma have been reported many times in the lumbar levels, however only twice in cervical spine and six times in thoracic spine. Double migration was reported only once. The exact cause of the migration of a schwannoma arising from the nerve sheath of a spinal nerve root is unclear and especially mysterious in cervical and thoracic spine. We report a 49 year old male who presented with multiple sclerosis confirmed on brain MRI and CSF showing oligoclonal bands, with concomitant spinal myelopathy from a thoracic intradural extramedullary lesion. Serial MRIs showed rostral migration of lesion initially from T10 level to T6 and then caudally to T9 level on day of surgery. Intra operatively it was mobile with respirations and disconnected from any neural or vascular attachments. Histopathology confirmed a benign schwannoma with areas of necrosis. This is the rare occurrence of double migration of thoracic intradural schwannoma with possibility of tumor disconnection due to high dose steroid therapy for multiple sclerosis.


Assuntos
Esclerose Múltipla/complicações , Neurilemoma/complicações , Neurilemoma/patologia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Vértebras Torácicas
6.
J Clin Neurosci ; 68: 308-311, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31327592

RESUMO

BACKGROUND: Malignant Intramedullary Spinal Cord Tumor are a relatively uncommon entity affecting patients whose prognosis is quickly and relentlessly dismal. Since the '50s Spinal Cordectomy' has been advocated for the surgical management of these conditions, but to date, no standard operative protocol has been reported yet. OBJECTIVE: Although apparently "easy", burdened by virtually no further risk for the neurological function in paraplegic or severely paraparetic patients, SCt conceals notable pitfalls and surgical problems that are to date not yet completely discussed. The objective of the present paper is therefore to report a detailed stepwise description of the surgical technique. METHODS AND RESULTS: SCt addresses the problem of reaching a surgical radicality in patients whom neurological preoperative conditions have already irreversibly declined to a deep nonfunctional motor impairment and whose preoperative Brain MRI scan rules out intracranial seeding. The dural sac along with the radicular pouches must be considered as possible seeding and recurrence locations therefore such structure should be "en-bloc" removed. The cranial medullary end of the resection should be identified on the ground of the preoperative MRI and intraoperatively confirmed with fresh histological examinations ruling out the presence of tumor cells above the cordectomy. Due to the topographic and functional medullary arterial anatomy, no SCt should be performed above T3. The risk of postoperative sagittal imbalance is high and therefore a concurrent posterior vertebral stabilization is required. CONCLUSION: Spinal Cordectomy is a safe and feasible "last chance" treatment to prolong survival in paraplegic or severely paraparetic patients.


Assuntos
Glioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Paraplegia/complicações , Neoplasias da Medula Espinal/cirurgia , Adulto , Idoso , Feminino , Glioma/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paraparesia/complicações , Medula Espinal/cirurgia , Neoplasias da Medula Espinal/complicações , Vértebras Torácicas , Resultado do Tratamento
7.
World Neurosurg ; 130: 222-226, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31302270

RESUMO

BACKGROUND: Hydrocephalus secondary to spinal cord tumors is rare. CASE DESCRIPTION: We present a 39-year-old male with gradual-onset headache whose initial diagnosis was cerebral aneurysm and communicating hydrocephalus. The correct diagnosis was primary intradural extramedullary malignant melanoma of the spinal cord. Initial brain magnetic resonance imaging demonstrated slight dilation of cerebral ventricles and a 3-mm unruptured anterior communicating artery aneurysm. He was placed under observation therapy. Two months later he was seen again due to severe headache. There was no intracranial hemorrhage on brain computed tomography scans. As we suspected rupture of the aneurysm, we operated on him for surgical clipping; however, there was no aneurysmal rupture. We found no lesions responsible for hydrocephalus, so we placed a ventriculoperitoneal shunt. His headache subsequently resolved. Nine months later he developed gait disturbance; a large volume of ascites was observed. Gadolinium-enhanced lumbar magnetic resonance imaging revealed an intradural extramedullary mass at the L-1 to S-5 level. Cytology and immunohistochemistry of the cerebrospinal fluid and ascites identified a few atypical cells positive for HMB-45, S-100 protein, and Melan-A. Whole-body examinations detected no primary lesions outside the central nervous system. Our final diagnosis was primary intradural extramedullary malignant melanoma of the spinal cord with cerebrospinal fluid dissemination. CONCLUSIONS: Our findings indicate that communicating hydrocephalus may be due to primary malignant melanoma of the spinal cord.


Assuntos
Hidrocefalia/cirurgia , Melanoma/cirurgia , Neoplasias Cutâneas/cirurgia , Neoplasias da Medula Espinal/cirurgia , Adulto , Descompressão Cirúrgica/métodos , Cefaleia/complicações , Cefaleia/cirurgia , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/etiologia , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/cirurgia , Masculino , Melanoma/complicações , Melanoma/diagnóstico , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/diagnóstico , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico
9.
J Neurooncol ; 144(2): 385-391, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31338784

RESUMO

PURPOSE: Few published articles have explicitly focused on cysts associated with intramedullary (IM) ependymomas. The objective was to assess the clinical, MRI, and oncological results of patients operated for an IM ependymoma associated with a cystic portion. METHODS: During the study period, 23 IM tumors resected were cystic ependymomas. The modified McCormick scale was used to assess the neurological function of patients. The diagnosis of cystic spinal cord tumor was made on preoperative MRI. RESULTS: Two types of cysts were identified according to their location: either intra-tumoral cysts (ITC) or satellite cysts (SC). ITC (52.2%) were more frequent than SC (21.7%), but 26.1% of patients presented both. ITC were enhanced by gadolinium while SC were not. The solid portion of ependymomas with ITC was significantly larger than the one of ependymomas with SC (p = 0.002). The mean time to the first occurrence of symptoms was significantly shorter in patients with neurological deficit than those without a deficit (p = 0.04). GTR was achieved in 78.2% of cases. Complete excision of the cysts was easier when they were larger (p = 0.006). Sixty percent of cysts disappear postoperatively. Persistence of satellite cysts despite GTR of the tumor, and with no recurrence of a tumor on the post-operative MRI, was observed for 3 patients. CONCLUSION: ITC and SC are different in location, volume, gadolinium enhancement. Their surgical management is different since ITC are resected while SC are drained. Cystic recurrence and/or persistence are not synonymous with tumor recurrence.


Assuntos
Cistos/patologia , Ependimoma/patologia , Imagem por Ressonância Magnética/métodos , Neoplasias da Medula Espinal/patologia , Adulto , Meios de Contraste , Cistos/complicações , Cistos/cirurgia , Ependimoma/complicações , Ependimoma/cirurgia , Feminino , Seguimentos , Gadolínio DTPA , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/cirurgia , Adulto Jovem
10.
Neuropathology ; 39(4): 313-318, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31243802

RESUMO

Giant cell ependymoma (GCE) is a very uncommon variant of ependymoma, known for having varying degrees of nuclear pleomorphism. There are only 34 reported cases of GCE in the English literature. We describe an additional case of a young woman who presented with a tumor located in sacral soft tissue, which was not connected to the spinal cord and did not show additional lesions in the central nervous system. Complete tumor resection was performed and no recurrences or metastasis were detected after 5 months of follow-up. Only one of all the reported GCE was located in the sacral subcutaneous region, where ependymomas are rarely found and usually have myxopapillary histology. Ours is the second report showing microscopic features of GCE in the soft-tissue region. GCE should be considered in the differential diagnosis of lumbosacral subcutaneous tumors to avoid misdiagnosing it as a malignant lesion. Since GCE could be an extraspinal extension of an intraneural ependymoma, it would be important to evaluate whether it is connected to the spinal cord.


Assuntos
Ependimoma/patologia , Neoplasias de Tecidos Moles/patologia , Neoplasias da Medula Espinal/patologia , Adulto , Diagnóstico Diferencial , Ependimoma/complicações , Ependimoma/diagnóstico , Feminino , Humanos , Região Sacrococcígea , Neoplasias de Tecidos Moles/complicações , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico
11.
J Am Acad Orthop Surg ; 27(12): e555-e567, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31170097

RESUMO

Cervical spinal deformity (CSD) in adult patients is a relatively uncommon yet debilitating condition with diverse etiologies and clinical manifestations. Similar to thoracolumbar deformity, CSD can be broadly divided into scoliosis and kyphosis. Severe forms of CSD can lead to pain; neurologic deterioration, including myelopathy; and cervical spine-specific symptoms such as difficulty with horizontal gaze, dysphagia, and dyspnea. Recently, an increased interest is shown in systematically studying CSD with introduction of classification schemes and treatment algorithms. Both major and minor complications after surgical intervention have been analyzed and juxtaposed to patient-reported outcomes. An ongoing effort exists to better understand the relationship between cervical and thoracolumbar spinal alignment, most importantly in the sagittal plane.


Assuntos
Vértebras Cervicais/cirurgia , Cifose/etiologia , Cifose/cirurgia , Escoliose/etiologia , Escoliose/cirurgia , Artrite Reumatoide/complicações , Transtornos de Deglutição/etiologia , Dispneia/etiologia , Fixação Ocular , Humanos , Doença Iatrogênica , Degeneração do Disco Intervertebral/complicações , Cifose/diagnóstico por imagem , Cervicalgia/etiologia , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias , Escoliose/diagnóstico por imagem , Doenças da Medula Espinal/etiologia , Neoplasias da Medula Espinal/complicações , Espondilose/complicações , Transtornos da Visão/etiologia
12.
World Neurosurg ; 128: 422-425, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31108251

RESUMO

BACKGROUND: Malignant melanotic schwannian tumors (MMSTs) are rare peripheral nerve sheath tumors that typically exhibit benign clinical presentation and histopathology but malignant long-term behavior. CASE DESCRIPTION: We report a case of a 22-year-old male with a T9-11 MMST who presented with acute paraplegia and complete loss of sacral function. Despite emergent decompression, he did not recover motor, sensory or bladder function, although bowel function did normalize. CONCLUSIONS: The anatomic location and rapid presentation of permanent deficits are suggestive of infarction of the spinal cord supplied by the artery of Adamkiewicz, a rare presentation of this disorder and of spinal schwannomas in general.


Assuntos
Infarto/etiologia , Neurofibrossarcoma/complicações , Paraplegia/etiologia , Isquemia do Cordão Espinal/etiologia , Neoplasias da Medula Espinal/complicações , Descompressão Cirúrgica , Humanos , Infarto/diagnóstico por imagem , Infarto/patologia , Masculino , Neurofibrossarcoma/diagnóstico por imagem , Neurofibrossarcoma/patologia , Neurofibrossarcoma/cirurgia , Distúrbios Somatossensoriais/etiologia , Isquemia do Cordão Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/patologia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia , Adulto Jovem
13.
World Neurosurg ; 128: 206-208, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31051309

RESUMO

Rupture of the spinal dermoid is rare. There may be intracranial deposition of fat secondary to it. We report a case of an adult male who presented with features of obstructive hydrocephalus secondary to ruptured lumbar dermoid. A 42-year-male presented with acute-onset headache and vomiting for 2 days. There was grade 3 papilledema on fundus examination. Magnetic resonance imaging showed ventriculomegaly with aqueductal obstruction. Multiple T1 and T2 hyperintense deposits were also noted along the ventricular wall. Magnetic resonance imaging of the spine showed a T1, T2 hyperintense intramedullary lesion at the lumbar region with multiple fat deposits along the spinal axis. He underwent endoscopic third ventriculostomy and is doing well at the 6-month follow-up. He is asymptomatic for the spinal lesion. Silent rupture of the spinal dermoid causing obstructive hydrocephalus is rare. These patients may remain asymptomatic for the spinal lesion and improves with cerebrospinal fluid diversion.


Assuntos
Cisto Dermoide/diagnóstico por imagem , Hidrocefalia/diagnóstico por imagem , Lipídeos , Neoplasias da Medula Espinal/diagnóstico por imagem , Espaço Subaracnóideo/diagnóstico por imagem , Adulto , Cisto Dermoide/complicações , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Imagem por Ressonância Magnética , Masculino , Neuroendoscopia , Ruptura Espontânea , Neoplasias da Medula Espinal/complicações , Tomografia Computadorizada por Raios X , Ventriculostomia
14.
World Neurosurg ; 126: 223-227, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30876988

RESUMO

BACKGROUND: Primary spinal glioblastoma multiforme is a rare and aggressive spinal tumor with dismal outcomes CASE DESCRIPTION: We have presented an unusual case-the first, to the best of our knowledge, to be reported-with intratumoral hemorrhage and sudden-onset quadriplegia in a patients with primary spinal glioblastoma multiforme. The patient underwent emergency surgical decompression. The patient died after a prolonged intensive care unit stay. CONCLUSION: The tumor was positive for histone molecular alteration, H3K27M.


Assuntos
Medula Cervical/patologia , Glioblastoma/complicações , Hemorragia/etiologia , Neoplasias da Medula Espinal/complicações , Adulto , Biomarcadores Tumorais/metabolismo , Medula Cervical/metabolismo , Medula Cervical/cirurgia , Descompressão Cirúrgica , Evolução Fatal , Feminino , Glioblastoma/metabolismo , Glioblastoma/patologia , Glioblastoma/cirurgia , Hemorragia/metabolismo , Hemorragia/patologia , Hemorragia/cirurgia , Humanos , Neoplasias da Medula Espinal/metabolismo , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia
15.
World Neurosurg ; 126: 369-375, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30902768

RESUMO

BACKGROUND: Intramedullary glial neoplasms affecting the entire spinal cord from the cervicomedullary junction to conus medullaris are termed holocord tumors. Pilocytic astrocytomas are relatively uncommon tumors forming holocord involvement. Hitherto 24 holocord astrocytoma cases were reported in the literature. Here, a case of an adult holocord pilocytic astrocytoma was presented. CASE DESCRIPTION: A 29-year-old female patient presented with a subtotal resection. Histopathologic examination revealed pilocytic astrocytoma, World Health Organization grade 1, presenting holocord involvement. Magnetic resonance imaging showed a mass containing necrotic and cystic foci leading to an expansion along the entire spinal cord extending from C4 to conus medullaris. CONCLUSIONS: Reported holocord pilocytic astrocytomas in the relevant literature cases were reviewed. When evaluating magnetic resonance imaging scans of adult patients with various neurologic symptoms, i.e., weakness and fecal and urinary incontinence, pilocytic astrocytoma should be considered among differential diagnoses of intramedullary mass lesions.


Assuntos
Astrocitoma/diagnóstico por imagem , Astrocitoma/patologia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Adulto , Astrocitoma/complicações , Feminino , Humanos , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Neoplasias da Medula Espinal/complicações
16.
World Neurosurg ; 127: 232-236, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30904797

RESUMO

BACKGROUND: Hyperhidrosis is caused by sympathetic dysfunction of the central or peripheral nervous system. However, intramedullary spinal cord tumors presenting with hyperhidrosis as an initial symptom have been rarely reported in the literature. CASE DESCRIPTION: This case involves an 18-year-old man who presented with abnormal enhanced sweating and flushing on the bilateral side of his face and neck that had persisted for 6 years. Magnetic resonance (MR) images revealed that at the C7-T2 levels of the spinal cord, a large intramedullary tumor was involved in the cervicothoracic region. The patient underwent gross total resection of the tumor via the fluorescein-guided technique and intraoperative neurophysiologic monitoring. The histopathologic diagnosis revealed ganglioglioma. The symptoms gradually improved after surgery, and the patient presented with virtually complete remission at the end of an 18-month follow-up. CONCLUSIONS: Few cases of intramedullary spinal cord tumors presenting as hyperhidrosis in clinical manifestation have been reported in the literature. Sympathetic irritation by the tumor, particularly in the location around the gray matter of the lateral spinal cord, may account for the hyperhidrosis as the initial symptom in this patient. Therefore, if a patient has autonomic dysfunction, the spine cord should be additionally examined using MR imaging.


Assuntos
Ganglioglioma/diagnóstico , Hiperidrose/diagnóstico , Neoplasias da Medula Espinal/diagnóstico , Adolescente , Diagnóstico Diferencial , Ganglioglioma/complicações , Ganglioglioma/cirurgia , Humanos , Hiperidrose/etiologia , Hiperidrose/cirurgia , Masculino , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/cirurgia
17.
World Neurosurg ; 126: 508-512, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30904802

RESUMO

BACKGROUND: Migratory tumors of the spinal cord are rare and can present as a missing tumor intraoperatively. This can lead to unnecessary abandonment of surgery or unnecessary laminectomies. CASE DESCRIPTION: We present a case of migratory intradural extramedullary tumor of the spine, which was missing intraoperatively. The surgery was abandoned, and on reimaging the tumor was found to have migrated. Here we summarize a review of the literature of such cases and the lessons we learned from our experience, emphasizing the measures to prevent tumor displacement and the importance of intraoperative imaging. CONCLUSIONS: Migratory schwannoma should be suspected in case of a missing lesion. Intraoperative ultrasonography and myelography use should be definitely considered where facility for intraoperative magnetic resonance imaging is not available. Preventive measures should be taken to avoid tumor migration in all routine cases of intradural extramedullary lesions.


Assuntos
Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Adulto , Medula Cervical/diagnóstico por imagem , Medula Cervical/patologia , Humanos , Masculino , Neurilemoma/complicações , Neoplasias da Medula Espinal/complicações
19.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(1): 33-37, ene.-feb. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-181459

RESUMO

Introducción: El tumor fibroso solitario (TFS) es un tumor poco frecuente de origen mesenquimal, que se localiza principalmente en pleura. De extraordinaria infrecuencia es su localización a nivel intraespinal, siendo la región torácica la más frecuente. Presentación del caso: Presentamos el caso de una paciente de 48 años con hipoestesia ascendente progresiva en miembros inferiores y mielopatía de un mes de evolución, que se diagnosticó de un tumor intraespinal en segmento D3-D4. Fue intervenida quirúrgicamente mediante abordaje dorsal posterior y laminoplastia D3-D4, hallándose un tumor intradural con componente intramedular, de 18×12mm, aproximadamente. La resección fue completa y la anatomía patológica resultó el diagnóstico de tumor fibroso solitario. La paciente, tras 7 meses de seguimiento se encuentra asintomática. Discusión: La resección completa tumoral junto con las características histopatológicas son los principales factores pronósticos, teniendo la cirugía un papel protagonista en este tipo de neoplasia. Conclusión: Son muy pocos los casos publicados en la literatura de tumor fibroso solitario con localización intraespinal. Con este artículo aportamos un nuevo caso a la misma


Introduction: Solitary fibrous tumor (TFS) is a rare tumor of mesenchymal origin, located mainly in the pleura. It is extraordinarily infrequent find it at the intraespinal level, being the thoracic region the most frequent. Case presentation: We present the case of a 48-year-old patient with progressive ascending lower limb and myelopathy of one month of evolution, with intraspinal location at the D3-D4 level. It was surgically operated by posterior dorsal approach and D3-D4 laminoplasty, with an intradural tumor with an intramedullary component of approximately 18×12mm. The resection was complete and the pathological anatomy gave the diagnosis of solitary fibrous tumor. The patient is currently asymptomatic. Discussion: Complete tumor resection and histopathological features are the main prognostic factors. Surgery have a main role in this type of neoplasia. Conclusion: There are few case published of solitary fibrous tumor with intraspinal localization. We apport another case to the literature


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Tumores Fibrosos Solitários/diagnóstico por imagem , Tumores Fibrosos Solitários/cirurgia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Hipestesia/complicações , Neurofisiologia , Imuno-Histoquímica/métodos
20.
World Neurosurg ; 125: 451-455, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30685376

RESUMO

BACKGROUND: Intramedullary capillary hemangiomas are rare lesions with only 14 cases reported so far and are found in middle-aged persons. Until now only a single case has been reported in the pediatric population. Ours was the second pediatric case and the youngest of all to be diagnosed with an intramedullary capillary hemangioma. CASE DESCRIPTION: We are reporting the case of a 2-month male child who presented with features of hydrocephalus and spastic paraparesis. On magnetic resonance imaging he had features suggestive of a D10-11 intradural extramedullary lesion and hydrocephalus. We did a ventriculoperitoneal shunt followed by excision of the lesion in the same sitting. Intraoperatively it was found to be an intramedullary lesion, and histopathologic examination showed features suggestive of capillary hemangioma. Postoperatively he recovered well and there is no recurrence 18 months after surgery. CONCLUSIONS: Intramedullary capillary hemangiomas are extremely rare lesions in infants but should be kept in mind while treating any patient with the spinal lesion. Further reporting of similar cases will help in understanding the natural history, pathogenesis, and management.


Assuntos
Hemangioma Capilar/complicações , Hidrocefalia/etiologia , Paraparesia Espástica/etiologia , Neoplasias da Medula Espinal/complicações , Hemangioma Capilar/cirurgia , Humanos , Hidrocefalia/cirurgia , Lactente , Imagem por Ressonância Magnética , Masculino , Paraparesia Espástica/cirurgia , Neoplasias da Medula Espinal/cirurgia , Derivação Ventriculoperitoneal/métodos
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