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1.
Artigo em Russo | MEDLINE | ID: mdl-35942843

RESUMO

Extramedullary spinal cord tumors at the level of craniovertebral junction are a rare group of neoplasms with their own characteristics. Taking into account the peculiarities of clinical course and complex anatomy of craniovertebral complex, these tumors present a complex diagnostic and surgical problem. A systematic review of literature data on epidemiology, clinical picture, diagnostic methods and dorsal minimally invasive methods of surgical treatment of patients with extramedullary spinal cord tumors of craniovertebral junction was performed.


Assuntos
Neoplasias da Medula Espinal , Humanos , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia
2.
Oper Neurosurg (Hagerstown) ; 23(2): e132-e136, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35838475

RESUMO

BACKGROUND AND IMPORTANCE: Capillary hemangiomas are space-occupying lesions that rarely affect the central nervous system. When they present within the spinal canal, they can cause insidious symptoms and threaten neurological function. In this study, we present a case of an intradural extramedullary capillary hemangioma of the lumbar spine, discuss our management strategy, and review the current literature. For the first time for this diagnosis, we also provide an operative video. CLINICAL PRESENTATION: The patient is a previously healthy 40-year-old man who presented with complaints of progressive low back and leg pain, numbness, and intermittent subjective urinary incontinence. MRI revealed a discrete, homogenously enhancing intradural extramedullary lesion at L4. This lesion was resected by performing an L4 laminoplasty, which entails en bloc removal of the L4 lamina and then securing it back into place once the intradural resection and dural closure are completed. Histological analysis revealed a diagnosis of capillary hemangioma. The patient had full resolution of his symptoms postoperatively. DISCUSSION: Definitive management of spinal capillary hemangiomas involves gross total resection and can be accomplished with laminoplasty. Because these benign tumors can be adherent to adjacent structures, intraoperative neuromonitoring is helpful adjunct to preserve neurological function for a good outcome. CONCLUSION: Capillary hemangiomas rarely affect the spine but should be considered on the list of differential diagnoses of intradural lesions.


Assuntos
Hemangioma Capilar , Neoplasias da Medula Espinal , Adulto , Hemangioma Capilar/diagnóstico por imagem , Hemangioma Capilar/patologia , Hemangioma Capilar/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Imageamento por Ressonância Magnética , Masculino , Procedimentos Neurocirúrgicos , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia
3.
Sci Rep ; 12(1): 10151, 2022 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-35710920

RESUMO

MRI is the primary diagnostic modality for spinal cord tumors. However, its validity has never been vigorously scrutinized in daily routine clinical practice, where MRI tissue diagnosis is usually not a single one but multiple ones with several differential diagnoses. Here, we aimed to assess the validity of MRI in terms of predicting the pathology and location of the tumor in routine clinical settings. We analyzed 820 patients with primary spinal cord tumors, who have a pathological diagnosis and location in the operation record which were confirmed. We modified traditional measures for validity based upon a set of diagnoses instead of a single diagnosis. Sensitivity and specificity and positive and negative predictabilities were evaluated for the tumor location and pathology. For tumor location, 456 were intradural extramedullary; 165 were intramedullary, and 156 were extradural. The overall sensitivity and specificity were over 90.0%. However, the sensitivity became lower when the tumor resided simultaneously in two spaces such as in the intradural-and-extradural or intramedullary-and-extramedullary space (54.6% and 30.0%, respectively). Most common pathology was schwannoma (n = 416), followed by meningioma (114) and ependymoma (87). Sensitivities were 93.3%, 90.4%, and 89.7%, respectively. Specificities were 70.8%, 82.9%, and 76.0%. In rare tumors such as neurofibromas, and diffuse midline gliomas, the sensitivity was much lower (less than 30%). For common locations and pathologies, the validity of MRI is generally acceptable. However, for rare locations and pathologies, MRI diagnosis still needs some improvement.


Assuntos
Ependimoma , Neoplasias Meníngeas , Meningioma , Neoplasias da Medula Espinal , Ependimoma/patologia , Humanos , Imageamento por Ressonância Magnética , Meningioma/diagnóstico , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia
4.
J Neurooncol ; 158(1): 117-127, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35538385

RESUMO

PURPOSE: Surgical resection is considered standard of care for primary intramedullary astrocytomas, but the infiltrative nature of these lesions often precludes complete resection without causing new post-operative neurologic deficits. Radiotherapy and chemotherapy serve as potential adjuvants, but high-quality data evaluating their efficacy are limited. Here we analyze the experience at a single comprehensive cancer center to identify independent predictors of postoperative overall and progression-free survival. METHODS: Data was collected on patient demographics, tumor characteristics, pre-operative presentation, resection extent, long-term survival, and tumor progression/recurrence. Kaplan-Meier curves modeled overall and progression-free survival. Univariable and multivariable accelerated failure time regressions were used to compute time ratios (TR) to determine predictors of survival. RESULTS: 94 patients were included, of which 58 (62%) were alive at last follow-up. On multivariable analysis, older age (TR = 0.98; p = 0.03), higher tumor grade (TR = 0.12; p < 0.01), preoperative back pain (TR = 0.45; p < 0.01), biopsy [vs GTR] (TR = 0.18; p = 0.02), and chemotherapy (TR = 0.34; p = 0.02) were significantly associated with poorer survival. Higher tumor grade (TR = 0.34; p = 0.02) and preoperative bowel dysfunction (TR = 0.31; p = 0.02) were significant predictors of shorter time to detection of tumor growth. CONCLUSION: Tumor grade and chemotherapy were associated with poorer survival and progression-free survival. Chemotherapy regimens were highly heterogeneous, and randomized trials are needed to determine if any optimal regimens exist. Additionally, GTR was associated with improved survival, and patients should be counseled about the benefits and risks of resection extent.


Assuntos
Astrocitoma , Neoplasias da Medula Espinal , Astrocitoma/patologia , Humanos , Procedimentos Neurocirúrgicos , Intervalo Livre de Progressão , Estudos Retrospectivos , Neoplasias da Medula Espinal/patologia , Resultado do Tratamento
5.
World Neurosurg ; 164: 178-198, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35552036

RESUMO

Benign tumors that grow in the spinal canal are heterogeneous neoplasms with low incidence; from these, meningiomas and nerve sheath tumors (neurofibromas and schwannomas) account for 60%-70% of all primary spinal tumors. Benign spinal canal tumors provoke nonspecific clinical manifestations, mostly related to the affected level of the spinal cord. These tumors present a challenge for the patient and healthcare professionals, for they are often difficult to diagnose and the high frequency of posttreatment complications. In this review, we describe the epidemiology, risk factors, clinical features, diagnosis, histopathology, molecular biology, and treatment of extramedullary benign meningiomas, osteoid osteomas, osteoblastomas, aneurysmal bone cysts, osteochondromas, neurofibromas, giant cell tumors of the bone, eosinophilic granulomas, hemangiomas, lipomas, and schwannomas located in the spine, as well as possible future targets that could lead to an improvement in their management.


Assuntos
Neoplasias Meníngeas , Meningioma , Neurilemoma , Neurofibroma , Neurofibromatoses , Neoplasias da Medula Espinal , Neoplasias da Coluna Vertebral , Humanos , Canal Medular/patologia , Neoplasias da Medula Espinal/patologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/epidemiologia , Neoplasias da Coluna Vertebral/cirurgia
6.
Spinal Cord Ser Cases ; 8(1): 43, 2022 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-35459220

RESUMO

INTRODUCTION: Spinal myxopapillary ependymomas (SME) are rare WHO grade II neoplasms of the spinal cord. Despite their good prognosis, they have a high propensity for metastasis and recurrence, although the presentation of SME as multifocal is uncommon. CASE PRESENTATION: Here we describe a rare case of a 34-year-old man who presented with painful bilateral radiculopathy with sexual dysfunction and altered sensation with defecation. The patient also reported worsening weakness of bilateral lower extremities when climbing stairs. Biopsy results revealed multifocal SME in the lumbar and sacral spine that was treated with staged surgical resection and post-operative focal radiation therapy. DISCUSSION: We discuss and evaluate surgical resection and the role of postoperative radiotherapy for SME. We also review the literature surrounding multifocal SME presenting in adults.


Assuntos
Ependimoma , Neoplasias da Medula Espinal , Adulto , Ependimoma/diagnóstico , Ependimoma/patologia , Ependimoma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia , Resultado do Tratamento
7.
World Neurosurg ; 164: 203-215, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35487493

RESUMO

OBJECTIVE: The primary objective of our systematic review and meta-analysis was to systematically compare the reported outcomes between laminectomy and laminectomy with fixation/fusion (LF) for the treatment of intradural extramedullary tumors (IDEMTs). Our secondary objective was to compare the outcomes between different laminectomy exposure techniques. METHODS: PubMed and Embase were queried for literature on laminectomy and LF for IDEMTs. Reports of transforaminal approaches, interlaminar approaches, corpectomy, pediatrics patients, intramedullary tumors, technical studies, animal or cadaver studies, and literature reviews were excluded. The outcome measures recorded were pain, neurologic function, functional independence, cerebrospinal fluid leak, and wound infection. Where possible, the laminectomy technique (partial laminectomy [PL] vs. total laminectomy [TL]) was specified. Stata, version 17, was used for the fixed effects inverse variance meta-analysis. RESULTS: Of 1849 reports assessed, 17 were included. The meta-analysis revealed that laminectomy (PL or TL) resulted in higher rates of postoperative sagittal instability compared with LF (odds ratio, 1.81; P < 0.001). No differences in any other postoperative outcome were observed between laminectomy and LF (P = 0.44). The systematic review also revealed no differences in postoperative pain, neurologic function, or functional independence or disability between PL and TL. Some evidence suggested that TL might result in greater rates of sagittal instability compared with PL. CONCLUSIONS: No differences between LF, PL, or TL in pain, neurologic deficit, functional independence, cerebrospinal fluid leak, or wound infection were reported. Laminectomy had greater odds of sagittal instability compared with LF. Patients with preoperative sagittal instability requiring extensive removal of the posterior spinal column to achieve adequate resection of large tumors might benefit from LF.


Assuntos
Neoplasias da Medula Espinal , Fusão Vertebral , Infecção dos Ferimentos , Vazamento de Líquido Cefalorraquidiano/cirurgia , Criança , Humanos , Laminectomia/métodos , Dor/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia , Resultado do Tratamento
8.
J Int Med Res ; 50(3): 3000605221082889, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35313772

RESUMO

BACKGROUND: Spinal ependymoma is the most common intramedullary tumor in adults. This study was performed to evaluate whether intraoperative yellow fluorescence use enhances our ability to identify the tumor margin and residual tumor tissue in intramedullary spinal cord ependymoma resection. We also evaluated patients' clinical conditions at a 3-month follow-up. METHODS: We retrospectively evaluated 56 patients with intramedullary ependymoma. Thirty minutes before anesthesia, the patients received intravenous sodium fluorescein injections. Tumor resection was performed under two illumination modes, traditional white light and yellow fluorescence, and the residual tumor tissue was detected. Magnetic resonance imaging was performed 3 months postoperatively to observe the tumor resection outcome and residual tumor tissue. The McCormick spinal cord function grade was evaluated preoperatively and 3 months postoperatively. RESULTS: The total resection rate was 100.0% in all patients. Nine patients had no significant fluorescence imaging. After 3 months, patients with a spinal function grade of I to IV showed significant spinal function improvement. Magnetic resonance imaging showed no residual tumor tissue or recurrence. CONCLUSION: Sodium fluorescein aids in total excision of intramedullary spinal cord ependymoma and intraoperative residual tumor tissue identification. At the 3-month follow-up, the patients' functional outcome in the fluorescein group was good.


Assuntos
Ependimoma , Neoplasias da Medula Espinal , Adulto , Ependimoma/diagnóstico por imagem , Ependimoma/patologia , Ependimoma/cirurgia , Humanos , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Canal Medular , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia
9.
Spinal Cord Ser Cases ; 8(1): 35, 2022 03 28.
Artigo em Inglês | MEDLINE | ID: mdl-35347111

RESUMO

INTRODUCTION: Non-dysraphic intradural spinal cord lipomas are rare, and true intramedullary cervical-thoracic lipomas are extremely rare. Spinal lipomas usually present with chronic, progressive myelopathic features. Unlike dysraphic lipomas, which are usually located in the lumbo-sacral region, non-dysraphic lipomas are usually located in the cervical or thoracic spine. CASE PRESENTATION: We present an unusual case of a 21-year-old female who presented with four months of severe back pain, progressive spasticity, and weakness in the lower limbs. Magnetic resonance imaging (MRI) revealed a T1- and T2-hyperintense lesion between D4 and D6. DISCUSSION: This fatty intramedullary lesion had undergone evolution and a possible hemorrhagic infarct and cord compression. The patient underwent an urgent dorsal laminoplasty and total resection of this lesion, which histopathology indicated was a fibrous lipoma. Total resection is possible in such cases if a micro-surgical technique that includes neurophysiological monitoring is used.


Assuntos
Lipoma , Compressão da Medula Espinal , Neoplasias da Medula Espinal , Adulto , Feminino , Humanos , Lipoma/complicações , Lipoma/diagnóstico por imagem , Lipoma/cirurgia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia , Coluna Vertebral/patologia , Adulto Jovem
10.
Neurocirugia (Astur : Engl Ed) ; 33(2): 95-98, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35248304

RESUMO

Primary spinal cord melanoma is a rare disease that accounts for only 1% of all melanocytomas. Here we report a case of primary melanoma of the cervical spinal cord. In our case, 26-year-old female who were admitted to the hospital for left arm pain. Spinal magnetic resonance image (MRI) revealed a spinal cord tumor at the level of C2-3. The MRI images showed that the tumor compressed the spinal cord. At surgery, the spinal cord was under pressure and covered with shaped blackish brown neoplastic tissue. There were not any metastatic lesions. The patient is still alive six months after surgery.


Assuntos
Neoplasias Encefálicas , Melanoma , Neoplasias da Medula Espinal , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Melanoma/diagnóstico por imagem , Melanoma/patologia , Melanoma/cirurgia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia
11.
Spine J ; 22(8): 1325-1333, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35257840

RESUMO

BACKGROUND CONTEXT: Primary malignant non-osseous spinal tumors are relatively rare and this has led to a paucity of studies specifically examining the epidemiology of malignant spinal tumors. PURPOSE: To provide an updated and more comprehensive study examining the epidemiology and relative survival of these rare tumors. STUDY DESIGN/SETTING: Data was retrospectively acquired from the Central Brain Tumor Registry of the United States (CBTRUS). PATIENT SAMPLE: Primary malignant non-osseous spinal tumor cases diagnosed between 2000 and 2017 in the United States. OUTCOME MEASURES: Incidence rates (IRs), relative survival rates, and hazard ratios (HR) were measured. METHODS: IRs were calculated only for histologically-confirmed cases between 2000 and 2017. Relative survival estimates were calculated from survival information on malignant spinal tumors between 2001 and 2016 for death from any cause. Multivariable Cox proportional hazards regression models were constructed to control for age, sex, race, and ethnicity. RESULTS: From 2000 to 2017, approximately 587 new cases of malignant non-osseous spinal tumors were diagnosed every year in the United States. The overall IR was 0.178 per 100,000 persons. Ependymomas were the most commonly diagnosed tumor in all age groups. The 10-year relative survival rates were 94.1%, 62.1%, 62.0%, and 13.3% for ependymomas, lymphomas, diffuse astrocytomas, and high-grade astrocytomas, respectively. Females have a significantly lower risk of death as compared with males for ependymomas (HR: 0.74, p<.001) and diffuse astrocytomas (HR: 0.70, p=.005). African-Americans have a significantly higher risk of death compared with Caucasians when diagnosed with ependymomas (HR: 1.52, p=.009) or lymphomas (HR: 1.55, p=.009). CONCLUSION: Primary malignant non-osseous spinal tumors are primarily diagnosed in adulthood or late adulthood. Ependymal tumors are the most commonly diagnosed primary malignant non-osseous spinal tumors and have the highest 10-year relative survival rates. High-grade astrocytomas are rare and portend the worst prognosis.


Assuntos
Astrocitoma , Ependimoma , Linfoma , Neoplasias da Medula Espinal , Neoplasias da Coluna Vertebral , Adulto , Astrocitoma/diagnóstico , Feminino , Humanos , Masculino , Estudos Retrospectivos , Neoplasias da Medula Espinal/patologia , Neoplasias da Coluna Vertebral/epidemiologia , Estados Unidos/epidemiologia
12.
Spine J ; 22(8): 1345-1355, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35342014

RESUMO

BACKGROUND CONTEXT: Intramedullary spinal cord tumors (IMSCTs) are rare tumors associated with significant morbidity and mortality. Surgical resection is often indicated for symptomatic lesions but may result in new neurological deficits and decrease quality of life. Identifying predictors of these adverse outcomes may help target interventions designed to reduce their occurrence. Nonetheless, most prior studies have employed population-level datasets with limited granularity. PURPOSE: To determine independent predictors of nonroutine discharge, prolonged length of stay (LOS), and 30 day readmission and reoperation, and to deploy these results as a web-based calculator. STUDY DESIGN: Retrospective cohort study PATIENT SAMPLE: A total of 235 patients who underwent resection of IMSCTs at a single comprehensive cancer center. OUTCOME MEASURES: Nonroutine discharge, prolonged LOS, 30 day readmission, and 30 day reoperation METHODS: Patients who underwent surgery from June 2002 to May 2020 at a single tertiary center were included. Data was collected on patient demographics, clinical presentation, tumor histology, surgical procedures, and 30 day readmission and reoperation. Functional status was assessed using the Modified McCormick Scale (MMS) and queried preoperative neurological symptoms included weakness, urinary and bowel dysfunction, numbness, and back and radicular pain. Variables significant on univariable analysis at the α≤0.15 level were entered into a stepwise multivariable logistic regression model. RESULTS: Of 235 included cases, 131 (56%) experienced a nonhome discharge and 68 (29%) experienced a prolonged LOS. Of 178 patients with ≥ 30 days of follow-up, 17 (9.6%) were readmitted within 30 days and 13 (7.4%) underwent reoperation. Wound dehiscence (29%) was the most common reason for readmission. Nonhome discharge was independently predicted by older age (OR=1.03/year; p<.01), thoracic location of the tumor (OR=2.36; p=.01), presenting with bowel dysfunction (OR=4.09; p=.03), and longer incision length (OR=1.44 per level; p=.03). Independent predictors of prolonged LOS included presenting with urinary incontinence (OR=2.65; p=.05) or a higher preoperative white blood cell count (OR=1.08 per 103/µL); p=.01), while GTR predicted shorter LOS (OR=0.40; p=.02). Independent predictive factors for 30 day unplanned readmission included experiencing ≥1 complications during the first hospitalization (OR=6.13; p<.01) and having a poor (A-C) versus good (D-E) baseline neurological status on the ASIA impairment scale (OR=0.23; p=.03). The only independent predictor of unplanned 30 day reoperation was experiencing ≥1 inpatient complications during the index hospitalization (OR=6.92; p<.01). Receiver operating curves for the constructed models produced C-statistics of 0.67-0.77 and the models were deployed as freely available web-based calculators (https://jhuspine5.shinyapps.io/Intramedullary30day). CONCLUSIONS: We found that neurological presentation, patient demographics, and incision length were important predictors of adverse perioperative outcomes in patients with IMSCTs. The calculators can be used by clinicians for risk stratification, preoperative counseling, and targeted interventions.


Assuntos
Alta do Paciente , Neoplasias da Medula Espinal , Humanos , Tempo de Internação , Readmissão do Paciente , Complicações Pós-Operatórias/diagnóstico , Qualidade de Vida , Reoperação , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia
13.
Sci Rep ; 12(1): 4926, 2022 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-35322104

RESUMO

Adult spinal ependymoma presents a rare low-grade tumor entity. Due to its incidence peak in the fourth decade of life, it mostly affects patients during a professionally and physically active time of life. We performed a retrospective monocentric study, including all patients operated upon for spinal ependymoma between 2009 and 2020. We prospectively collected data on professional reintegration, physical activities and quality-of-life parameters using EQ-5D and SF-36. Issues encountered were assessed using existing spinal-cord-specific questionnaires and free-text questions. In total, 65 of 114 patients agreed to participate. Most patients suffered from only mild pre- and postoperative impairment on the modified McCormick scale, but 67% confirmed difficulties performing physical activities in which they previously engaged due to pain, coordination problems and fear of injuries after a median follow-up of 5.4 years. We observed a shift from full- to part-time employment and patients unable to work, independently from tumor dignity, age and neurological function. Despite its benign nature and occurrence of formal only mild neurological deficits, patients described severe difficulties returning to their preoperative physical activity and profession. Clinical scores such as the McCormick grade and muscle strength may not reflect the entire self-perceived impairment appropriately.


Assuntos
Ependimoma , Neoplasias da Medula Espinal , Adulto , Ependimoma/patologia , Ependimoma/cirurgia , Humanos , Procedimentos Neurocirúrgicos , Qualidade de Vida , Estudos Retrospectivos , Retorno ao Trabalho , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia , Resultado do Tratamento
14.
Nature ; 603(7903): 934-941, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35130560

RESUMO

Diffuse intrinsic pontine glioma (DIPG) and other H3K27M-mutated diffuse midline gliomas (DMGs) are universally lethal paediatric tumours of the central nervous system1. We have previously shown that the disialoganglioside GD2 is highly expressed on H3K27M-mutated glioma cells and have demonstrated promising preclinical efficacy of GD2-directed chimeric antigen receptor (CAR) T cells2, providing the rationale for a first-in-human phase I clinical trial (NCT04196413). Because CAR T cell-induced brainstem inflammation can result in obstructive hydrocephalus, increased intracranial pressure and dangerous tissue shifts, neurocritical care precautions were incorporated. Here we present the clinical experience from the first four patients with H3K27M-mutated DIPG or spinal cord DMG treated with GD2-CAR T cells at dose level 1 (1 × 106 GD2-CAR T cells per kg administered intravenously). Patients who exhibited clinical benefit were eligible for subsequent GD2-CAR T cell infusions administered intracerebroventricularly3. Toxicity was largely related to the location of the tumour and was reversible with intensive supportive care. On-target, off-tumour toxicity was not observed. Three of four patients exhibited clinical and radiographic improvement. Pro-inflammatory cytokine levels were increased in the plasma and cerebrospinal fluid. Transcriptomic analyses of 65,598 single cells from CAR T cell products and cerebrospinal fluid elucidate heterogeneity in response between participants and administration routes. These early results underscore the promise of this therapeutic approach for patients with H3K27M-mutated DIPG or spinal cord DMG.


Assuntos
Astrocitoma , Neoplasias do Tronco Encefálico , Gangliosídeos , Glioma , Histonas , Imunoterapia Adotiva , Mutação , Receptores de Antígenos Quiméricos , Astrocitoma/genética , Astrocitoma/imunologia , Astrocitoma/patologia , Astrocitoma/terapia , Neoplasias do Tronco Encefálico/genética , Neoplasias do Tronco Encefálico/imunologia , Neoplasias do Tronco Encefálico/patologia , Neoplasias do Tronco Encefálico/terapia , Criança , Gangliosídeos/imunologia , Perfilação da Expressão Gênica , Glioma/genética , Glioma/imunologia , Glioma/patologia , Glioma/terapia , Histonas/genética , Humanos , Imunoterapia Adotiva/métodos , Receptores de Antígenos Quiméricos/imunologia , Neoplasias da Medula Espinal/genética , Neoplasias da Medula Espinal/imunologia , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/terapia
15.
Clin Neurol Neurosurg ; 214: 107176, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35183850

RESUMO

INTRODUCTION: Given the potential injury to the spinal cord and the nerve roots during the surgery and the necessity of minimal spinal cord manipulation during surgery, minimally invasive surgical techniques have emerged as alternatives to conventional open surgery in resection of ID-EM tumors. METHODS: An electronic database search was conducted, and the review was carried out according to PRISMA guidelines and recommendations. Inclusion criteria were as follows; (i) comparative studies of MIS vs OS; (ii) studies reporting outcomes for patients undergoing surgery for ID-EM tumors. Variables collected were patient demographics, estimated blood loss (EBL), mean operative time, length of stay, complications, extent of tumor resection. RESULTS: The search identified a total of 275 studies. After the selection criterion was applied 7 comparative studies were included. A total of 302 patients were included in the analysis with 149 (49.3%) of them undergoing MIS and 153 of them (50.7%) undergoing open surgery. EBL, operative time, and LOS were significantly lower in MIS group (p < 0.0001, p < 0.0001, and p = 0.0002 respectively). Two groups were similar with regards to the rates of surgical complications, medical complications and gross total resection. The most common surgical complication was CSF leak (52.3% of all complications). CONCLUSION: Results of this meta-analysis show a significant reduction in EBL, operative time, and length of stay with MIS while proving safe and preserving high rates of gross-total resection. The findings suggest that the minimally invasive spine surgery may serve as a beneficial alternative for patients undergoing spine surgery for ID-EM tumors of the spinal cord.


Assuntos
Neoplasias da Medula Espinal , Fusão Vertebral , Neoplasias da Coluna Vertebral , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Neoplasias da Coluna Vertebral/cirurgia , Resultado do Tratamento
16.
J Clin Neurosci ; 97: 108-114, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35091315

RESUMO

BACKGROUND: Intradural spinal cord pathologies have traditionally been managed with open surgical procedures and require the completion of a durotomy. Minimally invasive techniques are emerging as alternative procedures with the goal of reducing complications, but often require specialized equipment with additional training. METHODS: We conduct a single institution retrospective review from 2016 to 2019 of patients undergoing minimally invasive durotomy closure for intradural extramedullary pathologies using a novel technique that utilizes standard operating room equipment. This cohort is compared to a cohort of patients treated with a traditional open approach. RESULTS: Patients treated with minimally invasive surgery (MIS) had no statistically significant differences in baseline characteristics compared to patients treated with open procedures. Patients treated with MIS had decreases in complication rates, estimated blood loss, and length of stay in the hospital compared to the patients treated with open procedures, but these differences did not reach levels of statistical significance. CONCLUSIONS: Our novel MIS technique for intradural extramedullary pathologies appears to be safe and effective in creating a watertight dural closure using standard operating room equipment, while avoiding the costs and training associated with specialized equipment and possibly improving surgical outcome measures when compared to open approaches.


Assuntos
Neoplasias da Medula Espinal , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia , Resultado do Tratamento
17.
Medicine (Baltimore) ; 101(4): e28682, 2022 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-35089217

RESUMO

ABSTRACT: This is a retrospective study. The aim of this study was to determine the indicators of neurological outcome after surgery in patients with intramedullary spinal ependymomas by using magnetic resonance imaging (MRI).A total of 106 consecutive patients (mean age: 42.4 ±â€Š1.3 years; 52.8% male) diagnosed with intramedullary spinal ependymomas were retrospectively recruited. All patients underwent spine MRI and subsequent surgical resection for the spinal tumors. Data regarding clinical symptoms and pathological grades of tumors were collected from clinical records. The McCormick score was used for grading patients' neurological status before and after surgery at 12 months. Good outcome was defined as stable McCormick score (McC) score (no change of McC score between preoperation and post-operation at 12 months) or improvement in McC score (post-operative McC score at 12 months < preoperative McC score). Poor outcome was determined when there was an increase in McC score at 12 months after surgery. The MRI characteristics of spinal ependymomas between patients with good and poor neurological outcomes were compared. Logistic regression was performed to assess the association between MRI characteristics of tumors and post-operative neurological outcomes.Patients with poor neurological outcomes had larger longitudinal length (4.7 ±â€Š0.5 vs 3.3 ±â€Š0.2, P = .004) and higher enhancement signal-to-noise-ratio (SNR) (102.4 ±â€Š12.3 vs 72.8 ±â€Š4.6, P = .022) than those with good neurological outcomes. After adjusting for confounding factors, longitudinal length (OR, 0.768; 95% CI, 0.604-0.976; P = .031) and enhancement SNR (OR, 0.988; 95% CI, 0.978-0.999; P = .026) of spinal ependymomas were significantly associated with poor neurological prognosis.The longitudinal length of tumor and enhancement SNR on T1-weighted images are independently associated with neurological outcome after surgery.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Ependimoma/cirurgia , Imageamento por Ressonância Magnética/métodos , Neoplasias da Medula Espinal/cirurgia , Adulto , Ependimoma/diagnóstico por imagem , Ependimoma/patologia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Resultado do Tratamento
18.
Childs Nerv Syst ; 38(8): 1599-1603, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35006339

RESUMO

There are no specific guidelines regarding best treatment for focal, distant metastasis in ependymoma in the context of a well-controlled primary site. A combination using maximal safe resection and adjuvant radiotherapy is usually advised. As wound healing might be hindered by repeated radiotherapy, and delay future radiation treatment if needed, there is a growing interest in less invasive surgeries to reduce post-operative pain and wound healing complications. Those approaches have been extensively used and studied in adult but never in the pediatric population. Here, we present a pediatric case of a 12-year-old boy known for a posterior fossa ependymoma completely resected 18 months earlier who presented with a dual lumbosacral intradural ependymoma metastasis. A single-stage complete resection was achieved using a fixed tubular retractor with no complication. Post-operative course was favorable with rapid healing and discharge, minimal post-operative pain, and a rapid return to normal activities. Re-irradiation could be performed 2 weeks later without any problem. To our knowledge, this is the first report of the use of minimally invasive techniques to achieve complete resection of dual intradural metastasis of an ependymoma in the pediatric population. We demonstrate its feasibility and safety as well as its advantages.


Assuntos
Ependimoma , Neoplasias da Medula Espinal , Neoplasias da Coluna Vertebral , Criança , Ependimoma/patologia , Humanos , Masculino , Dor Pós-Operatória , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias da Coluna Vertebral/cirurgia , Resultado do Tratamento
19.
Clin Nucl Med ; 47(4): 385-386, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35020638

RESUMO

ABSTRACT: Myxopapillary ependymoma is a rare tumor. Most of them occur exclusively in the conus medullaris, cauda equina, or filum terminale. Here, we present the 68Ga-FAPI PET/CT findings in a 37-year-old woman with presacral myxopapillary ependymoma.


Assuntos
Cauda Equina , Ependimoma , Neoplasias da Medula Espinal , Adulto , Cauda Equina/diagnóstico por imagem , Ependimoma/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Quinolinas , Neoplasias da Medula Espinal/patologia
20.
Neurosurg Rev ; 45(2): 1563-1569, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34708272

RESUMO

Sodium fluorescein (NaFL) has been used to aid in the resection of primary and secondary lesions within the brain. Comparatively, there is limited research on clinical applications for lesions within the spinal cord. Fluorescein-guided microsurgery may increase the ability to localize and safely surgically treat spinal lesions. Twelve patients with spinal cord lesions received fluorescein sodium 10% (Alcon Laboratories INC, Fort Worth, TX, USA) at 3 mg/kg prior to surgical resection. Intraoperative visualization of fluorescence was performed using a Zeiss Pentero (Carl Zeiss AG, Oberkochen, Germany) microscope equipped with a Yellow560 filter or a Leica OH6 (Leica Microsystems, Wetzlar, Germany) equipped with a FL560 filter. Administration of NaFL resulted in lesional fluorescent contrast extravasation and facilitated surgical resection and localization in all twelve patients. In patients with a goal of complete resection, NaFL aided in complete resection of the spinal lesions in seven patients. In surgical resection patients, pathology was consistent with WHO grade I myxopapillary ependymoma in one patient, WHO grade II ependymoma in five patients, and nerve sheath tumor in one patient. In the other five patients, NaFL allowed for intraoperative tissue identification and successful tissue biopsy. In patients undergoing biopsy, tissue samples were positive for an intramedullary abscess, EBV-driven lymphoproliferative disease, and primary glial neoplasms. Fluorescein is a helpful microsurgical tool in guiding surgical resection and in the localization of intramedullary spinal lesions. Further research is necessary to explore fluorescein sodium applications in the resection of spinal cord lesions.


Assuntos
Ependimoma , Neoplasias da Medula Espinal , Biópsia , Ependimoma/cirurgia , Fluoresceína , Humanos , Procedimentos Neurocirúrgicos/métodos , Medula Espinal/patologia , Medula Espinal/cirurgia , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia
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