Cases Of Spinal Cord Tumors Research Articles

Clinical utility of intraoperative direct wave monitoring in patients with pre-operative motor deficits: Case series

Introduction and importanceD-wave (Direct waves) are Motor Evoked Potentials (MEPs) generated by a single transcranial stimulation and captured by attaching an epidural recording electrode caudal to the vulnerable area. Intraoperative neurophysiologic monitoring (IONM) is widely used in neurosurgery to recognize important neurological structures but can be challenging in the pediatric population due to incomplete neural development. Case presentationCase 1: A 48-year-old female presented to the outpatient department with complaints of difficulty walking for the past six months, numbness and weakness in bilateral lower limbs with recurrent falls for the past 1 month. Case 2: A 12-year-old boy presented to the emergency room with a history of inability to use both upper and lower limbs on the right side with tremulousness. Clinical discussionMagnetic resonance imaging (MRI) Spine in the first case revealed a D9-D10 calcified meningioma with significant spinal cord compression. In the second case, MRI Spine showed C1-C2 Intramedullary Space Occupying Lesion (SOL) and was planned for C1-C2 laminectomy with midline myelotomy. The first case was planned for microsurgical excision of the lesion under IONM guidance. The procedure went smoothly. Microsurgical gross total resection (GTR) of the intramedullary SOL under IONM Guidance was done for the second case. Postoperatively, the first patient showed no neurological compromise or complications. In the second case, following surgery, the child recovered gradually from surgery. ConclusionThis case series demonstrates the successful surgical management of two cases of spinal cord tumors through an IONM-guided surgery and the effective use of D waves in such challenging cases.

Intramedullary spinal cord tumors: A retrospective multicentric study.

Context:Intramedullary tumors are neoformations taking part on the spinal cord, and they are a rare pathology. Due to the rarity of such lesions, clinical studies take years to ensure a decent feedback with a significant number of cases.Design:Our study is retrospective and descriptive.Participants:We share a Tunisian multicentric experience of 27 years through a retrospective study of 120 cases of spinal cord tumors that have been operated in six different centers.Outcome Measures:The clinical, radiological, and histological findings have been analyzed along with postoperative results and tumoral progression so that we could conclude to some factors of prognosis concerning the management of these tumors.Results:The mean age of our patients is 33.84 years. We had 57 males and 63 females. The most frequent revealing symptom was motor trouble presented as frequent as 77.5% of the patients. Glial tumors were represented in 81 of the cases (67.5%) and nonglial by 39 cases (32.5%). Glial tumors we found were essentially 39 ependymomas and 35 astrocytomas. Surgical resection is key in the management of these lesions; the quality of tumoral resection was a significant factor of disease progression as subtotal resection is correlated to more important progression than total one.Conclusion:We conclude this work with some statements. In terms of functional results, age is not a significant factor. Presurgical functional state, the histological type, and the extent of surgical resection are the important factors.

L. Bruns. Klinische und pathologisch-anatomische Beit räge zur Chirurgie der Rückenmarkstumoren. Archiv f. Psychiatrie, Bd. ХХVIII, Heft. 1

Based on two own observations with consistent pathological and anatomical studies and critical analysis of the literature of the subject, the author comes to the conclusion that in one third of cases of spinal cord tumors, surgery can lead to cure. The precise recognition of the tumor site, which is necessary for success, is possible much more often than it was customary to think until recently.

Fluorescence Diagnosis in Neurooncology: Retrospective Analysis of 653 Cases.

Objective: This study is to analyze fluorescence sensitivity in the diagnosis of brain and spinal cord tumors.Material and methods: The authors conducted a multicenter retrospective analysis of data on 653 cases in 641 patients: 553 of them had brain tumors and 88 spinal cord tumors. Brain tumor resection was performed in 523 patients, of whom 484 were adults and 39 children. The analyzed series was presented by 320 gliomas, 101 meningiomas, and 72 metastases. A stereotactic biopsy was performed in 20 patients and endoscopic surgery in 10 patients. In all cases, 20 mg/kg of 5–Aminolaevulinic acid was administered orally 2-h before surgery. All surgical interventions were performed with a microscope BLUE 400 to visualize fluorescence, while endoscopic surgery—with an endoscope equipped with a fluorescent module. Fluorescence spectroscopy was conducted in 20 cases of stereotactic biopsies and in 88 cases of spinal cord tumors.Results: Among adult brain tumors operated by microsurgical techniques, meningiomas showed the highest 5-ALA fluorescence sensitivity 94% (n = 95/101), brain metastases 84.7% (n = 61/72), low-grade gliomas 46.4% (n = 26/56), and high-grade gliomas 90.2% (n = 238/264). In children the highest 5-ALA visible fluorescence was observed in anaplastic astrocytomas 100% (n = 4/4) and in anaplastic ependymomas 100% (n = 4/4); in low-grade gliomas it made up 31.8% (n = 7/22). As for the spinal cord tumors in adults, the highest sensitivity was demonstrated by glioblastomas 100% (n = 4/4) and by meningiomas 100% (n = 4/4); Fluorescence was not found in gemangioblastomas (n = 0/6) and neurinomas (n = 0/4). Fluorescence intensity reached 60% (n = 6/10) in endoscopic surgery and 90% (n = 18/20) in stereotactic biopsy.Conclusion: 5-ALA fluorescence diagnosis proved to be most sensitive in surgery of HGG and meningioma (90.2 and 94.1%, respectively). Sensitivity in surgery of intracranial metastases and spinal cord tumors was slightly lower (84.7 and 63.6%, correspondingly). The lowest fluorescence sensitivity was marked in pediatric tumors and LGG (50 and 46.4%, correspondingly). Fluorescence diagnosis can also be used in transnasal endoscopic surgery of skull base tumors and in stereotactic biopsy.

A CASE OF PRIMARY INTRAMEDULLARY TUMOR

Primary spinal cord tumors are rare neoplasms that can lead to significant patient disability and mortality. Given their rarity, they are often misdiagnosed, especially in the early stages, when a high index of suspicion is required. In rare cases of spinal cord tumors there may be a discrepancy between the sensory level and the real site of the tumor. This phenomenon, called “false localizing sign” is rare but well known and, if unrecognized, may delay the appropriate diagnosis and treatment. The aim of this work is to present a clinical case with a false localizing low thoracic sensory level due to an upper thoracic grade II ependymoma.

A Population-based Study on Pediatric Spinal Cord Tumors, with Emphasis on Intramedullary Ones

Purpose: Pediatric spinal cord tumors are rare accounting for 4-6% of all primary CNS tumors in this age group. Collecting large number of cases has always been difficult due to their scarcity. SEER database provides a source on varioustumors. Methods: We performed analysis on tumors of the spinal cord in patients between births to 20 years of age using the SEER data available for the period 1973-2005. Analysis of the incidence rate, the frequency of the most common types, the age, gender, treatment modality including radiotherapy and surgery is provided. In addition; the overall survival and the median survival has been analyzed for each tumor type and comparison between various types is performed. Results: There were 483 cases of spinal cord tumors with available data, representing 4.7% of all pediatric central nervous system tumors diagnosed over the same period. They predominated in males and in whites. The median age for diagnosis was 10 years, with two age peaks noted; in <3 years old and in adolescents 12 to 17 years old. Of intramedullary tumors astrocytoma was the most common histology followed by ependymoma. Low grade tumors predominated. Of all variables examined; histologic type, grade, gross total resection and not receiving radiotherapy showed significant association with outcome. Conclusions: Low- grade astrocytoma is the most common intramedullary tumor in first 2 decades of life, while ependymoma is mostly seen in the second decade of life. Assigning the appropriate histologic type and grade is important in determining the outcome of the patients.

Spinal dumbbell tumors: an analysis of a series of 118 cases

The authors analyzed a series of 118 cases of spinal dumbbell tumors to elucidate the feature of the tumors. Of 674 cases of spinal cord tumors, the incidence of dumbbell tumors was studied. The tumors were analyzed, and the authors focus on the distribution of age and sex, the pathological diagnoses, their locations, Eden classification, and the surgical methods used. The incidence of dumbbell tumors was 18%. The mean patient age was 43 years, which was younger than that for all spinal cord tumors (mean 50 years). There were 11 patients younger than 10 years of age. The rate of dumbbell tumors in the cervical spine was significantly higher than that of all spinal cord tumors. Fifteen (18%) of the 81 schwannomas were observed in the C-2 nerve root, thus having a higher incidence than those in the other nerve roots. In 99 cases (84%), the tumors were removed through a hemilaminectomy with or without a facetectomy and posterior fusion. Of 118 cases, 69% of the tumors were schwannomas, and malignant tumors were found in 10 cases (8.5%). Seven (64%) of 11 patients younger than 10 years of age had malignant tumors. Three patients older than 10 years of age had malignant tumors, thus accounting for 2.8% of the 107 older patients. The incidence of dumbbell tumors was 18%, and they are not uncommon. Malignant dumbbell tumors were more common in children younger than 10 years of age than in older patients.

Three Cases of Spinal Cord Tumor Originating from the Second Cervical Nerve Root

Determination of the level of spinal cord tumors that develop around the foramen magnum or high cervical region can be difficult, because the symptoms of such tumors are quite variable. The surgical approach to use in such cases remains controversial. We describe here three cases of spinal cord tumor originating from the second cervical nerve root. Initial symptoms included occipital pain, glove-type numbness, and paresthesia of the upper extremities. In all three cases, myelopathic signs preceded radicular signs. It was possible to resect the tumors almost completely by using a posterior approach with microsurgical technique. Several reports have concerned the best surgical approach for high cervical spinal cord tumors. However, by using our method, tumors originating from the C2 root could be exposed without destroying the facet joints, because the nerve root runs dorsal to the lateral facet joints. We therefore recommend resecting these tumors except when they involve the vertebral artery and facet joints.

A Case of Spinal Cord Tumor (A-V Malformation): as Unusual Cause of Anginal Chest Pain

Spinal cord tumors usually present themselves with severe pain without neurologic deficits during early stages. Cervical or thoracic spinal tumors can evoke anterior neck pain or chest pain without neurologic symptoms. As a result, when chest pain or anterior neck pain occurs initially, many physicians think its origin is a cardiac disorder such as angina. Eventually, during cardiac evaluation and treatment, myelopathy or radiculopathy develops to reveal spinal cord tumor. Even though it is rare, when anterior neck or chest pain is the presenting complaint, the possibility of spinal cord tumors should be considered. We report a case of spinal cord tumor with initial presentations of anginal chest pain and electrocardiographic myocardial ischemic changes (ST segment depression and T-wave inversion in a 45 year old male patient who had no history of hypertension. It was later discovered that the cause was due to an A-V malformation. ( ( ( (Korean Circulation J 1998;28(4 :638-641

Anaplastic astrocytoma of the spinal cord presenting with features of raised intracranial pressure

Intramedullary tumors of the spinal cord in childhood are usually of low grades (grades I and II) and are most commonly seen in the cervical and cervicothoracic regions. They present with symptoms and signs of spinal cord tumor. It is uncommon to find an anaplastic astrocytoma situated in the thoracolumbar segment of the spinal cord. Whereas papilledema and raised intracranial symptoms have been reported in about 12.5% of cases of spinal cord tumors it is rare to find them presenting initially only with symptoms of raised intracranial pressure and only later followed by spinal cord symptoms. The case of an 11-year-old female child is reported here because of a combination of these two rare features.

A Study of Spinal Cord Tumors by Magnetic Resonance Imaging

We studied 17 cases of spinal cord tumors using magnetic resonance imaging. According to the intensity of image and histological feature of spinal cord tumors, we identified two groups in T2 weighted imaging. One was a hypointensity group showing cystic or vascular tumors, and the other was hyperintensity group of solid tumors. Preoperative images of swelling, narrowing, deviation of the spinal cord were remained after the operations. Grafted free fatty tissue for the prevention of adhesion was recognized well also after the operation. Postoperative imagings sometime showed pseudo-deviation of the spinal cord which was easy to be mistaken as the remains of tumors and narrowing of the spinal cord. In conclusions, The magnetic resonance imaging makes very early detection of spinal cord tumors possible, and it is valuable for a diagnosis of the spinal cord tumor associated with brain tumor.

Spinal Cord Monitoring in Spinal Surgery

Spinal Cord Evoked Potentials (SPEP) were used for spinal cord monitoring in 9 cases of spinal surgery. In 3 cases of them, some changes were noted during operation. In one case of spinal cord tumor, a little increase of the amplitude was observed when the tumor was extirpated. In other two cases, one with idiopathic scoliosis and the other with epidural tumor, checking the decrease of the amplitude during operation was considered to be very helpful to avoid the spinal cord damage.

当科における脊髄腫ようの治療経験

Between the years of 1975-1987, 20 cases of spinal cord tumor were operated at Beppu National Hospital. 8 cases were female and 12 were male. There were 7 neurinomas, 5 meningiomas, 2 extradural cysts, 2 malignant lymphomas, 2 hemangiomas, an ependymoma, and a glioblastoma. These patients had neurological deficits in varying degrees before oparation. 13 patients had severe muscle weakness, 13 had anesthetic area in limbs and 12 had bowel and bladder dysfunctions. After operation these patients were improved by 66%, according to our evaluation score, but 3 cases died and 5 cases had some neurological deficits disturbing their daily life.

当院における脊髄腫よう例の検討

37 cases of spinal cord tumors were treated in our clinic. Seven cases were malignant tumors: astrocytoma, glioblastoma, malignant neurofibroma, reticulosarcoma, germinoma and malignant melanoma. 30 cases were benign tumors: 17 neurinomas, 4 meningiomas, 4 hemangiomas, 2 ependymomas, 2 epidermoid cysts and lipoma.Prognosis of these tumors were not good, so that early diagnosis and atraumatic extirpation were necessary.

最近経験したせき髄しゅようの２例

Two cases of spinal cord tumor were reported herein. Case 1, a 65-year old woman, consulted us complaining of pain in legs and disturbance of gait. Myelogram showed a complete block from C7 to Th1. Operation was performed and intradural extramedullary type tumor with ossification tissues was removed. Histologically the tumor was diagnosed as psommamatous meningioma. After operation the symptoms disappeared quickly. Case 2 was a 34-year-old man whose complaint was motor palsy of four extremities and hypesthesia below C3 level. Myelogram showed a complete block from C2 to Th4. Operation was done and the intramedullary type tumor was removed. Histologically the tumor was diagnosed as ependymoma.

最近経験したせき髄しゅようの４例

Four cases of spinal cord tumor were treated surgically from 1980 to 1982. Complete cure was obtained in a case of extradural schwannoma and in two cases of intraduralextramedullary tumors (schwannoma and meningioma). One case of intramedullary ependymoma resulted in spastic gait with one crutch. A Nine-year-old girl with intradural-extramedullary schwannoma showed radiological instability after extensive laminectomy.

Follow up results of operated cases of spinal cord tumor

48 cases of spinal cord tumors which had been treated surgically in our clinic were able to be followed up for 5.7 years (average) and the clinical results and the X-ray findings were reviewed. Intradural extramedurally tumors were in 34 cases, intramedurally in 8 and extradural in 6.Results are as follows:1) “Excellent” + “good” are 86.2% in intradural extramedurally tumors, and 100% in extradural tumors, but all cases of intramedurally tumors are under “fair”.2) Post operative results are influenced by those factors as follows; i) nature of the tumor, ii) localization of the tumor, iii) interval from onset to operation, iv) size of the tumor, v) total resection of the tumor, vi) post operative bony changes of the spine.3) Post operative deformities of the spine are found in 35% in X-ray examination and 3 of them are performed anterior body fusion for correction of swan neck deformity of the cervical spine.

Spinal Cord Tumors In our Clinic

Eight cases of Spinal cord tumors (four cases of Schwannomas, two of plasmacytomas, one of psammomatous osteogenic meningeoma and ganglioneuroma) were treated in our clinic for these four years.In this paper, two of them are reported.Case 1; 41 year-old male of plasmacytoma, he had fallen into paraplegia following acute back pain. On the myelogram, extradural tumor was suggested at the 6th thoracic level. At operation, the tumor adhered to the surface of dura and was seemed originated from it. Serum immunological study revealed abnormally high Ig. D value, 320mg/dl, but he had no hyperproteinemia nor M-protein.Case 2; 49 year-old female of psamonomatous osteogenic meningioma, she had worried about paraplegia and lower limbs' pain for five years. She had been treated as lumber disc hernia but was not ftee from her symptoms. By Myelography, contrast medium stopped at 8th thoracic level. At operation, an ossicle (7×12×3mm in size) and tumorous soft tissue around it were found in the intradural space. The bone chip had tight adhesion to dura. Histologically, the ossicle was made of mature bone tissue.After the operations, these two cases recovered but incompletely, the former can walk without a cruch but the latter with a cruch.

From the Operated Cases of Spinal Cord Tumor

We have reported the end-result of 23 cases of the spinal cord tumor which were operated on our clinic from 1960 to 1969. The result was as follow:Exeellent: 5, Good: 1, Fair: 7, Unchanged: 5, Worse: 1, Death: 4. 14 cases were neurinoma. We have reported 6 interesting cases from these cases.Case I which had 4 neurinomas into the different spinal cord.Case II which had 6 neurinomas in the different nerves include the spinal cord neurinoma.Case III which had disc henna and spinal cord tumor.Case IV haemoangioma which could not take out.Case V cholesteatoma.Case VI which had spinal cord cancer without spinal bone metastase.We have found the good result in the operated cases of spinal cord tumor within a half year from leg complaint had appeared.

Two Cases of Spinal Cord Tumor

1st caseA 77 year-old man; histologic aspects of the cervicothoracic extramedullary tumor could be malignant meningioma (fibroplastic sarcoma). He was severely symptomatic within three months before his death. It was only 20 days for him to survive aftor surgical treatment.2nd caseA 36 year-old man; histologic aspects of the spinal cord was glioma (extremely similar to astrocytoma). He lost his life 13 years after apperance of the first symptoms. In this case, the tumor was extended from the medulla to the filum terminale.