Intramedullary Mass Lesion Research Articles

Intramedullary Mass Lesion of the Spinal Cord in Children of a Developing Milieu

A retrospective study of 22 children with intramedullary mass lesions (neoplastic and nonneoplastic) was performed to see the frequency of different histotypes of tumors/lesions and the functional outcome in Indian children. The age of the children varied from 1.5 to 16 years with a median of 8 years. The male to female ratio was 2.7:1. The children having a minimum follow-up of 3 months and a complete clinicopathological record were entered into this study. McCormick functional grading was applied retrospectively to assess the preoperative grade and postoperative functional outcome of the children. Histopathologically, these 22 cases were astrocytomas (n = 6, 27.3%), ependymomas (n = 3, 13.6%), dermoids (n = 3, 13.6%), epidermoids (n = 2, 9.1%), ependymal cysts (n = 2, 9.1%), and myxopapillary ependymoma, neurenteric cyst, ganglioglioma, teratoma, tuberculoma and anteriovenous malformation one each (4.55%). Near-total or gross-total resection was achieved in 13 (59%) and subtotal resection in 7 patients (32%), while complete excision of tuberculoma was achieved in 1 patient. Coagulation of perimedullary vessels was done in another single patient with anteriovenous malformations. Fourteen of the 22 cases having had functional grade IV or V preoperatively, improved to grade I or II (n = 7) and to grade III (n = 4, all astrocytomas) following surgery. Two patients died (1 within 2 days and 1 after 3 months due to recurrence of the tumor) and 1 case deteriorated at the follow-up of 4 months. Eight out of the 22 patients who had been admitted with functional grade II or III improved to grade I or II following surgery. The following conclusions were drawn after evaluation of these cases: (1) astrocytomas and ependymomas constituted only 50% of intramedullary tumors; (2) nonneoplastic, malformative tumors like dermoid and epidermoid showed a higher incidence (23%) in comparison with the Western World where all congenital intramedullary tumors (including dermoids and epidermoids) account for 5–8% only; (3) extremely rare cystic lesions like ependymal cyst and inflammatory granuloma may manifest as an intramedullary lesion; (4) even neurenteric cyst, though rare, may manifest as a pure intramedullary lesion without the stigmata of spinal dysraphism, and (5) delayed presentation was the cause of unfavorable outcome in a developing milieu.

Commentary

BACKGROUND Primary oligoastrocytomas of the spinal cord are rare, and the treatment options for low-grade intramedullary tumors are controversial. DESCRIPTION A 10-year-old girl presented with thoracic scoliosis. Magnetic resonance imaging (MRI) revealed an enhancing intramedullary mass lesion extending from C-5 to T-5, associated with whole spine syringomyelia and syringobulbia. 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET) showed high uptake in the lesion. The patient underwent C-5 to T-5 laminoplastic laminotomy and subtotal removal of the tumor. Histologic examination revealed that the tumor was an oligoastrocytoma without anaplastic findings. Genetic analysis revealed loss of heterozygosity of 1p and 19q but not 10q, which is characteristic of oligodendroglial tumors. CONCLUSION To our knowledge, this is only the second report describing primary oligoastrocytoma of the spinal cord. Genetic analysis may provide a clue in selecting optimal adjuvant therapies.

Primary spinal oligoastrocytoma: a case report

Background Primary oligoastrocytomas of the spinal cord are rare, and the treatment options for low-grade intramedullary tumors are controversial. Description A 10-year-old girl presented with thoracic scoliosis. Magnetic resonance imaging (MRI) revealed an enhancing intramedullary mass lesion extending from C-5 to T-5, associated with whole spine syringomyelia and syringobulbia. 18F-fluorodeoxyglucose–positron emission tomography (FDG-PET) showed high uptake in the lesion. The patient underwent C-5 to T-5 laminoplastic laminotomy and subtotal removal of the tumor. Histologic examination revealed that the tumor was an oligoastrocytoma without anaplastic findings. Genetic analysis revealed loss of heterozygosity of 1p and 19q but not 10q, which is characteristic of oligodendroglial tumors. Conclusion To our knowledge, this is only the second report describing primary oligoastrocytoma of the spinal cord. Genetic analysis may provide a clue in selecting optimal adjuvant therapies.

Spinal intradural perimedullary arteriovenous fistula with varix in infant

A rare occurrence of type IV spinal arteriovenous malformation (intradural perimedullary arteriovenous fistula) is described in an 18-month-old boy initially misdiagnosed with Guillain-Barré syndrome. An intramedullary mixed-intensity mass lesion at Th1 was demonstrated by magnetic resonance imaging together with flow voids over the dorsal aspect of the swollen spinal cord. Angiography demonstrated an intradural perimedullary arteriovenous fistula including an intraparenchymal vascular pocket. After partial embolisation of the posterior spinal arteries through the left intercostal-radicular artery, the arteriovenous fistula was removed completely together with an organised haematoma. The fistula directly opened into a vascular pocket, which was confirmed pathologically to be a varix. The postoperative course was uneventful, and the patient resumed ambulation within 4 months. The case, subclassifiable as a type IVb spinal perimedullary AVF, was unique given its location and the patient’s age at presentation.

A case of spinal low-grade astrocytoma with exophytic and intracranial extension

BACKGROUND Ventral exophytic growth of a spinal intramedullary glioma into the cranial cavity is an unusual condition. CASE DESCRIPTION A 16-year-old boy was admitted because of lower cranial nerve dysfunction and acute hydrocephalus. Magnetic resonance images showed an intramedullary mass lesion in the upper cervical spinal cord with exophytic extension into the medullary and prepontine cisterns. The patient underwent suboccipital craniectomy and C1–2 laminectomy for decompression and histologic evaluation. The histopathologic findings were characteristic of astrocytoma grade II. Although radiotherapy was performed, the patient died 7 months later. CONCLUSIONS This is considered to be a rare case of spinal low-grade astrocytoma with ventral exophytic intracranial extension.

Leigh's Disease Presenting as an Intramedullary Mass Lesion

An unusual presentation of Leigh's disease consisting of rapid progression of leg weakness in a young child is discussed. Magnetic resonance imaging revealed an intramedullary mass lesion of the conus medullaris. Surgical exploration revealed only necrosis and inflammation. Subsequent studies revealed pathology in the cerebrum as well as the spinal cord. Metabolic abnormalities confirmed the diagnosis of Leigh's disease. The differential diagnosis of intramedullary mass lesions demonstrated by magnetic resonance imaging should include metabolic, inflammatory, and ischemic processes as well as neoplastic disease.

Leighʼs Disease Presenting as an Intramedullary Mass Lesion

An unusual presentation of Leigh's disease consisting of rapid progression of leg weakness in a young child is discussed. Magnetic resonance imaging revealed an intramedullary mass lesion of the conus medullaris. Surgical exploration revealed only necrosis and inflammation. Subsequent studies revealed pathology in the cerebrum as well as the spinal cord. Metabolic abnormalities confirmed the diagnosis of Leigh's disease. The differential diagnosis of intramedullary mass lesions demonstrated by magnetic resonance imaging should include metabolic, inflammatory, and ischemic processes as well as neoplastic disease.

Intramedullary mass lesions of the spinal cord

Intramedullary tumors form 10% of all the spinal cord tumors. Majority of them are gliomas and rarely benign tumors are encountered. Twenty five cases of intramedullary mass lesions are studied regarding their clinical presentation, radiological features, surgical aspects and outcome following the surgery and radiotherapy. There were six benign lesions where the outcome was excellent. There were 11 patients with astrocytoma and 8 cases with ependymoma. In all, arrest of the disease or improvement could be achieved in 20 cases. Extent of surgical resection and role of radiotherapy, which are still controversial, are discussed.

Hematomyelia With Arteriovenous Malformation of the Cord: Successful Surgical Treatment

To the Editor.— The most common consequence of these embryologic abnormalities is gradual progression from paraparesis to paraplegia. 1 Less common is the acute onset of hematomyelia, thrombosis of the malformation, or subarachnoid hemorrhage with associated deficits in function. Report of a Case.— A 6-year-old boy had progressive thoracic back pain of one month's duration, with an acute spastic paraparesis. Mental status, cranial nerve function, coordination of his arms and anal tone were normal. There was impairment to light touch and proprioception in the legs. Myelography showed a complete obstruction at the T-6 level due to an intramedullary mass lesion with dilated and tortuous vessels. The spinal fluid was discolored but not xanthochromic, acellular, with a protein content of 500 mg/dl and a glucose level of 52 mg/dl. At operation, distended tortuous vessels were seen between T-9 and T-12 typical of an arteriovenous malformation (AVM) of the spinal cord. At

A percutaneous technique for producing intraspinal mass lesions in experimental animals.

✓ The authors describe a percutaneous technique for producing extra- and intramedullary mass lesions in the dog and monkey. Small balloon catheters introduced through needles into the spinal canal can be positioned under fluoroscopic control to simulate epidural masses or masses within the cord. Selective spinal cord arteriography and silicone perfusion studies demonstrate the effect of such masses on spinal cord blood flow.

Intramedullary spinal cord sarcoidosis. Case report.

✓ A dorsal laminectomy was performed on a 68-year-old woman with an intramedullary mass lesion, ultimately diagnosed as sarcoidosis. This rare lesion of the spinal cord is presented with references to similar cases.