Intramedullary Tumors Research Articles

Electron microscopic study of the median structure of the posterior column of the spinal cord of the adult rat with a special reference to the posterior median septum.

In neuroanatomy textbooks on humans, the posterior median septum is commonly depicted along the midline of the posterior column of the spinal cord. For intramedullary spinal cord tumors, the standard surgical treatment is posterior midline myelotomy. However, its anatomical basis is still unclear. Therefore, in this study we focused on the ultrastructural characterization of the median structure of the posterior column in an adult rat. In the median part of the fasciculi gracilis, a fine lineal tissue continued from the posterior median sulcus to the 3/4th depth of the fasciculi. At higher magnification, this fine lineal tissue consisted of bundles of astrocytes, which are often disrupted and eventually disappeared. At the junction of the ventral part of the fasciculi cuneatus and the gray commissure, short lineal figures of glial tissues extended dorsally. These lineal figures of glial tissues were morphologically similar to other lineal figures of glial tissues found in the posterior column; bundles of astrocytes extending along the axons that entered the gray commissure and the perivascular lineal figures of glial tissues. In conclusion, this study revealed that the posterior median septum is composed of very fine lineal figures of glial tissues that are often disrupted and eventually disappear. We consider these basic structures to be similar in humans. Therefore, during posterior midline myelotomy, accurately separating along the posterior median septum in the posterior column is extremely difficult.

Genomic Profiling of Low-grade Intramedullary Cartilage Tumors Can Distinguish Enchondroma From Chondrosarcoma.

Low-grade intramedullary cartilage tumors include enchondroma and grade 1 chondrosarcoma. Classification based on radiopathologic correlation guides treatment, typically observation for asymptomatic enchondroma and surgery for chondrosarcoma. However, some tumors elude classification because radiographic and morphologic findings are equivocal. To date, no ancillary tests are available to aid the diagnosis of such indeterminate or suspicious tumors. We investigated the genomic landscape of low-grade cartilage tumors to determine the profile. We studied 10 each enchondroma, grade 1 chondrosarcoma, and suspicious cartilage neoplasms, respectively, by capture-based next-generation sequencing targeting 479 cancer genes and copy number. In enchondroma, IDH1 or IDH2 hotspot activating mutations and/or COL2A1 alterations were identified in 70% and 60% of cases, respectively; copy number changes were rare (20%). Suspicious cartilage neoplasms had frequent hotspot mutations in IDH1 or IDH2 and alterations in COL2A1 (90% and 70%, respectively); copy number changes were rare (20%). Overall, 80% of suspicious cartilage neoplasms were genomically indistinguishable from enchondroma. In contrast, 20% of chondrosarcoma had IDH1 or IDH2 alterations, 100% demonstrated alteration of COL2A1, and 70% had genomes with numerous copy number gains and losses. In total, 80% of chondrosarcomas demonstrated additional pathogenic mutations, deep deletions, or focal amplifications in cancer genes, predominantly CDKN2A. These results demonstrate distinct genomic profiles of enchondroma and grade 1 chondrosarcoma. Further, sequencing may aid in the correct classification of diagnostically challenging tumors. Additional pathogenic alterations (such as in CDKN2A) or numerous copy number gains or losses would support a diagnosis of chondrosarcoma although the absence of such findings does not exclude the diagnosis.

Determination of skeletal tumor extent: is an isotropic T1-weighted 3D sequence adequate?

To test the hypothesis that an accelerated, T1-weighted 3D CAIPIRINHA SPACE sequence with isotropic voxel size offers a similar performance to conventional T1-weighted 2D TSE (turbo spin echo) for the evaluation of bone tumor extent and characteristics. Thirty-four patients who underwent 3-T MRI with 3DT1 (CAIPIRINHA SPACE TSE) and 2DT1 (TSE) were included. Sequence acquisition time was reported. Two radiologists independently evaluated each technique for tumor location, size/length, tumor-to-joint distance, signal intensity, margin/extraosseous extension, and signal-to-noise (SNR) and contrast-to-noise (CNR) ratios. Tumors were located in long (20/36, 55.5%) and pelvic (16/36, 44.4%) bones. 3DT1 sequence required an average acquisition time of 235 s (± 42 s, range 156-372), while two plane 2DT1 sequences combined (coronal and axial) had an average acquisition time of 381 s (± 73 s, range 312-523). There was no difference in the measurements of tumor length and tumor-to-joint distance (p = 0.95) between 3DT1 and 2DT1 images. Tumors were hypointense (17/36, 47.2% vs 17/36, 47.2%), isointense (12/36, 33.3% vs 12/36, 33.3%), or hyperintense (7/36, 19.4% vs 7/36, 19.4%) on 3DT1 vs 2DT1, respectively. Assessment of tumor margins and extraosseous extension was similar, and there was no difference in tumor SNR or CNR (p > 0.05). An accelerated 3D CAIPIRINHA SPACE T1 sequence provides comparable assessments of intramedullary bone tumor extent and similar tumor characteristics to conventional 2DT1 MRI. For the assessment of bone tumors, the isotropic volume acquisition and multiplanar reformation capability of the 3DT1 datasets can obviate the need for 2DT1 acquisitions in multiple planes. • 3DT1 offers an equivalent performance to 2DT1 for the assessment of bone tumor characteristics, with faster and higher resolution capability, obviating the need for acquiring 2DT1 in multiple planes. • There was no difference in the measurements of tumor length and tumor-to-joint distance obtained on 3DT1 and 2DT1 images. • There was no difference in signal-to-noise ratio (SNR) or contrast-to-noise ratio (CNR) measures between 3DT1 and 2DT1.

Long-term outcomes of spinal ependymomas: an institutional experience of more than 60 cases.

Spinal ependymomas represent the most common primary intramedullary tumors for which optimal management remains undefined. When possible, gross total resection (GTR) is often the mainstay of treatment, with consideration of radiotherapy (RT) in cases of residual or recurrent tumor. The impact of extent of resection and radiotherapy remain understudied. Report on a large institutional cohort with lengthy follow-up to provide information on long-term outcomes and to contribute to limited data assessing the value of extent of resection and RT. Patients with pathologically proven primary spinal ependymoma between 1990 and 2018 were identified. Kaplan-Meier estimates were used to calculate progression-free survival (PFS); local-control (LC) and overall survival (OS). Logistic regression was used to analyze variables' association with receipt of RT. We identified 69 patients with ependymoma of which 4 had leptomeningeal dissemination at diagnosis and were excluded. Of the remaining cohort (n = 65), 42 patients (65%) had Grade II spinal ependymoma, 20 (31%) had Grade I myxopapillary ependymoma and 3 (5%) had Grade III anaplastic ependymoma; 54% underwent GTR and 39% underwent RT. With a median follow-up of 5.7 years, GTR was associated with improved PFS. For grade II lesions, STR+RT yielded better outcomes than STR alone (10y PFS 77.1% vs 68.2%, LC 85.7% vs 50%). Degree of resection was the only significant predictor of adjuvant radiotherapy (p < 0.0001). Our findings confirm the importance of GTR in spinal ependymomas. Adjuvant RT should be utilized in the setting of a subtotal resection with expectation of improved disease-related outcomes.

Gross Total Resection of Pediatric Cervical Intramedullary Ependymoma with D-Wave Monitoring: A Case Report

Intramedullary spinal cord tumors (IMSCTs) are treated with gross total resection (GTR) for favorable long-term outcome. Monitoring of D-waves in combination with motor evoked potentials (MEPs) minimizes risk of permanent injury to the spinal cord. We present the case of an 8-year-old female with cervical intramedullary ependymoma, an uncommon IMSCT in children. Though > 50% decrement in amplitude of MEPs was noted intraoperatively, D-waves remained stable and GTR of the tumor was thus continued. Despite an immature corticospinal tract in children, we recommend monitoring of D-waves in addition to MEPs to ensure safe GTR of an IMSCT.

Comparison of T1-weighted turbo spin echo and out-of-phase T1-weighted gradient echo Dixon MRI for the assessment of intra-medullary length of appendicular bone tumours.

Intra-medullary tumour length is accurately assessed on T1-weighted turbo spin echo (T1W TSE) MRI which can be relatively time consuming, whilst the gradient echo Dixon (T1W GrE Dixon) technique is a rapid sequence (imaging time ~ 30s). The aim of this study was to determine if the out-of-phase Dixon (OP T1W GrE Dixon) sequence can produce equivalent measurements of intra-medullary tumour length compared to the T1W TSE sequence. Tumour length was assessed in 90 patients undergoing MRI for staging of primary bone tumours with both T1W TSE and OP T1W GrE Dixon MRI sequences at 3T (n = 42) and 1.5T (n = 48). Tumour length was measured independently by different observers allowing assessment of inter-observer correlation, and the correlation between measurements on T1W TSE and OP T1W GrE Dixon sequences was also determined. There were 53 males and 37 females (mean age 36.4years; range 2-77years). Inter-observer correlation for tumour length on both the T1W TSE and T1W OP GrE Dixon sequences was very good (ICC = 0.94-0.98), and measurement of tumour length comparing T1W TSE and T1W GrE Dixon was also very good (ICC = 0.91-0.99). In 4 cases, tumour length was significantly overestimated on T1W TSE images due to extensive reactive marrow oedema, but more accurately determined on the OP sequence when compared to resection specimens. The OP T1W GrE Dixon sequence is comparable to T1W TSE for assessment of the intra-medullary length of appendicular bone tumours, and more accurate in the presence of extensive reactive marrow oedema.

MRI characteristics and resectability in spinal cord glioma

ObjectiveThe histopathology of intramedullary spinal cord tumors (IMSCT) can be suspected from the MRI features and characteristics. Ultimately, the confirmation of diagnosis requires surgery. This retrospective study addresses MRI features including homogeneity of enhancement, margination, and associated syrinx in intramedullary astrocytomas (IMA) and ependymomas (IME) that assist in diagnosis and predict resectability of these tumors. MethodsSingle-center retrospective analysis of IMA and IME cases since 2005 extracted from the departmental registry/electronic medical records post IRB approval (IRB 201,710,760). We compared imaging findings (enhancement, margination, homogeneity, and associated syrinxes) between tumor types and examined patient outcomes. ResultsThere were 18 IME and 21 IMA. On preoperative MRI, IME was favored to have homogenous enhancement (OR 1.8, p = 0.0001), well-marginated (p < 0.0001, OR 0.019 [95 % CI 0.002−0.184]), and associated syrinx (p = 0.015, OR 0.192 [95 % CI 0.049−0.760]). Total excision, subtotal excision, and biopsy were performed in 12, 5, and 1 patients in the IME cohort, respectively. In the IMA group, tumors were heterogeneous and poorly marginated in 20 of the 21 patients. Total excision, subtotal excision, and biopsy were undertaken in 2, 13, and 6 patients, respectively. The success of excision was predicted by MRI, with a significant difference in the extent of resection between IME and IMA (X2 = 14.123, p = 0.001). In terms of outcome, ordinal regression analysis showed that well-margined tumors and those with homogeneous enhancement were associated with a better postoperative McCormick score. Extent of resection had statistically significant survival (p = 0.026) and recurrence-free survival (p = 0.008) benefits. ConclusionThe imaging characteristics of IME and IMA have meaningful clinical significance. Homogeneity, margination, and associated syrinxes in IME can predict resectability and complexity of surgery.

Multiple myeloma presenting as an intramedullary spinal cord tumor: a case report and\xa0review of the literature

BackgroundExtramedullary disease in multiple myeloma often portends a worse diagnosis. In approximately 1% of cases, multiple myeloma may metastasize to the central nervous system as either leptomeningeal involvement or an intracranial, intraparenchymal lesion. Spinal cord metastases, however, are exceedingly rare. We present a case of spinal cord multiple myeloma as well as a literature review of reported cases.Case presentationA 66-year-old African American man with multiple myeloma presented with acute midthoracic pain and lower extremity paresis and paresthesia. Magnetic resonance imaging of the spine revealed two contrast-enhancing intramedullary enhancing lesions in the T1–T2 and T6–T7 cord. Resection with biopsy yielded a diagnosis of metastatic multiple myeloma.ConclusionTo date, only six cases of extramedullary disease to the spinal cord in patients with multiple myeloma have been reported, including our patient’s case. In all cases, neurologic deficit was observed at presentation, and magnetic resonance imaging of the spine revealed an intramedullary, homogeneously enhancing lesion. Current evidence suggests worse prognosis in patients with extramedullary disease to the central nervous system, and treatment paradigms remain debatable.

Management of intramedullary spinal cord tumors: A single-center experience of 247 patients.

Intramedullary spinal cord tumors (ISCT) are rare tumors requiring multidisciplinary care in an expert center. Here, we report a single-center experience including 247 patients with ISCT: 134 ependymomas, 54 astrocytomas and 59 hemangioblastomas. Preoperative evaluation and surgical considerations are discussed to share our principles in managing these patients. Ependymomas are largely benign lesions (95% of WHO grade II) for which total resection (91% rate of gross total resection (GTR)) without neurological impairment (79% of patients remained stable or improved) is the goal in order to ensure long-term oncological control (94.5% overall survival at 5 years, excluding anaplastic ependymomas). On the other hand, astrocytomas are more frequently high-grade tumors (30% of WHO grade III or IV) for which partial resection (60% of cases) is often necessary to preserve neurological status (48% of patients deteriorate at one year), leading to higher rates of recurrence (60% recurrence rate at 5 years for grade III astrocytomas). Lastly, spinal hemangioblastomas require a specific microsurgical resection with particular attention to the vasculature in order to ensure en bloc resection (95% GTR), allowing excellent neurological results (12% of patients improved, 86% remained stable). Altogether, these results demonstrate that ISCT can be managed surgically with good functional outcome, while oncological results will mostly depend on the histopathological grading.

Correlation between preoperative somatosensory evoked potentials and intraoperative neurophysiological monitoring in spinal cord tumors.

Intraoperative neurophysiological monitoring (IONM) is widely used in spinal cord tumors (SCTs) removal surgery. This study mainly hypothesized that patients with prolonged latency of preoperative somatosensory evoked potentials (preSEPLat) would have more deteriorated intraoperative evoked potentials. Among 506 patients who underwent SCTs removal surgery, 74 underwent both preSEPs and IONM. The correlation between preSEPLat and intraoperative SEPs (ioSEPs) was mainly analyzed, and subgroup analysis according to anatomical type was also conducted. Secondly, whether preSEPLat related to intraoperative motor evoked potentials (ioMEPs) or postoperative motor deterioration (PMD) was analyzed. In addition, risk factors for PMD were examined among anatomical factors, including operation level, tumor-occupying area ratio, and anatomical type, as well as electrophysiological factors, such as preSEPLat, ioSEPs, and ioMEPs. Changes in ioSEP and ioMEP were considered significant even if they were recovered before the end of the monitoring. Patients with prolonged preSEPLat were more likely to have significant ioSEP changes for intradural-extramedullary (IDEM) but not for intramedullary or extradural tumors. The anatomical type and tumor-occupying area ratio were prognostic factors for transient PMD, while the ioSEPs were the only prognostic factor for persisted PMD over 4weeks after surgery. PreSEPs are helpful in predicting the significant changes in ioSEPs during IDEM tumor removal surgery. The tumor-occupying area ratio and anatomical type are contributing factors for the transient PMD, whereas ioSEPs are prognostic factors in predicting the PMD that persists over 4weeks after SCTs removal surgery. To our knowledge, this is the first study that mainly focused on the correlations of preoperative and intraoperative evoked potentials.

Preclinical Development of Near-Infrared-Labeled CD38-Targeted Daratumumab for Optical Imaging of CD38 in Multiple Myeloma.

Cluster of differentiation 38 (CD38) is a promising therapeutic target in multiple myeloma (MM) patients and has resulted in the development of several CD38 immunotherapies. Current methods to evaluate CD38 expression in the preclinical setting include ex vivo flow cytometry and immunohistochemistry, which can be cumbersome and do not give whole-body information. In vivo imaging technologies such as positron emission tomography rely on decay of radioisotopes, limiting the number of molecular interactions observed at any given time point. Here, we demonstrate the use of near-infrared (NIR) fluorescence imaging for spatiotemporal monitoring of CD38 expression in preclinical MM using the anti-CD38 daratumumab (DARA) conjugated to the NIR fluorophore IRDye800CW (DARA-IRDye800). Stability studies with human serum and binding assays with human myeloma cells were performed with DARA-IRDye800. Immunocompromised mice with intra- and extramedullary tumors (n = 5/group) were administered with DARA-IRDye800 for in vivo imaging up to 7 days after injection. Ex vivo biodistribution and flow cytometry studies were performed to validate in vivo imaging results. A separate therapy study was performed in mice with intramedullary tumors that were treated and not treated with DARA at a therapeutic dose (n = 7/group). DARA-IRDye800 was administered for subsequent in vivo and ex vivo imaging in both cohorts of mice. DARA-IRDye800 maintained stability and had high affinity for CD38 (KD = 3.5 ± 0.05 nM). DARA-IRDye800 demonstrated a 5- and 18-fold increase in contrast in tumor-bearing regions of mice with extra- and intramedullary MM. Finally, mice treated with therapeutic doses of DARA and imaged with DARA-IRDye800 showed an 11-fold decrease in fluorescence intensities in vivo compared with untreated controls. Our studies establish DARA-IRDye800 as a promising contrast agent for preclinical evaluation of CD38 expression and for further investigating myeloma engraftment and kinetics in relation to anti-CD38 therapies.

Spinal meningiomas: Treatment outcome and long-term follow-up

BackgroundSpinal intradural tumors can be classified as intradural extramedullary or intramedullary tumors. Spinal meningiomas are among the most frequent intradural, extramedullary tumors (IDEMs), representing 12 % of all meningiomas and 25–45 % of all intradural spinal tumors. ObjectiveTo evaluate postoperative outcome, defined by mortality, tumor recurrence and modified Rankin Scale in patients with spinal meningiomas. Furthermore, to identify factors related to these outcome measures and define possible prognosticators. MethodsA large single center retrospective analysis of 166 consecutive spinal meningioma patients during a 29-year period (1989–2018). ResultsFemale to male ratio was 5.15 to 1. Of all 166 resected tumors, 159 were WHO grade I and seven were WHO grade II. Histopathologically, the psammomatous type was most common (42.8 %). The thoracic region was the most frequent location (71.1 %), followed by cervical and lumbar locations. A complete resection (Simpson I-III) was achieved in 88.7 %. In 12 cases (7.2 %) recurrences of a spinal meningioma occurred after an interval of 0.70–13.78 years. Postoperative complications consisted of CSF leakage and wound healing problems. Three patients died of direct postoperative complications (1.8 %), nine patients died in follow-up due to unrelated causes. Post-operative complications were related to the overall outcome (p = 0.029). Clinical outcome showed improvement in 117 patients out of 148 (79.1 %) according to modified Rankin Scale; 24 patients remained stable and 7 patients deteriorated. Patients with pre-existing bladder/bowel problems and incomplete resections had higher chance of recurrences. Younger patients also had a higher recurrence rate. Follow-up ranged from 0 to 23 years, median of 0.77 years, most were discontinued after 2 years. ConclusionsThe primary treatment of spinal meningiomas remains surgery. Complete resection of spinal meningiomas is achieved in most of the cases, however preserving and improving neurological status has priority over complete tumor resection. Morbidity and mortality is relatively low. Longer follow-up periods are recommended, since recurrences can occur after 10–15 years.

The Role of Minimally Invasive Spine Surgery

Introduction :In the past half of century, the spinal surgery techniques has advanced significantly. Along with the improvement and various of techniques and technologies in general, there has been a big movement to reduce the morbidity of surgery. Case review : As opposed to open spine surgery, minimally invasive surgical approaches can be faster, safer and require less recovery time. The minimally invasive spine surgery also need to make an efficient target of surgery. The roots in minimally invasive spine surgery (MISS) are based primarily on technique modifications. Discussion: The Williams microdiscectomy, described in 1978, revolutionized MISS by starting the evolution of lumbar discectomy from an open surgery through a 6-inch incision to a microsurgical approach through as small an opening as possible. Conclusion :We don’t use the MISS technique when the extension of tumor is more than 2 levels; extension of the tumor is 20% longer than diameter of largest retractor; the tumor &gt; 3cm for interlaminary approach, the wide durotomy is needed; and also the case with intramedullary tumor with 80% extention, from left to the right side; en bloc as the the goal of surgery for extradural tumor

Syringomyelia and hydromyelia: Current understanding and neurosurgical management

Syringomyelia is a rare disorder in which a fluid-filled cyst forms within the spinal cord, resulting in myelopathy. Meanwhile, the abnormal dilatation of the central canal is referred to as hydromyelia or slit-like syrinx. The most prevailing classification is based on anatomical features and pathogeny rather than pathophysiological mechanisms. It is usual to distinguish foraminal syringomyelia related mainly to abnormalities at the craniocervical junction, non-foraminal syringomyelia dealing with any cause of arachnoiditis (infection, inflammation, trauma…) and more rarely syringomyelia associated with intramedullary tumors. Although many pathophysiological theories have been argued over time, the prevailing one is that disturbances in cerebrospinal fluid (CSF) flow in the sub-arachnoid spaces disrupt flow velocity leading to the syrinx. Symptoms of paralysis, sensory loss and chronic pain commonly develop during the third/fourth decades of life. The natural history of syringomyelia is typically one of gradual, stepwise neurological deterioration extending over many years. Diagnosis is based on magnetic resonance imaging (MRI) including excellent morphological sequences (T1-, T2-, FLAIR-, T2*-, enhanced T1-) and dynamic MRI with careful study of CSF velocity (CISS, cine-MR sequences). Surgical management is at first dedicated to treat the cause of the syringomyelia, mainly to re-establish a physiological CSF pathway in the subarachnoid spaces. Mostly, the surgical goal is to enlarge the craniocervical junction with duraplasty. Other surgical strategies such as arachnoidolysis or shunt procedures are performed based on the pathogenic mechanisms or as second-line treatment. Medical treatments are also necessary as chronic pain is the main long-lasting symptom. As evolutive syringomyelia is a severe disease with a high impact on quality of life, it is recommended to treat without delay. There is no evidence for surgery for incidental asymptomatic syringomyelia or hydromyelia. Finally, syringomyelia associated with intramedullary tumors resolves spontaneously after tumor resection. Syringomyelia is a rare disease, which requires a dedicated multidisciplinary approach, emphasizing the need for a nationwide scientific organization so as to offer optimal care to the patient.

Surgical Management of Nondysraphic Giant Thoracic Intramedullary Lipoma: A Case Report

Spinal cord intramedullary lipomas are rare and commonly associated with spinal dysraphism and account for 2% of intramedullary tumors, while lipomas not associated with spinal dysraphism are even less frequent, accounting for 1% of cases. Most of the intradural lipomas are subpial and not intramedullary.

Characterization of the role of Samsn1 loss in multiple myeloma development.

The protein SAMSN1 was recently identified as a putative tumor suppressor in multiple myeloma, with re‐expression of Samsn1 in the 5TGM1/KaLwRij murine model of myeloma leading to a near complete abrogation of intramedullary tumor growth. Here, we sought to clarify the mechanism underlying this finding. Intratibial administration of 5TGM1 myeloma cells into KaLwRij mice revealed that Samsn1 had no effect on primary tumor growth, but that its expression significantly inhibited the metastasis of these primary tumors. Notably, neither in vitro nor in vivo migration was affected by Samsn1 expression. Both knocking‐out SAMSN1 in the RPMI‐8226 and JJN3 human myeloma cell lines, and retrovirally expressing SAMSN1 in the LP‐1 and OPM2 human myeloma cell lines had no effect on either cell proliferation or migration in vitro. Altering SAMSN1 expression in these human myeloma cells did not affect the capacity of the cells to establish either primary or metastatic intramedullary tumors when administered intratibially into immune deficient NSG mice. Unexpectedly, the tumor suppressive and anti‐metastatic activity of Samsn1 in 5TGM1 cells were not evidenced following cell administration either intratibially or intravenously to NSG mice. Crucially, the growth of Samsn1‐expressing 5TGM1 cells was limited in C57BL/6/Samsn1−/− mice but not in C57BL/6 Samsn1+/+ mice. We conclude that the reported potent in vivo tumor suppressor activity of Samsn1 can be attributed, in large part, to graft‐rejection from Samsn1−/− recipient mice. This has broad implications for the design and interpretation of experiments that utilize cancer cells and knockout mice that are mismatched for expression of specific proteins.

“Twins Intramedullary Tumors”: Case Report of a Double Spinal Metastasis from Breast Cancer. Technical Nuances and Review of the Literature

Intramedullary spinal cord metastases (ISCMs) represent a rare complication of malignancies and have been identified...

Preclinical study of boron neutron capture therapy for bone metastasis using human breast cancer cell lines

Bone metastasis has a major impact on the quality of life that general therapy cannot control. We established a bone metastasis model with a human breast cancer cell line and investigated the therapeutic effect of boron neutron capture therapy (BNCT). BNCT suppressed tumor growth in cases of intramedullary small tumors without damaging normal tissues, providing preliminary evidence that it is a potentially new therapeutic option for controlling tumor growth from bone metastasis. Further research is warranted for its clinical application.

Coexistence of Lumbar Intramedullary Lipoma and Epidermoid Tumor in a Child with Tethered Cord Syndrome: Case Report

Spinal epidermoid tumors and intramedullary lipomas are rare lesions of the spinal cord. In childhood, each of them may cause tethered cord syndrome (TCS). However, the coexistence of lumbar epidermoid tumors and intramedullary lipoma is much rarer. In this article, we present a 6-year-old female child who admitted with paraparesis and diagnosed lumbar epidermoid tumor and intramedullary lipoma causing TCS. She was treated surgically. Clinical presentation and surgical features of this rare case are presented and discussed. It should be kept in mind that children with TCS may have two tumors of different natures together, and both may contribute to the clinical picture of the patient.

Invited Commentary: A Framework for the Differential Diagnosis of Benign and Malignant Intramedullary Tumors.

Invited Commentary: A Framework for the Differential Diagnosis of Benign and Malignant Intramedullary Tumors.