Regression of Recurrent Spinal Cord High-Grade Glioma After Convection-Enhanced Delivery of Nimustine Hydrochloride: Case Reports and Literature Review

2019 ◽  
Author(s):  
Toshiki Endo ◽  
Tomoo Inoue ◽  
Shinichiro Sugiyama ◽  
Ryuta Saito ◽  
Teiji Tominaga
Keyword(s):  
Spinal Cord ◽  
Case Reports ◽  
High Grade Glioma ◽  
Chemotherapeutic Agents ◽  
High Grade ◽  
Convection Enhanced Delivery ◽  
Thoracic Spinal Cord ◽  
Lower Extremity Weakness ◽  
Thoracic Spinal ◽  
Nimustine Hydrochloride

Abstract BACKGROUND Spinal cord high-grade glioma has poor prognosis. Especially, no treatment protocols have been established for recurrent cases. OBJECTIVE To apply a novel treatment method, convection-enhanced delivery (CED), for recurrent high-grade glioma. CED can deliver chemotherapeutic agents directly into the intramedullary lesion and possibly lead to remarkable regression of enlarging tumors that are, otherwise, difficult to control. METHODS Two patients developed high-grade glioma in the thoracic spinal cord. Partial resection and chemotherapy and radiotherapy induced remission of the disease. However, following the initial treatment, recurrence was noted in the spinal cord at 6 and 12 mo, respectively. No effective treatment was available for these recurrent lesions. Therefore, the authors decided to use CED to infuse nimustine hydrochloride (ACNU) directly into the spinal cord. During the procedure, the infusion cannula was inserted into the spinal cord lesion under intraoperative computed tomography scan. RESULTS After ACNU CED, successive magnetic resonance imaging confirmed remarkable shrinkages of the tumors in both cases. However, the patient's preinfusion symptoms, including bilateral lower extremity weakness, did not change after the treatment. Importantly, overall survivals of the 2 patients were as long as 67 and 33 mo. CONCLUSION The authors report the first 2 cases of recurrent spinal cord high-grade glioma. ACNU CED dramatically regressed enhanced mass lesions and provided local tumor controls in the spinal cord.

scholarly journals Convection-Enhanced Delivery of Nimustine Hydrochloride for Recurrent Spinal Cord High-grade Glioma

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Toshiki Endo ◽  
Ryuta Saito ◽  
Teiji Tominaga
Keyword(s):  
Spinal Cord ◽  
High Grade Glioma ◽  
Chemotherapeutic Agents ◽  
High Grade ◽  
Convection Enhanced Delivery ◽  
Thoracic Spinal Cord ◽  
Treatment Protocols ◽  
Lower Extremity Weakness ◽  
Thoracic Spinal ◽  
Nimustine Hydrochloride

Abstract INTRODUCTION Spinal cord high-grade glioma has poor prognosis. Especially, no treatment protocols have been established for recurrent cases.This paper describes a novel treatment method, convection enhanced delivery (CED), for recurrent high-grade glioma. CED can deliver chemotherapeutic agents directly into the intramedullary lesion and possibly lead remarkable regression of enlarging tumors that are otherwise difficult to control. METHODS Two patients developed high-grade glioma in the thoracic spinal cord. Partial resection and chemo- and radiotherapy-induced remission of the disease. However, following the initial treatment, recurrence was noted in the spinal cord 6 and 12 mo, respectively. No effective treatment was available for these recurrent lesions. Therefore, the authors decided to use CED to infuse nimustine hydrochloride (ACNU) directly into the spinal cord. During the procedure, the infusion cannula was inserted into the spinal cord lesion under intraoperative computed tomography scan. RESULTS After ACNU CED, successive magnetic resonance imaging confirmed remarkable shrinkages of the tumors in both cases. However, the patient's preinfusion symptoms including bilateral lower extremity weakness, did not change after the treatment. Importantly, overall survivals of the two patients were as long as 67 and 33 mo. CONCLUSION The authors report the first 2 cases of recurrent spinal cord high-grade glioma. ACNU CED dramatically regressed enhanced mass lesions and provided local tumor controls in the spinal cord.

scholarly journals Spinal Cord Diffuse Midline Glioma in a 4-Year-Old Boy

2019 ◽  
Vol 6 ◽  
pp. 2329048X1984245 ◽  
Author(s):  
Ashutosh Kumar ◽  
Salman Rashid ◽  
Sumit Singh ◽  
Rong Li ◽  
Leon S. Dure
Keyword(s):  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
World Health ◽  
Thoracic Spinal Cord ◽  
Lower Extremity Weakness ◽  
Thoracic Spinal ◽  
History Of ◽  
Health Organization ◽  
Cerebrospinal Fluid Pleocytosis ◽  
Diffuse Midline Glioma

Objective: We report a child presenting with spinal myelopathy secondary to H3K27M mutant diffuse midline glioma. Case Report: A 4-year-old boy presented with a 3-week history of progressive gait difficulty. Examination revealed bilateral hand and lower extremity weakness, left leg hypertonia with ankle clonus, and a right hemisensory deficit. Magnetic resonance imaging of neuroaxis showed cervical and thoracic spinal cord with expansion and irregular areas of enhancement. Serum and cerebrospinal fluid studies were unremarkable for infectious, autoimmune, inflammatory, and neoplastic causes but showed mild cerebrospinal fluid pleocytosis, hypoglycorrhachia, and high protein level. A thoracic cord biopsy revealed a diffuse midline glioma (World Health Organization grade IV). Consequently, the tumor involved intracranial structures and patient died within 4 months after diagnosis. Conclusion: High-grade spinal cord gliomas are very rare but should be considered in the differential diagnosis of pediatric myelopathy. Tissue biopsy is recommended in indeterminate cases to facilitate diagnosis and to guide management.

scholarly journals Acute Polyradiculomyelitis With Spinal Cord Gray Matter Lesions: A Report of Two Cases

2021 ◽  
Vol 12 ◽  
Author(s):  
Charidimos Tsagkas ◽  
Maria Janina Wendebourg ◽  
Matthias Mehling ◽  
Johannes Lorscheider ◽  
Philippe Lyrer ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Gray Matter ◽  
Case Reports ◽  
Motor Impairment ◽  
Bowel Dysfunction ◽  
Motor Deficits ◽  
Spinal Cord Lesions ◽  
Rare Presentation ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal

Objective: Inflammatory polyradiculomyelitis belongs to a rare group of immune-mediated diseases affecting both the central and peripheral nervous system. We aimed to describe an unusual presentation of acute polyradiculomyelitis with marked spinal cord lesions restricted to the gray matter.Methods: Thorough examination of two case reports including clinical, MRI, serologic, electrophysiologic and CSF examinations as well as short-term follow-up.Results: We present two adult patients with acute polyradiculomyelitis and unusual spinal cord lesions restricted to the gray matter on MRI. The clinical presentation, serologic, electrophysiologic and CSF features of the two patients varied, whereas both patients demonstrated severe, asymmetrical, predominantly distal, motor deficits of the lower extremities as well as bladder and bowel dysfunction. Both patients only partially responded to anti-inflammatory treatment. Severe motor impairment and bladder dysfunction persisted even months after symptom onset.Conclusions: To our best of knowledge, these are the first reports of acute polyradiculomyelitis with distinct involvement of the lower thoracic spinal cord gray matter. Currently, it remains unclear whether gray matter lesions reflect a separate pathophysiologic mechanism or an exceedingly rare presentation of spinal cord involvement in acute polyradiculomyelitis.

scholarly journals Role of Multimodality Intraoperative Neurophysiological Monitoring during Embolisation of a Spinal Cord Arteriovenous Malformation

2000 ◽  
Vol 6 (3) ◽  
pp. 223-234 ◽  
Author(s):  
F. Sala ◽  
Y. Niimi ◽  
A. Berenstein ◽  
V. Deletis
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
General Anesthesia ◽  
Endovascular Procedures ◽  
Motor Evoked Potentials ◽  
Neurological Deficits ◽  
Neurophysiological Monitoring ◽  
Thoracic Spinal Cord ◽  
Lower Extremity Weakness ◽  
Thoracic Spinal

The decision whether or not to embolise during endovascular procedures for arteriovenous malformations (AVMs) of the spinal cord under general anesthesia, relies primarily on neurophysiological results of provocative tests with Lidocaine and short-acting barbiturates. Because of the complex haemodynamics of spinal AVMs, when either sensory (CSEPs) or muscle motor evoked potentials (mMEPs) are used independently, they can mislead the interpretation of provocative tests. This report illustrates the specific but complementary role played by provocative tests using CSEPs and mMEPs during embolisation of a low thoracic spinal cord AVM. We present the case of a 46 year old male with six year history of right lower extremity weakness. At that time, Magnetic Resonance (MR) imaging of the spine disclosed an intramedullary AVM at T11. He remained neurologically stable up to seven months before admission, when he developed sudden onset of low back pain, followed by progressive paraparesis, numbness in lower extremities, urinary retention and fecal incontinence. A new MR imaging study indicated venous thrombosis of the AVM. A two-stage embolisation was performed. During the first procedure, after provocative tests did not affect either CSEPs or mMEPs, an embolisation was performed through a sulco-commisure feeder from the anterior spinal artery (ASA) at T9. Conversely, provocative tests with Lidocaine performed from a right posterior spinal artery (PSA) feeder to the AVM nidus resulted in a significant (>50%) decrease of CSEPs, while mMEPs remained unchanged. The repeatedly positive tests warranted further investigation of the vascular anatomy which disclosed a normal right PSA distal to the nidus; the distal normal PSA was protected with coils. A repeated Lidocaine test was negative and the posterior feeder was embolised with no subsequent changes in CSEPs or mMEPs. After the procedure, the patient experienced only a mild transitory increase in right leg numbness, but no additional motor deficits. Five days later, the embolisation through the ASA feeder at T9 was completed on the basis of negative provocative tests. No additional neurological deficits were observed. Favoring either CSEPs or MEPs during endovascular procedures in the spinal cord is not justified by a solid scientific background. This case report illustrates that monitoring both CSEPs and mMEPs combined with provocative tests allows the safest and most effective embolisation of spinal cord AVMs under general anesthesia.

Surgical Management of a Patient With Thoracic Spinal Cord Herniation

Neurosurgery ◽  
2015 ◽  
Vol 77 (3) ◽  
pp. E492-E499 ◽  
Author(s):  
Eduardo Martinez-del-Campo ◽  
Karam Moon ◽  
Samuel Kalb ◽  
Hector Soriano-Baron ◽  
Nicholas Theodore
Keyword(s):  
Spinal Cord ◽  
Subarachnoid Space ◽  
Motor Evoked Potentials ◽  
Foot Drop ◽  
Dural Defect ◽  
Thoracic Spinal Cord ◽  
Lower Extremity Weakness ◽  
Computed Tomographic Myelography ◽  
Thoracic Spinal ◽  
Spinal Cord Herniation

Abstract BACKGROUND AND IMPORTANCE: Thoracic spinal cord herniation (TSCH) is rare and likely underdiagnosed. It is characterized by ventral herniation of the spinal cord through a dural defect, effacement of the anterior subarachnoid space, and increased posterior subarachnoid space. We present here a case of TSCH diagnosed and surgically treated at Barrow Neurological Institute, along with supplemental intraoperative video. CLINICAL PRESENTATION: A 61-year-old man with a history of progressive myelopathy causing left lower-extremity weakness with associated numbness, impaired gait, foot drop, incontinence, and sexual impotence was referred without any previous treatment. Computed tomographic myelography and magnetic resonance imaging of the thoracic spine showed ventral spinal cord herniation at T3-T4. Neurological monitoring was recorded preoperatively and intraoperatively. The patient underwent left-sided posterolateral exploration via T3-T4 laminectomies and costotransversectomy for intradural cord release/detethering of the spinal cord with additional superior and inferior extension and repair of the dural defect. Arthrodesis was not considered necessary. After cord release, motor evoked potentials showed immediate improvement from baseline. Dural duplication was considered the cause of TSCH in this case. Total reduction of herniation was evident in postoperative images. The postoperative course was uneventful, and at the last follow-up, the patient had regained ambulation and sphincter control. CONCLUSION: Anterior displacement of the thoracic spinal cord should elicit consideration of herniation to prevent misdiagnosis and inadequate surgery. Surgical cord release and enlargement of the dural defect are safe and associated with good clinical outcomes.

Case reports

Neurosurgery ◽  
1991 ◽  
Vol 29 (6) ◽  
pp. 893-898 ◽  
Author(s):  
Cheryl P. Harris ◽  
Mark S. Dias ◽  
Douglas L. Brockmeyer ◽  
Jeannette J. Townsend ◽  
Brian K. Willis ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cerebellopontine Angle ◽  
Case Reports ◽  
Primitive Streak ◽  
Jugular Foramen ◽  
Thoracic Spinal Cord ◽  
Prepontine Cistern ◽  
Thoracic Spinal ◽  
Upper Thoracic ◽  
4Th Ventricle

Abstract Neurenteric cysts are endothelium-lined structures most commonly encountered in the lower cervical or upper thoracic spinal cord. The occurrence of neurenteric cysts within the cranial vault is unusual. We present three patients with neurenteric cysts located within the posterior fossa: one near the jugular foramen deforming the 4th ventricle, a second in the cerebellopontine angle, and a third in the prepontine cistern. Several different theories have been advanced to explain the embryogenesis of neurenteric cysts. We review these theories and conclude that cranial neurenteric cysts may arise from a disturbance of early gastrulation, shortly after the onset of primitive streak regression.

scholarly journals Primary Spinal Germ Cell Tumors: A Case Analysis and Review of Treatment Paradigms

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Joshua J. Loya ◽  
Henry Jung ◽  
Caroline Temmins ◽  
Nam Cho ◽  
Harminder Singh
Keyword(s):  
Spinal Cord ◽  
Germ Cell ◽  
Germ Cell Tumors ◽  
Giant Cells ◽  
Thoracic Spinal Cord ◽  
Lower Extremity Weakness ◽  
Thoracic Spinal ◽  
Highly Sensitive ◽  
Local Radiation ◽  
Mass Lesions

Objective. Primary intramedullary spinal germ cell tumors are exceedingly rare. As such, there are no established treatment paradigms. We describe our management for spinal germ cell tumors and a review of the literature.Clinical Presentation. We describe the case of a 45-year-old man with progressive lower extremity weakness and sensory deficits. He was found to have enhancing intramedullary mass lesions in the thoracic spinal cord, and pathology was consistent with an intramedullary germ cell tumor. A video presentation of the case and surgical approach is provided.Conclusion. As spinal cord germinomas are highly sensitive to radiation and chemotherapy, a patient can be spared radical surgery. Diverse treatment approaches exist across institutions. We advocate biopsy followed by local radiation, with or without adjuvant chemotherapy, as the optimal treatment for these tumors. Histological findings have prognostic value if syncytiotrophoblastic giant cells (STGCs) are found, which are associated with a higher rate of recurrence. The recurrence rate in STGC-positive spinal germinomas is 33% (2/6), whereas it is only 8% in STGC-negative tumors (2/24). We advocate limited volume radiotherapy combined with systemic chemotherapy in patients with high risk of recurrence. To reduce endocrine and neurocognitive side effects, cranio-spinal radiation should be used as a last resort in patients with recurrence.

scholarly journals Recurrent thoracic cord compression due to extramedullary haematopoiesis in thalassaemic patients–A case presentation and literature review

2019 ◽  
Vol 26 (1) ◽  
pp. 43-47
Author(s):  
Athena Cheuk Yiu Au ◽  
Chun Kong Wong ◽  
Ka Kin Li
Keyword(s):  
Spinal Cord ◽  
Literature Review ◽  
Spinal Cord Compression ◽  
Case Reports ◽  
Case Series ◽  
Cord Compression ◽  
Surgical Decompression ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Anaemia Management

Extramedullary haematopoesis (EMH) in thalassaemic patients to result in spinal cord compression is a rare phenomenon. EMH occurs as compensatory sequelae in those with chronic anaemia such as thalassaemia, other congenital haemolytic anaemia, haemoglobinopathies, and myelofibrosis. Common sites of EMH include liver, spleen, kidneys and lymph nodes, but rarely the paravertebral and spinal cord regions. In our literature review, it was found that only case reports and case series have been published. We present a case of recurrent thoracic spinal cord compression caused by EMH in a 32-year-old thalassaemic Chinese man treated with surgical decompression and spinal stabilisation. The key to successful treatment is prompt diagnosis with early clinical suspicion, magnetic resonance imaging and individualised treatment for each patient. Surgical decompression provides immediate neural decompression while subsequent anaemia management may reduce the risk of recurrence. In the present case, a combination therapy of blood transfusion, surgical decompression and radiotherapy has been shown to deliver successful outcomes in such cases.

Resection of Ventral Thoracic Calcified Meningiomas Through a Transpedicular Approach: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Michael A Galgano ◽  
Haydn Hoffman
Keyword(s):  
Spinal Cord ◽  
Posterior Instrumentation ◽  
Video Recording ◽  
Tumor Resection ◽  
Thoracic Spinal Cord ◽  
Lower Extremity Weakness ◽  
Transpedicular Approach ◽  
Institutional Review ◽  
Thoracic Spinal ◽  
Microsurgical Resection

Abstract The surgical resection of ventrally located thoracic lesions carries additional complexity because of the constraints of the mediastinum and pleural cavity as well as the intolerance of the spinal cord to manipulation. The creation of a ventrolateral operative corridor through a transpedicular, transarticular route is effective for accessing the ventral thoracic spinal cord. This operative video demonstrates the surgical management of a 67-yr-old female who presented with progressive gait ataxia and bilateral lower extremity weakness and was found to have noncontiguous calcified ventral thoracic meningiomas at T6 and T10. The surgical plan consisted of T4-11 posterior instrumentation, T5-6 and T9-10 laminectomies with unilateral facetectomies and pediculectomies at both segments, and microsurgical resection of both tumors. Postoperatively, the patient's gait and paraparesis improved. Although instrumentation is infrequently utilized when managing intradural pathology, it permitted aggressive bone removal in order to create an unobstructed ventrolateral corridor to the tumor. This allowed us to perform generous durotomies spanning the length of each lesion and obviated the need for spinal cord manipulation during tumor resection. The patient provided informed consent for the surgery and video recording, and institutional review board approval was determined to be unnecessary.

Spontaneous Herniation of the Thoracic Spinal Cord: A Case Report

2001 ◽  
Vol 45 (4) ◽  
pp. 353 ◽  
Author(s):  
Sung Chan Jin ◽  
Seoung Ro Lee ◽  
Dong Woo Park ◽  
Kyung Bin Joo
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Spontaneous Herniation
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