scholarly journals MRI-guided stereotactic ablative radiation therapy of spinal bone metastases: a preliminary experience

2020 ◽  
Vol 93 (1105) ◽  
pp. 20190655
Author(s):  
Ricardo Llorente ◽  
Benjamin O Spieler ◽  
James Victoria ◽  
Cristiane Takita ◽  
Raphael Yechieli ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Soft Tissues ◽  
Spinal Cord Tumor ◽  
Cauda Equina ◽  
Spinal Metastases ◽  
Patient Positioning ◽  
Stereotactic Ablative Radiotherapy ◽  
Spinal Bone Metastases ◽  
Mri Guided ◽  
Dose Constraints

Objective: MRI provides clear visualization of spinal cord, tumor, and bone for patient positioning and verification during MRI-guided radiotherapy (MRI-RT). Therefore, we wished to evaluate spine stereotactic ablative radiotherapy (SABR) feasibility with MRI-RT. Given dosimetric limitations of first generation Co-60 MRI-RT, we then evaluated improvements by newer linear accelerator (linac) MRI-RT. Methods: Nine spinal metastases were treated with Co-60 MRI-RT. Seven received a single 16 Gy fraction, and two received three fractions totaling 24 or 30 Gy. After replanning with linac MRI-RT software, comparisons of organ at risk and dose spillage objectives between Co-60 and linac plans were performed. Results: Spinal cord and cauda equina dose constraints were met in all Co-60 cases. Treatments were delivered successfully with real-time imaging during treatment and no treatment-related toxicities. While limits for dose spillage into surrounding soft tissues were not achieved due to the limitations of the Co-60 system, this could be corrected with linac MRI-RT delivery. Conclusions: MRI-RT SABR of spinal metastases is feasible with Co-60 MRI-RT. Dose delivery is improved by linac MRI-RT. Advances in knowledge: This is the first report of MRI-RT for SABR of spinal metastases. The enhanced visualization of anatomy by MRI may facilitate RT dose escalation for spine SABR.

Recent advances and new discoveries in the pipeline of the treatment of primary spinal tumors and spinal metastases: A scoping review

2021 ◽  
Author(s):  
Julio C Furlan ◽  
Jefferson R Wilson ◽  
Eric M Massicotte ◽  
Arjun Sahgal ◽  
Fehlings G Michael
Keyword(s):  
Spinal Cord ◽  
Scoping Review ◽  
Clinical Studies ◽  
Spinal Metastasis ◽  
Spinal Cord Tumor ◽  
Treatment Strategies ◽  
Spinal Metastases ◽  
Spinal Tumors ◽  
Spinal Neoplasms ◽  
Primary Tumors

Abstract The field of spinal oncology has substantially evolved over the past decades. This review synthesizes and appraises what was learned and what will potentially be discovered from the recently completed and ongoing clinical studies related to the treatment of primary and secondary spinal neoplasms. This scoping review included all clinical studies on the treatment of spinal neoplasms registered in the ClinicalTrials.gov website from February/2000 to December/2020. The terms “spinal cord tumor”, “spinal metastasis”, and “metastatic spinal cord compression” were used. Of the 174 registered clinical studies on primary spinal tumors and spinal metastasis, most of the clinical studies registered in this American registry were interventional studies led by single institutions in North America (n=101), Europe (n=43), Asia (n=24) or other continents (n=6). The registered clinical studies mainly focused on treatment strategies for spinal neoplasms (90.2%) that included investigating stereotactic radiosurgery (n=33), radiotherapy (n=21), chemotherapy (n=20), and surgical technique (n=11). Of the 69 completed studies, the results from 44 studies were published in the literature. In conclusion, this review highlights the key features of the 174 clinical studies on spinal neoplasms that were registered from 2000 to 2020. Clinical trials were heavily skewed towards the metastatic population as opposed to the primary tumours which likely reflects the rarity of the latter condition and associated challenges in undertaking prospective clinical studies in this population. This review serves to emphasize the need for a focused approach to enhancing translational research in spinal neoplasms with a particular emphasis on primary tumors.

Radiation-Sensitive Spine Tumor

2018 ◽  
pp. 159-174
Author(s):  
Adam M. Robin ◽  
Ilya Laufer
Keyword(s):  
Spinal Cord ◽  
Multiple Myeloma ◽  
Spinal Cord Compression ◽  
Cauda Equina ◽  
Spinal Metastases ◽  
Cord Compression ◽  
External Beam Radiation ◽  
Spinal Instability ◽  
Mechanical Instability

A decision-making framework called NOMS (neurologic, oncologic, mechanical and systemic) facilitates and guides therapeutic decisions for patients with spinal metastases. Patients should be evaluated for signs of myelopathy or cauda equina syndrome. The Epidural Spinal Cord Compression (ESCC) scale facilitates reporting of the degree of radiographic spinal cord compression. A determination of the expected histology-specific tumor response to conventionally fractionated external beam radiation (cEBRT) and systemic therapy should be made. Radiation therapy effectively treats biologic pain for radiosensitive tumors such as multiple myeloma. Patients should undergo a careful evaluation of movement-associated pain as tumor-induced spinal instability is an independent indication for surgery. Determination of tumor-associated mechanical instability can be facilitated by the Spinal Instability Neoplastic Score (SINS). Herein, the authors present a case of spinal multiple myeloma managed using the NOMS framework and in consideration of current evidence and treatment paradigms.

Thoracic diastematomyelia with concurrent intradural epidermoid spinal cord tumor and cervical syrinx in an adult

2002 ◽  
Vol 97 (2) ◽  
pp. 231-234 ◽  
Author(s):  
Jason P. Sheehan ◽  
Jonas M. Sheehan ◽  
M. Beatriz Lopes ◽  
John A. Jane
Keyword(s):  
Spinal Cord ◽  
Lower Extremity ◽  
Epidermoid Cyst ◽  
Spinal Cord Tumor ◽  
Cauda Equina ◽  
Content Type ◽  
Lower Extremity Pain ◽  
Microscopic Evaluation ◽  
The Right ◽  
Fine Print

✓ Diastematomyelia is a rare entity in which some portion of the spinal cord is split into two by a midline septum. Most cases occur in childhood, but some develop in adulthood. A variety of concurrent spinal anomalies may be found in patients with diastematomyelia. The authors describe a 38-year-old right-handed woman who presented with a 7-month history of lower-extremity pain and weakness on the right side. She denied recent trauma or illness. Sensorimotor deficits, hyperreflexia, and a positive Babinski reflex in the right lower extremity were demonstrated on examination. Neuroimaging revealed diastematomyelia extending from T-1 to T-3, an expanded right hemicord from T-2 to T-4, and a C6–7 syrinx. The patient underwent T1–3 total laminectomies, resection of the septum, untethering of the cord, and excision of the hemicord lesion. The hemicord mass was determined to be an intramedullary epidermoid cyst; on microscopic evaluation the diastematomyelia cleft was shown to contain fibroadipose connective tissue with nerve twigs and ganglion cells. Postoperatively, the right lower-extremity pain, weakness, and sensory deficits improved. Diastematomyelia can present after a long, relatively asymptomatic period and should be kept in the differential diagnosis for radiculopathy, myelopathy, tethered cord syndrome, or cauda equina syndrome. Numerous spinal lesions can be found in conjunction with diastematomyelia. To the authors' knowledge, this is the first case in which a thoracic epidermoid cyst and cervical syrinx occurred concurrently with an upper thoracic diastematomyelia. Thorough neuraxis radiographic evaluation and surgical treatment are usually indicated.

Syringomyelia and Syringobulbia Associated with an Ependymoma of the Cauda Equina Involving the Conus Medullaris: Case Report

Neurosurgery ◽  
1986 ◽  
Vol 18 (3) ◽  
pp. 357-360 ◽  
Author(s):  
Shinji Nagahiro ◽  
Yasuhiko Matsukado ◽  
Jun-ichi Kuratsu ◽  
Yoshiki Saito ◽  
Seishi Takamura
Keyword(s):  
Computed Tomography ◽  
Spinal Cord ◽  
Case Report ◽  
Spinal Cord Tumor ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Postoperative Study

Abstract A patient with syringomyelia and syringobulbia secondary to an asymptomatic ependymoma of the cauda equina involving the conus medullaris is described. Delayed metrizamide computed tomography myelography was decisive for making the diagnosis of a highly extended syrinx associated with the tumor. Syringomyelic symptoms improved remarkably following the removal of the tumor, and the syrinx was not visualized in a postoperative study. The pathogenesis of syringomyelia associated with a caudally located spinal cord tumor is discussed.

Microsurgical resection of intramedullary spinal cord ependymoma

2014 ◽  
Vol 37 (v2supplement) ◽  
pp. Video9
Author(s):  
Paul C. McCormick
Keyword(s):  
Spinal Cord ◽  
Growth Rate ◽  
Spinal Cord Tumor ◽  
Intramedullary Spinal Cord ◽  
Clear Margin ◽  
Intramedullary Spinal Cord Tumor ◽  
Link Type ◽  
Microsurgical Resection ◽  
Spinal Cord Ependymoma ◽  
Posterior Midline

Ependymomas are the most commonly occurring intramedullary spinal cord tumor in adults. With few exceptions these tumors are histologically benign, although they exhibit some biologic variability with respect to growth rate. While unencapsulated, spinal ependymomas are non-infiltrative and present a clear margin of demarcation from the surrounding spinal cord that serves as an effective dissection plane. This video demonstrates the technique of microsurgical resection of an intramedullary ependymoma through a posterior midline myelotomy.The video can be found here: http://youtu.be/lcHhymSvSqU.

scholarly journals Autonomic dysreflexia associated with cervical spinal cord gliofibroma: case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hiroyuki Mizuno ◽  
Fumiaki Honda ◽  
Hayato Ikota ◽  
Yuhei Yoshimoto
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Spinal Cord Tumor ◽  
Autonomic Dysreflexia ◽  
Tumor Biopsy ◽  
Intramedullary Lesion ◽  
First Case ◽  
Cord Injury ◽  
Paroxysmal Hypertension ◽  
Upper And Lower Extremities

Abstract Background Autonomic dysreflexia (AD) is an abnormal reflex of the autonomic nervous system normally observed in patients with spinal cord injury from the sixth thoracic vertebra and above. AD causes various symptoms including paroxysmal hypertension due to stimulus. Here, we report a case of recurrent AD associated with cervical spinal cord tumor. Case presentation The patient was a 57-year-old man. Magnetic resonance imaging revealed an intramedullary lesion in the C2, C6, and high Th12 levels. During the course of treatment, sudden loss of consciousness occurred together with abnormal paroxysmal hypertension, marked facial sweating, left upward conjugate gaze deviation, ankylosis of both upper and lower extremities, and mydriasis. Seizures repeatedly occurred, with symptoms disappearing after approximately 30 min. AD associated with cervical spinal cord tumor was diagnosed. Histological examination by tumor biopsy confirmed the diagnosis of gliofibroma. Radiotherapy was performed targeting the entire brain and spinal cord. The patient died approximately 3 months after treatment was started. Conclusions AD is rarely associated with spinal cord tumor, and this is the first case associated with cervical spinal cord gliofibroma. AD is important to recognize, since immediate and appropriate response is required.

scholarly journals Intraoperative 3T MR Imaging for Spinal Cord Tumor Resection: Feasibility, Timing, and Image Quality Using a “Twin” MR–Operating Room Suite

2008 ◽  
Vol 29 (10) ◽  
pp. 1991-1994 ◽  
Author(s):  
T.P. Duprez ◽  
A. Jankovski ◽  
C. Grandin ◽  
L. Hermoye ◽  
G. Cosnard ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Image Quality ◽  
Mr Imaging ◽  
Operating Room ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
3T Mr

scholarly journals Epidemiology of spinal cord and column tumors

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. i5-i9
Author(s):  
Joshua T Wewel ◽  
John E O’Toole
Keyword(s):  
Spinal Cord ◽  
Treatment Options ◽  
Survival Rates ◽  
Spinal Metastases ◽  
Cord Compression ◽  
Severe Form ◽  
Spinal Instability ◽  
Treatment Cascade ◽  
Tumor Pathology ◽  
Pathologic Fractures

Abstract The spine is a frequent location for metastatic disease. As local control of primary tumor pathology continues to improve, survival rates improve and, by extension, the opportunity for metastasis increases. Breast, lung, and prostate cancer are the leading contributors to spinal metastases. Spinal metastases can manifest as bone pain, pathologic fractures, spinal instability, nerve root compression, and, in its most severe form, spinal cord compression. The global extent of disease, the spinal burden, neurologic status, and life expectancy help to categorize patients as to their candidacy for treatment options. Efficient identification and workup of those with spinal metastases will expedite the treatment cascade and improve quality of life.

Infantile Spinal Cord Tumor: Diagnostic Difficulties. A Case Report

2002 ◽  
Vol 11 (1) ◽  
pp. 1-5
Author(s):  
Taichi Tsuji ◽  
Yukihiro Matsuyama ◽  
Koji Sato ◽  
Hisashi Iwata
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Spinal Cord Tumor ◽  
Diagnostic Difficulties
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