scholarly journals Intradural cyst: intramedullary or extramedullary? Illustrative case

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Timothy Kim ◽  
Brendan Judy ◽  
Timothy Witham
Keyword(s):  
Spinal Cord ◽  
Back Pain ◽  
Cystic Lesion ◽  
Conus Medullaris ◽  
Preoperative Imaging ◽  
Illustrative Case ◽  
Spinal Cord Cysts

BACKGROUND Intradural spinal cord cysts are uncommon and generally benign. It can be difficult to determine whether the cyst is intramedullary or extramedullary on preoperative imaging, and the location of the cyst may be determined intraoperatively. This patient presented with intractable back pain associated with imbalance and was found to have a cystic lesion of the ventriculus terminalis (VT). OBSERVATIONS The patient was found to have a cystic lesion of the VT that was intramedullary rather than extramedullary, as initially expected based on preoperative imaging. LESSONS VT is a rare cystic expansion of the conus medullaris that can appear extramedullary on preoperative imaging. Intraoperatively, this lesion was found to be intramedullary and was successfully treated with fenestration.

scholarly journals Acute thoracic disc heralded by change in spinal cord stimulation pattern: illustrative case

2021 ◽  
Vol 2 (20) ◽  
Author(s):  
Faraz Behzadi ◽  
Edvin Telemi ◽  
Tarek R. Mansour ◽  
Thomas M. Zervos ◽  
Muwaffak M. Abdulhak ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Back Pain ◽  
Spinal Cord Stimulation ◽  
Chronic Back Pain ◽  
Cord Compression ◽  
Illustrative Case ◽  
Disc Protrusion ◽  
Stimulation Parameters ◽  
Spine Pathology ◽  
Thoracic Disc

BACKGROUND Spinal cord stimulation (SCS) uses unique electric stimulation parameters to selectively treat specific regions of chronic or refractory back pain. Changing these parameters can lead to spreading paresthesia and/or pain beyond the desired region. OBSERVATIONS A patient with a history of stable, successful SCS treatment presented with acute development of paresthesias that were relieved by reduction of stimulation parameters. The patient required paradoxically lower SCS settings for control of chronic back pain. This presentation prompted further investigation, which revealed a new disc protrusion and cord compression at the level of the paddle lead. LESSONS In patients with SCS, a new onset of back pain accompanied by acute paresthesia that is reversible by reducing the SCS amplitude warrants investigation for new spine pathology.

Dermoid tumors of the spinal cord

1970 ◽  
Vol 33 (6) ◽  
pp. 676-681 ◽  
Author(s):  
Ian C. Bailey
Keyword(s):  
Spinal Cord ◽  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina ◽  
Complete Removal ◽  
Cord Compression ◽  
Conus Medullaris ◽  
Low Back ◽  
Content Type ◽  
Fine Print

✓ This is an analysis of 10 cases of dermoid tumor occurring in the spinal canal (8 lumbar and 2 thoracic). Low-back pain was the commonest presenting symptom, especially if the tumor was adherent to the conus medullaris. Other complaints included urinary dysfunction and motor and sensory disturbances of the legs. Clinical and radiological evidence of spina bifida was found in about half of the cases and suggested the diagnosis of a developmental type of tumor when patients presented with progressive spinal cord compression. At operation, the tumors were often found embedded in the conus medullaris or firmly adherent to the cauda equina, thus precluding complete removal. Evacuation of the cystic contents, however, gave lasting relief of the low-back pain and did not cause any deterioration in neurological function. In a follow-up study, ranging from 1 to 15 years, virtually no improvement in the neurological signs was observed. On the other hand, only one case has deteriorated due to recurrence of tumor growth.

scholarly journals Lumbar Laminoplasty for Resection of Myxopapillary Ependymoma of the Conus Medullaris: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Michael J Strong ◽  
Timothy J Yee ◽  
Siri Sahib S Khalsa ◽  
Yamaan S Saadeh ◽  
Robert North ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Back Pain ◽  
Recurrence Rate ◽  
Conus Medullaris ◽  
Gross Total Resection ◽  
External Beam Radiation ◽  
Preoperative Imaging ◽  
Myxopapillary Ependymoma ◽  
Total Resection ◽  
Patient Consent

Abstract Myxopapillary ependymomas are slow-growing tumors that are located almost exclusively in the region of the conus medullaris, cauda equina, and filum terminale of the spinal cord. Surgical intervention achieving a gross total resection is the main treatment modality. If, however, a gross total resection cannot be achieved, surgery is augmented with radiation therapy. In this video, we present the case of a 27-yr-old male with persistent back pain and radiculopathy who was found to have a myxopapillary ependymoma that was adherent to the conus. Preoperative imaging demonstrated that the tumor was displacing the conus and nerve roots ventrally. A laminoplasty at L1-L2 was performed with near-total resection because of the intimate involvement of neural tissue. The key features of the video include performing laminoplasty and rationale, and performing maximum safe tumor resection with a combination of bipolar cautery, suction, and ultrasonic aspiration augmented with frequent stimulation, gel foam pledgets intradurally, and achieving a watertight closure of the dura and fascia. The patient tolerated the surgery well without any complications. Given his gross residual disease along the conus and young age, he was at a high risk for continued tumor growth without adjuvant therapy, with a recurrence rate of roughly 33% to 45% in patients who underwent subtotal resection. With the addition of adjuvant radiation therapy, the recurrence rate is 20% to 29%.1,2 He was discharged to home with a plan for conventional fractionated external beam radiation. At the most recent follow-up, he reported decreased back pain and radiculopathy. Appropriate patient consent was obtained.

scholarly journals Cauda equina and conus medullaris syndromes due to Spinal Cord Schistosomiasis: a case report

2021 ◽  
Author(s):  
Lucas Cardoso Siqueira Albernaz ◽  
Izabel Feitosa da Mata Leite ◽  
Guilherme de Aguiar Moraes ◽  
Adelina Mouta Moreira Neto ◽  
Matheus de Campos Medeiros
Keyword(s):  
Spinal Cord ◽  
Low Back Pain ◽  
Back Pain ◽  
Case Report ◽  
Complete Blood Count ◽  
Clinical Symptoms ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
High Morbidity ◽  
Low Back

Context: Schistosomiasis is a prevalent disease in Brazil whose medullary form can be a serious and disabling condition. Diagnosis is clinical and laboratorial, based on neurological symptoms besides Schistosoma infection exams. Spinal Cord Schistosomiasis (SCS) can be associated with cauda equina syndrome (CES) adding “saddle” anesthesia and low back pain as symptoms. Case Report: A 22- year-old male presenting progressive bilateral and proximal pelvic weakness associated with urinary and fecal incontinence besides mild low back pain during 4 months. Patient reports daily swimming practice in rivers. Neurological examination revealed grade 3 weakness of the proximal muscles, patellar hyporeflexia, saddle anesthesia and hypotonia of the proximal muscles. Magnetic resonance imaging of the lumbar spine showed conus medullaris fusiform enlargement, associated with T2 and STIR hyperintensity (edema), hyposignal in T1, findings suggestive of an inflammatory / infectious etiology. Laboratory tests revealed a complete blood count with mild leukocytosis and eosinophilia; positive IgG serology for schistosomiasis; increased protein levels in the cerebrospinal fluid; stool analysis was normal. The diagnosis of CES and conus medullaris syndrome due to SCS was established and treatment with prednisone and praziquantel was initiated, with significant improvement in clinical symptoms. Conclusion: This case emphasizes the importance of early diagnosis and the initiation of appropriate therapy in order to prevent irreversible injuries in cases of CES and conus medullaris syndrome, both conditions of high morbidity that are often overlooked.

Intramedullary bronchogenic cyst of the conus medullaris

2009 ◽  
Vol 11 (4) ◽  
pp. 477-479 ◽  
Author(s):  
Cem Yilmaz ◽  
Salih Gulsen ◽  
Erkin Sonmez ◽  
Ozkan Ozger ◽  
Muge Unlukaplan ◽  
...  
Keyword(s):  
Back Pain ◽  
Mr Imaging ◽  
Cystic Lesion ◽  
Bronchogenic Cyst ◽  
Lower Extremities ◽  
Conus Medullaris ◽  
Histopathological Analysis ◽  
Congenital Lesions ◽  
Intradural Extramedullary ◽  
Bronchogenic Cysts

Spinal bronchogenic cysts are rare congenital lesions. The authors describe their experience in the treatment of a 17-year-old boy who presented with back pain and paresthesia in both lower extremities. Lumbar MR imaging revealed the presence of an intramedullary cystic lesion at the conus medullaris and histopathological analysis revealed a bronchogenic cyst. To the best of the authors' knowledge, this is the first report of an intramedullary spinal bronchogenic cyst arising at the conus; all previously reported spinal bronchogenic cysts were either intradural extramedullary or not located at the conus.

scholarly journals Spinal intramedullary hemangioblastoma and schwannoma collision tumor: illustrative case

2021 ◽  
Vol 1 (3) ◽  
Author(s):  
Matthew T. Neal ◽  
Alexandra E. Richards ◽  
Kara L. Curley ◽  
Kliment Donev ◽  
Mark K. Lyons ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Collision Tumor ◽  
Preoperative Imaging ◽  
Histopathological Diagnosis ◽  
Illustrative Case ◽  
Spinal Cord Tumors ◽  
Ongoing Research ◽  
Intramedullary Spinal Cord ◽  
Radiographic Findings ◽  
Collision Tumors

BACKGROUNDIntramedullary spinal cord tumors represent a minority of intradural tumors. Among intramedullary spinal cord tumors, hemangioblastomas are uncommon, and schwannomas are extremely rare. Collision tumors are histologically distinct tumors that are intermingled and growing together.OBSERVATIONSIn this report, the authors describe a patient with a cervical intramedullary collision tumor involving a hemangioblastoma and schwannoma. To the authors’ knowledge, no prior spinal intramedullary collision tumor involving multiple neoplasms has been described. The patient’s presentation and management are described.LESSONSClinicians should consider the possibility of collision tumors when evaluating intramedullary spinal cord tumors, especially when patient presentation and radiographic findings are atypical. When tumors with similar radiographic characteristics form collision tumors, distinction using preoperative imaging can be extremely challenging. In addition, surgical management of intramedullary collision tumors, like that for all intramedullary spinal cord tumors, should involve meticulous perioperative care and a methodical surgical technique. Maximal safe resection will depend upon histopathological diagnosis, anatomical location of the tumor, presence of distinct dissection planes, and stability of neuromonitoring. Finally, ongoing research on the genetics of intramedullary spinal cord tumors may identify underlying genetic links for intramedullary hemangioblastomas and schwannomas.

Multisession CyberKnife Radiosurgery for Intramedullary Spinal Cord Arteriovenous Malformations

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1081-1089 ◽  
Author(s):  
John Sinclair ◽  
Steven D. Chang ◽  
Iris C. Gibbs ◽  
John R. Adler
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Arteriovenous Malformations ◽  
Conus Medullaris ◽  
Spinal Angiography ◽  
Resonance Imaging ◽  
Intramedullary Spinal Cord ◽  
Cyberknife Radiosurgery

Abstract OBJECTIVE: Intramedullary spinal cord arteriovenous malformations (AVMs) have an unfavorable natural history that characteristically involves myelopathy secondary to progressive ischemia and/or recurrent hemorrhage. Although some lesions can be managed successfully with embolization and surgery, AVM size, location, and angioarchitecture precludes treatment in many circumstances. Given the poor outlook for such patients, and building on the successful experience with radiosurgical ablation of cerebral AVMs, our group at Stanford University has used CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) to treat selected spinal cord AVMs since 1997. In this article, we retrospectively analyze our preliminary experience with this technique. METHODS: Fifteen patients with intramedullary spinal cord AVMs (nine cervical, three thoracic, and three conus medullaris) were treated by image-guided SRS between 1997 and 2005. SRS was delivered in two to five sessions with an average marginal dose of 20.5 Gy. The biologically effective dose used in individual patients was escalated gradually over the course of this study. Clinical and magnetic resonance imaging follow-up were carried out annually, and spinal angiography was repeated at 3 years. RESULTS: After a mean follow-up period of 27.9 months (range, 3–59 mo), six of the seven patients who were more than 3 years from SRS had significant reductions in AVM volumes on interim magnetic resonance imaging examinations. In four of the five patients who underwent postoperative spinal angiography, persistent AVM was confirmed, albeit reduced in size. One patient demonstrated complete angiographic obliteration of a conus medullaris AVM 26 months after radiosurgery. There was no evidence of further hemorrhage after CyberKnife treatment or neurological deterioration attributable to SRS. CONCLUSION: This description of CyberKnife radiosurgical ablation demonstrates its feasibility and apparent safety for selected intramedullary spinal cord AVMs. Additional experience is necessary to ascertain the optimal radiosurgical dose and ultimate efficacy of this technique.

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