Clinical characteristics and surgical outcomes of spinal myxopapillary ependymomas
AbstractSpinal myxopapillary ependymoma (SME) is a rare pathological variant of ependymoma, which most commonly occurs in the cauda equina and filum terminale of the spinal cord. Although SME is considered as a benign entity, histologically corresponding to WHO grade I, local recurrence and metastasis have been reported in many cases. The purpose of this large-scale, single-center study was to investigate the clinical characteristics and surgical outcomes of SME. A total of 34 consecutive patients diagnosed with SME were enrolled in this retrospective study. All patients underwent magnetic resonance imaging (MRI) and were treated with surgical resection. Individual clinical data were collected, and surgical outcomes were evaluated during the follow-up period. There were 21 males and 13 females, with an average age of 29.97 years. Clinical symptoms included back pain (82.4%), weakness (44.1%) and numbness (20.6%) in extremities, and sphincter dysfunction (26.5%). The tumor locations included lumbar segments (52.9%), thoracolumbar segments (23.5%), lumbosacral segments (17.6%), and thoraco-lumbo-sacral segments (5.9%) . On MRI, all SMEs appeared hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging, with remarkable enhancement. Gross total resection was achieved in 18 patients, and subtotal resection (STR) was achieved in 16 patients. After an average follow-up period of 41.5 months, recurre nce was noted in 5 patients (5 of 16) who underwent STR...
We present a case of a 46-year-old woman with lower back pain radiating to the right gluteal and posterior femoral regions, without a history of traumatic injury. Magnetic resonance imaging (MRI) of the thoracic and lumbar spine showed an intradural, extramedullary, well-circumscribed, contrast-enhancing lesion located in the T12–L1 region, hypo- to isointense on T2-weighted imaging, and isointense on T1. Complete surgical removal of the lesion, measuring 3 × 2.5 × 1 cm, was performed. The histopathologic findings revealed the lesion was an ectopic adrenal cortical adenoma, wit...
Conclusions: Neuraxial anesthesia can be performed safely in patients who have previously undergone lumbar resections of intradural ependymomas. However, the anesthesiologist should place the epidural needle/catheter at a nonoperative level (e.g. above/below). Furthermore, epidural local anesthetics and opioids, as in this case, placed at the L5-S1 level below an L1-L3 prior surgical scar, may diffuse intradurally, bypassing the obliterated surgical epidural space and/or attendant scar tissue. PMID: 30488009 [PubMed]
In this report, we present a 36-year-old woman who have been seen in another hospital with complaints of back pain radiating into both legs 5 years ago. Magnetic resonance imaging (MRI) examinations revealed a lesion releated to the spinal cord.
ConclusionWe presented the first case of using VNT based fusion imaging of real-time US/MRI to guide the surgical resection of an intraspinal tumour. Future study with larger patient number is needed to validate this technique as an alternative to fluoroscopy in patients who need to avoid radiation exposure.
A 23-year-old female was admitted to our hospital because she had suffered from back pain for 3 years and paralysis of both lower limbs for 10 days. Neurologic examination showed sensory disturbance and complete paralysis in bilateral lower extremities with negative Babinski sign. Contrast-enhanced magnetic resonance imaging showed there was an enhanced intradural lesion between T2 and T12, which pressed the spinal cord. The lesion was resected completely by laminectomy approach, and the tumor was totally intradural extramedullary.
Publication date: Available online 19 September 2017 Source:Interdisciplinary Neurosurgery Author(s): Jeffrey H. Zimering, Bryan D. Choi, Matthew J. Koch, John C. Dewitt, Anat Stemmer-Rachamimov, John H. Shin The aim of the present paper is to report undiagnosed sporadic neurofibromatosis type 2 presenting with symptomatic compressive spinal tumors following pregnancy. A 36-year-old woman experienced progressive, severe lumbar radicular pain in the second trimester of pregnancy which became intractable soon after delivery. Magnetic resonance imaging revealed a complex heterogeneous hypointense mass lesion around the conus...
A 15-year-old girl presented with a 1-year history of lower back pain and a 2-month history of headaches. Fundus examination revealed high-grade papilledema (Figure 1). Brain magnetic resonance imaging (MRI) showed extensive susceptibility artifact throughout the infratentorial and supratentorial subarachnoid space, reflecting superficial siderosis (Figure 2, A). MRI of the lumbosacral spine revealed an intradural, extramedullary spinal mass between L3 and S5 (Figure 2, B).
CONCLUSION: CEPs commonly present with mild symptoms and signs rather than the acute-onset of a flaccid paraparesis/cauda equina syndrome as seen in this case. Here, the authors review the radiological and histopathological characteristics of CEP and emphasize the role of IHC in differentiating "CEP" from the more common ependymomas. PMID: 27127702 [PubMed]
Conclusion Because the primary symptoms of spinal intramedullary ependymomas can mimic ordinary LBP presentations, in particular lumbar intervertebral disc herniations, clinicians need to be sensitive to subtle changes in the clinical presentation of LBP patients. Prompt referral to advanced medical imaging such as MRI and early neurosurgical intervention is key to achieve best possible outcomes for patients with spinal intramedullary ependymomas.
A 30-year-old man presented with complaints of neck pain and weakness of bilateral upper limbs for 6 months. Magnetic resonance imaging revealed an ill-defined lesion at the C2–C4 levels that appeared isointense on T1-weighted, hyperintense on T2-weighted, causing fusiform enlargement of cord and slight enhancement on gadolinium (Fig. 1). There was evidence of intratumoral hemorrhage in the form of hypointense foci on T2-weighted image. The patient underwent urgent C2–C4 laminectomy and complete excision of tumor was achieved.