31/34. Cavernous hemangioma of the spinal cord - conservative or operative management?Once believed to be extremely uncommon, due to magnetic resonance imaging cavernous hemangiomas of the spinal cord are detected with increasing frequency. Management of both symptomatic and asymptomatic intramedullary cavernous hamangiomas is therefore of growing importance. However, experience with treatment and follow-up is very limited. In particular, patients with multiple central nervous system cavernous hemangiomas represent a therapeutical dilemma. We present a patient with a ruptured intramedullary and multiple cerebral cavernous hemangiomas and a survey of current knowledge of epidemiology, pathophysiology and treatment options. We conclude that the benefit of operative treatment possibly decreases with the number of clinically silent vascular malformations.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
32/34. Intradural-extramedullary cavernous hemangioma of the left motor root C7--case report and update of the literature.OBJECTIVE: Intradural-extramedullary cavernomas of the spine are rare lesions with only 21 published cases to date. Due to their rareness and special characteristics diagnosis often is difficult. We report on an additional case of an intradural-extramedullary cavernoma of the spine. PATIENT: A 56-year-old male presented with left shoulder pain and acute onset of pain affecting the whole spinal column two weeks prior to admission. There were no motor deficits, but a hypesthesia corresponding to the right distal C8-dermatome. MRI revealed an intradural-extramedullary, expansive lesion at the level of C6 with a hyperintense appearance in both T (1)- and T (2)-weighted images. Neither a hemosiderin rim nor contrast enhancement was visible. RESULTS: During surgery a hematoma and a reddish, berry-like tumor adherent to the left motor root C7 were removed. There were no new neurological deficits, and shoulder and back pain resolved within a few weeks after surgery. Histopathologically a cavernous hemangioma was diagnosed. CONCLUSIONS: The patient's symptoms were caused both by direct nerve compression and by spinal hemorrhage, most likely spinal SAH. As there was no characteristic hemosiderin rim and due to the hyperintense appearance in T (1)- and T (2)-weighted MR scans, a radiological diagnosis of hemorrhage and classification of the lesion was difficult. Despite their rareness, in patients with signs of spontaneous, spinal SAH and/or nerve compression syndromes cavernous hemangiomas have to be considered as a potential cause.- - - - - - - - - - ranking = 0.87838538643187keywords = spinal, nerve (Clic here for more details about this article) |
33/34. Three-dimensional ultrasonography navigation in spinal cord tumor surgery. Technical note.The authors describe the technical application of three-dimensional (3D) ultrasonography navigation in spinal cord tumor surgery. The spinal cord is a complex neurological structure in which there is the potential for causing neurological morbidity during tumor resection. Standard neuronavigation systems based on computed tomography or C-arm images are not adapted to tumor surgery in the spinal cord. Since 2004 the authors have been using a 3D ultrasonography-based neuronavigation system. During surgery, two-dimensional ultrasound images were acquired and reconstructed into 3D image data to assist in tumor resection. The navigation cameras read the position of a patient reference frame attached to a spinous process, the ultrasonography probe, and surgical instruments. Five- and 10-MHz phased-array ultrasonography probes equipped with optical tracking frames were used for image data acquisition. spinal cord tumors were visualized using ultrasonography, and 3D ultrasonography-guided tumor biopsy sampling and resection were performed. The practice of attaching the reference frame to a spinous process adjacent to the spinal cord tumor, as well as performing image acquisition just before starting the resection, reduced the possible sources of inaccuracy. The technical application of a navigation system based on intraoperative 3D ultrasound image reconstruction seems feasible and may have the potential of improving functional outcome in association with spinal cord tumor surgery.- - - - - - - - - - ranking = 1.8keywords = spinal (Clic here for more details about this article) |
34/34. Neuroendoscopic appearance of an intraventricular cavernous angioma blocking the foramen of monro - case report.A 47-year-old woman presented with unilateral ventricular enlargement detected by magnetic resonance imaging during a medical checkup. Neuroendoscopic exploration identified a multilocular lesion in which dark red fluid formed a niveau near the right side of the foramen of Monro. The diagnosis was intraventricular cavernous angioma. Restricted flow of cerebrospinal fluid at the foramen of Monro was observed. Xanthochromia, which seemed to be due to previous bleeding, was observed at the fornix. When the neuroendoscope touched the angioma, the wall collapsed and bled. Endoscopic removal of the angioma was abandoned, and craniotomy and resection of the angioma were performed. No new neurological anomalies were observed after surgery. Preoperative diagnosis of intraventricular cavernous angioma is difficult based on neuroimaging. neuroendoscopy is effective for diagnosis and the decision-making process regarding treatment.- - - - - - - - - - ranking = 0.2keywords = spinal (Clic here for more details about this article) |
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