1/132. Extraneural metastasizing ependymoma of the spinal cord.This paper reports a case of the rare entity of an extraneural metastasizing ependymoma of the spinal cord. The tumor which arose in the conus medullaris and in the cauda equina was first diagnosed in 1956 when a thoracolumbar myeloresection was performed. At autopsy, 40 years after the primary diagnosis, a massive local tumor recurrence with extraneural metastases in the lungs, the pleura, the liver, and the thoracal and abdominal lymph nodes were found. Immunohistochemical stains of the extraneural metastases showed a strong cytoplasmatic expression of glial fibrillary acidic protein (GFAP). Neither the primary tumor nor its metastases showed any of the conventional morphological criteria of malignancy. Reviewing the literature we discuss the possible mechanism of extraneural tumor spread and the incidence of metastases with regard to the tumor type.- - - - - - - - - - ranking = 1keywords = cauda equina, equina, cauda (Clic here for more details about this article) |
2/132. Spinal subarachnoid hemorrhage attributable to schwannoma of the cauda equina.BACKGROUND: cauda equina syndrome occurring as a result of spontaneous spinal subarachnoid hemorrhage (SAH) from a spinal tumor is reported to be rare. CASE DESCRIPTION: A 28-year-old woman presented at our clinic with a history of severe back pain for 10 days, progressive paraparesis, and urinary retention. Her physical examination revealed a mass located intradurally at the level of L1-2 and a massive SAH. An L1-L2, laminectomy and a hemilaminectomy from D9 to D12 were performed and the SAH was evacuated and the cord was decompressed. CONCLUSION: At the first year follow-up, her restricted dorsal and plantar flexion continued. Post-gadolinium magnetic resonance imaging revealed no mass.- - - - - - - - - - ranking = 4.1730005818842keywords = cauda equina, equina, cauda (Clic here for more details about this article) |
3/132. Cutaneomeningospinal angiomatosis (Cobb syndrome) with tethered cord.A newborn presented with a skin-covered lumbar mass with a subcutaneous hemangioma and on a magnetic resonance image (MRI) revealed a tethered spinal cord with a local mass. The mass had signal characteristics compatible with a lipoma. An initial diagnosis of a lipomeningocele with tethered cord was made, and the patient underwent surgical exploration and subtotal resection of the mass. A follow-up MRI revealed that the cord was still tethered, but an additional mass was present. The initial mass with signal characteristics of lipomatous tissue was accompanied by a low-signal mass in the lumbosacral canal, ventral to the cord, and bilateral enlargement of the foramina at the lumbosacral level. Because of a concern for an intraspinal tumor, a second operative intervention was performed. Multiple biopsies of the mass inside the spinal cord, the nerve roots and at the level of the foramina revealed angiomas that had similar pathology in all the specimens. A partial resection of the masses and a release of the tethered cord was performed by sectioning the thickened filum terminale. The diagnosis of Cobb's syndrome was made. The unique association of a tethered cord and the Cobb syndrome is reported here.- - - - - - - - - - ranking = 2.6268574607436keywords = filum terminale, terminale, filum (Clic here for more details about this article) |
4/132. Renal cell carcinoma: a rare source of cauda equina metastasis. Case report.The authors present the case of a patient in whom intradural metastasis from renal cell carcinoma spread to the cauda equina. To the authors' knowledge, this is only the second report of its kind. This male patient had undergone nephrectomy for the treatment of renal cell carcinoma for 5 years and was diagnosed as having metastatic lung disease 1 year prior to admission. The patient presented with lower back pain that radiated to both legs, but he exhibited no sensorimotor deficits. The majority of cauda equina tumors are primary tumors, and metastases are very rare. The literature is reviewed with reference to current molecular genetic paradigms of metastatic renal cell carcinoma.- - - - - - - - - - ranking = 6keywords = cauda equina, equina, cauda (Clic here for more details about this article) |
5/132. Intramedullary spinal teratoma presenting with urinary retention: case report and review of the literature.OBJECTIVE AND IMPORTANCE: Intramedullary tumors affect a small but significant segment of patients with spinal cord tumors. Intramedullary teratomas are rare entities that are usually located in the sacrococcygeal region. Although some reports claim that diagnostic studies can exactly predict the nature of intramedullary tumors, this case report demonstrates the lack of preoperative diagnostic specificity. Therefore, the aim of surgery should be radical extirpation whenever possible. CLINICAL PRESENTATION: A case report of a thoracolumbar intramedullary teratoma is presented. This young male patient displayed urinary retention and motor deficits. Computed tomographic and magnetic resonance imaging examination revealed an intramedullary tumor; however, the exact nature of the tumor could not be determined preoperatively. The literature concerning these tumors is extensively reviewed. INTERVENTION: During surgery, a multicystic tumor was found at the base of the filum terminale, which was resected as far as possible. CONCLUSION: It is concluded that surgery should be the first choice for treatment. More aggressive teratomas are found in intramedullary locations, especially in children, emphasizing the importance of radical tumor resection. The use of adjuvant chemo- or radiotherapy should be explicitly substantiated for the nonbenign teratoma group.- - - - - - - - - - ranking = 2.6268574607436keywords = filum terminale, terminale, filum (Clic here for more details about this article) |
6/132. Ependymomas of the spinal cord and cauda equina: An analysis of 26 cases and a review of the literature.STUDY DESIGN: Retrospective review. OBJECTIVES: To clarify the clinical features of patients with spinal ependymomas and to compare the clinical results between the patients in whom microsurgical technique and spinal cord monitoring were used intraoperatively and the patients in whom they were not used. SETTING: Keio University Hospital, tokyo, japan. methods: Twenty-six consecutive patients with spinal ependymomas were treated surgically between 1958 and 1995. All patients underwent tumor resection through a posterior approach. Complete tumor resection was possible in 15 patients (57. 7%), and subtotal tumor resection (more than 90%) was done in two patients (7.7%). Only a partial tumor resection (less than 90%) was performed in the remainder of the patients (34.6%). The operative results of the patients were evaluated by the Japanese Orthopaedic association Scoring System (JOA score) and its recovery rate. RESULTS: The overall average recovery rate was 18.3%. The mean recovery rate was 14.4% in cervical lesion, 11.1% in thoracic lesion and 40% in lumbar lesion. The recovery rate of eight patients with cervical ependymomas who underwent tumor resection under both microscopic surgical procedure and intraoperative spinal cord monitoring was 37.1% although the recovery rate of the rest of the patients was -1.6%. There was a statistical difference between the two groups (P<0.02). The survival rate of patients following complete excision was statistically better compared to that of patients after incomplete resection. CONCLUSION: Both microsurgical technique and spinal cord monitoring are indispensable to achieve total removal of ependymomas and to obtain improvement of neurological recovery.- - - - - - - - - - ranking = 4keywords = cauda equina, equina, cauda (Clic here for more details about this article) |
7/132. Isolated eccentric syrinx of the conus medullaris simulating a tumour.There are many reasons for the formation of cavities in the spinal cord. A focal cavitation is distinguished from syringomyclia by the absence of an ependymal lining in the former as opposed to the latter. The authors report a case of an isolated eccentrically placed syringomyelia of the conus medullaris, which caused a cauda equina syndrome and resembled a tumour on MRI.- - - - - - - - - - ranking = 1keywords = cauda equina, equina, cauda (Clic here for more details about this article) |
8/132. Granulocytic sarcoma of the spine.OBJECTIVE: Granulocytic sarcomas (chloromas) are tumors consisting of primitive myeloid cells. They are rare manifestations of acute and chronic leukemias and can occasionally precede the development of systemic disease by weeks to years. Spinal complications of chloromas, such as cord compression secondary to epidural tumor or cauda equina syndrome, have been described but are uncommon. methods: We present eight new cases of spinal chloroma. Three patients displayed significant motor deficit in the form of paraparesis or paraplegia. All patients complained of lower back pain, with other complaints including generalized pain, abdominal pain, numbness and pain in the lower extremities and perianal region, and poor appetite. The average age of the patients was 37 years. Treatment strategies included surgery, chemotherapy, and radiotherapy. Three patients underwent surgical decompression. Six patients received chemotherapy, and six patients received radiotherapy at doses of 2000 to 3000 cGy in up to 30 fractions. RESULTS: Patient survival ranged from 18 days to 9.5 years after diagnosis. A review of the previously reported cases of granulocytic sarcoma in addition to our new cases reveals that the most effective treatment is multimodality therapy coupled with early diagnosis. CONCLUSION: Increased awareness of this entity will facilitate early diagnosis and minimize potentially preventable neurological morbidity.- - - - - - - - - - ranking = 1keywords = cauda equina, equina, cauda (Clic here for more details about this article) |
9/132. Multiple hemangiomas (hemangiomatosis) of the cauda equina and spinal cord. Case report.A case of multiple hemangiomas of the cauda equina nerve roots, conus medullaris, and lower spinal cord is described. The 74-year-old male patient presented with a 9-month history of progressive bilateral leg weakness. He had a history of lymphoma at the age of 39 years and renal cell carcinoma in his early 40s. Neither disease was evident at the time of this presentation. A magnetic resonance image revealed multiple enhancing nodules in the cauda equina region as well as on the pial surface of the lower thoracic spinal cord and conus medullaris. The patient underwent an L2-3 laminectomy. cauda equina nerve roots were found to be studded with numerous purple nodules, the largest measuring 6 to 8 mm. The nodules were adherent to nerve roots from which they could not be resected. Two lesions were histologically examined and found to be capillary hemangiomas. Twelve months into an uneventful postoperative course, the patient is neurologically unchanged. This unique case might represent a distinct form of hemangiomatosis confined to the cauda equina nerve roots and spinal cord.- - - - - - - - - - ranking = 7.1730005818842keywords = cauda equina, equina, cauda (Clic here for more details about this article) |
10/132. Intradural spinal lipoma of the conus medullaris without spinal dysraphism.A 42-year-old man suffering from progressive left radicular sensory motor loss (L4 level) underwent neurosurgical repair. neuroimaging (RMI) had led to the diagnosis of schwannoma of the filum terminale with lipomatous component. Histological examination visualized a true mature lipoma associated with numerous bundles of more or less dystrophic nerve fibers. This histological benign tumor raised the problem of the genesis of intradural lipomas of spinal cord.- - - - - - - - - - ranking = 2.6268574607436keywords = filum terminale, terminale, filum (Clic here for more details about this article) |
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