1/22. Thyroid carcinoma with isolated spinal metastasis: case history and review of the literature.An unusual case of metastatic follicular thyroid cancer presenting with symptoms of a radiculopathy at C6 is presented. The patient underwent a laminectomy and removal of tumor with resolution of his symptoms. He was found to have a well differentiated follicular thyroid carcinoma and subsequently had total thyroidectomy and 131I treatment. This patient's presentation raised questions about appropriate preoperative evaluation in this clinical scenario. This case highlights the importance of a thorough pre-operative work up for metastatic spine tumors. This should include evaluation of the thyroid consisting of thorough clinical history with particular attention to prior radiation exposure. palpation of the thyroid also should be included as part of a routine pre-operative physical in cases of metastatic lesions of unknown origin. Thyroid function studies should not be utilized unless a clinical suspicion for thyroid cancer is raised during the examination.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/22. Follow-up evaluation of resected lumbar vertebral chordoma over 11 years: a case report.STUDY DESIGN: A case report with an 11-year follow-up assessment after resection and reconstruction for lumbar chordoma is given. The literature relevant to this topic is reviewed. OBJECTIVES: To report the long-term outcome in a case of lumbar chordoma, to review the literature on vertebral chordoma, and to outline the rationale for surgical resection in such cases. SUMMARY OF BACKGROUND DATA: chordoma is a malignant bone tumor that grows slowly, often recurs locally, and metastasizes late. Although different treatment approaches exist, including radiation and surgery, the only curative treatment is early and complete surgical excision of the tumor. Immediate spinal stability must be achieved with appropriate replacement or bone graft with rigid fixation. methods: The 11-year follow-up evaluation of a 42-year-old woman with L3 and L4 vertebral body chordoma treated with complete removal, femoral shaft allograft replacement, fusion, and rigid metal fixation is reported. The patient was observed with serial physical examinations, radiographs, and laboratory studies over 11 years. RESULTS: At this writing, 11 years after the resection of the L3 and L4 chordoma, the patient is asymptomatic without evidence of recurrence or metastasis. CONCLUSIONS: As reported, vertebral chordomas are not curable, but the authors' experience contradicts this. The surgeon should aim at a wide, or at least a marginal, excision followed by a stable reconstruction.- - - - - - - - - - ranking = 9.9057028466483keywords = physical examination, physical (Clic here for more details about this article) |
3/22. cementoplasty and the oncologic population.The first and only description of percutaneous cementoplasty, to date, has been described in the French medical literature in 1994. In this series of 12 cases, radiologists successfully instilled a cement derivative into the acetabulum under fluoroscopic control. As in these cases, the major indication for cementoplasty is to provide pain control and stabilization of an osteolytic lesion. Potential complications include physical or thermal damage to the adjacent neurovascular structures, either during needle positioning or from cement leakage, respectively. Although no absolute contraindications exist, one should proceed cautiously in patients with coagulopathies. Results may be suboptimal as well in patients with pathologic fractures.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/22. Preoperative embolization and intraoperative cryocoagulation as adjuncts in resection of hypervascular lesions of the thoracolumbar spine.OBJECT: The purpose of this study was twofold. First the authors evaluated preoperative embolization alone to reduce estimated blood loss (EBL) when resecting hypervascular lesions of the thoracolumbar spine. Second, they compared this experience with intraoperative cryotherapy alone or in conjunction with embolization to minimize further EBL. methods: Twelve patients underwent 13 surgeries for hypervascular spinal tumors. In 10 cases the surgeries were augmented by preoperative embolization alone. In one patient, two different surgeries involved intraoperative cryocoagulation, and in one patient surgery involved a combination of preoperative embolization and intraoperative cryocoagulation for tumor resection. When cryocoagulation was used, its extent was controlled using intraoperative ultrasonography or by establishing physical separation of the spinal cord from the tumor. In the 10 cases in which embolization alone was conducted, intraoperative EBL in excess of 3 L occurred in five. Mean EBL was of 2.8 L per patient. In one patient, who underwent only embolization, excessive bleeding (> 8 L) required that the surgery be terminated and resulted in suboptimum tumor resection. In another three cases, intraoperative cryocoagulation was used alone (in two patients) or in combination with preoperative embolization (in one patient). In all procedures involving cryocoagulation of the lesion, adequate hemostasis was achieved with a mean EBL of only 500 ml per patient. No new neurological deficits were attributable to the use of cryocoagulation. CONCLUSIONS: Preoperative embolization alone may not always be satisfactory in reducing EBL in resection of hypervascular tumors of the thoracolumbar spine. Although experience with cryocoagulation is limited, its use, in conjunction with embolization or alone, suggests it may be helpful in limiting EBL beyond what can be achieved with embolization alone. Cryocoagulation may also assist resection by preventing spillage of tumor contents, facilitating more radical excision, and enabling spinal reconstruction. The extent of cryocoagulation could be adequately controlled using ultrasonography or by establishing physical separation between the tumor and spinal cord. Additionally, somatosensory evoked potential monitoring may provide early warning of spinal cord cooling.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
5/22. Spinal osteochondromas in middle-aged to elderly patients.STUDY DESIGN: Three case reports of solitary spinal osteochondromas in middle-aged and elderly patients. OBJECTIVES: To describe the treatment of three rare cases of spinal osteochondromas in patients significantly older than the cases previously reported in the literature. SUMMARY OF BACKGROUND DATA: Osteochondromas arising in the vertebral column are considered rare. The mean age of clinical appearance is said to be in the second or third decade of life. methods: Clinical history, physical examinations, plain radiographs, magnetic resonance imaging, myelography, computed tomographic myelography, and histopathologic findings for each case were reviewed in conjunction with previous cases reported in the literature. RESULTS: Total removal of the tumor was effective in causing the symptoms to disappear. CONCLUSIONS: Spinal osteochondromas are rare and tend to appear in young adults. Three cases of spinal osteochondromas that were unusual in terms of age at clinical presentation and localization were reported, suggesting a continuous growth of the tumor beyond skeletal maturity.- - - - - - - - - - ranking = 9.9057028466483keywords = physical examination, physical (Clic here for more details about this article) |
6/22. Presacral multiple cellular schwannomas.STUDY DESIGN: Case report. The authors documented a patient presenting with multiple cellular schwannomas along the sciatic nerve. The patient had no stigmas of neurofibromatosis. Thirteen tumors were resected via both anterior and posterior approaches. OBJECTIVES: To point out that presacral cellular schwannoma can display multiple occurrences. SUMMARY OF BACKGROUND DATA: Cellular schwannoma, which is a well-recognized variant of benign schwannoma, is often misdiagnosed as sarcoma. The tumor is usually a solitary lesion. MATERIALS AND methods: Medical history, physical findings, imaging features, and histologic findings were reviewed in a case of multiple cellular schwannomas in the presacral regions. RESULTS: A 39-year-old woman without any evidence of neurofibromatosis underwent removal of presacral multiple tumors along the sacral nerve root. Nineteen years after the surgery, the tumors recurred with multiple fashion. Thirteen tumors were resected via both anterior and posterior approaches. Immunohistochemical analysis of S-100 protein and Ki-67 were beneficial with respect to differentiation of cellular schwannoma from malignant peripheral nerve sheath tumor. CONCLUSIONS: The present case illustrated that multiple cellular schwannomas can develop in nonneurofibromatosis patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/22. Metastatic hemangiopericytoma presenting as an epidural spinal cord lesion.OBJECTIVE: hemangiopericytoma is an aggressive vascular tumour that rarely affects the central nervous system and is even more rarely spinal in presentation. The clinical features of a patient with a recurrent extraspinal hemangiopericytoma presenting with an epidural spinal cord compression by local invasion are described, including a review of the literature on metastatic hemangiopericytoma to the spine. methods: A case of a 53-year-old male, with a recurrent extraspinal hemangiopericytoma which metastasized to the thoracic spine five years after detection of the primary tumour is presented. A chart review was conducted where all pertinent history, physical, laboratory, and radiological data were collected. A Pub-Med search using the keyword "hemangiopericytoma" identified all reported cases documenting clinical features, treatment, recurrence and outcome with respect to metastatic hemangiopericytoma to the spine. RESULTS: Nine patients have been reported to have metastatic hemangiopericytoma to the spine. The median patient age was 47 years and there was a slight male preference. An unusual feature of the hemangiopericytoma is the prolonged period, up to 16 years, between the diagnosis of the primary hemangiopericytoma and the metastases to the spine. All patients were treated with a combination of radiation and surgery. CONCLUSIONS: Hemangiopericytomas show a slow clinical evolution with a strong propensity to relapse long after previous treatment and thus, once identified, prolonged follow-up for recurrence is indicated. A close follow-up of these patients is required because of frequent recurrences and delayed metastases even if the primary lesion was well-controlled. Although overall uncommon, hemangiopericytoma should be kept in mind in the differential diagnosis of vascular epidural spinal cord tumours.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/22. Importance of precise positioning for proton beam therapy in the base of skull and cervical spine.Using proton beam therapy, high doses have been delivered to chordomas and chondrosarcomas of the base of skull and cervical spine. Dose inhomogeneity to the tumors has been accepted in order to maintain normal tissue tolerances, and detailed attention to patient immobilization and to precise positioning has minimized the margins necessary to ensure these dose constraints. This study examined the contribution of precise positioning to the better dose localization achieved in these treatments. Three patients whose tumors represented different anatomic geometries were studied. Treatment plans were developed which treated as much of the tumor as possible to 74 cobalt-Gray-Equivalent (CGE) while maintaining the central brain stem and central spinal cord at less than or equal to 48 CGE, the surface of the brain stem, surface of the spinal cord, and optic structures at less than or equal to 60 CGE, and the temporal lobes at less than or equal to 5% likelihood of complication using a biophysical model of normal tissue complication probability. Two positioning accuracies were assumed: 3 mm and 10 mm. Both proton beam plans and 10 MV X ray beam plans were developed with these assumptions and dose constraints. In all cases with the same positioning uncertainties, the proton beam plans delivered more dose to a larger percentage of the tumor volume and the estimated tumor control probability was higher than with the X ray plans. However, without precise positioning both the proton plans and the X ray plans deteriorated, with a 12% to 25% decrease in estimated tumor control probability. In all but one case, the difference between protons with good positioning and poor positioning was greater than the difference between protons and X rays, both with good positioning. Hence in treating these tumors, which are in close proximity to critical normal tissues, attention to immobilization and precise positioning is essential. With good positioning, proton beam therapy permits higher doses to significantly more of the tumor in these sites than do X rays.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/22. adamantinoma of the spine: case report.OBJECTIVE: We report a patient with a cervicothoracic spinal and a mandibular adamantinoma. adamantinoma is a rare malignant neoplasm of bone and, to our knowledge, there have been only five cases of spinal adamantinoma reported. The pathogenesis of the adamantinoma, as well as the management of this extremely rare spinal tumor, is reviewed. CLINICAL PRESENTATION: A 55-year-old man was admitted to our service with cervical pain and signs of C8 and T1 radiculopathy. On physical examination, cervical spine deformity, swelling in the left mandible region, and signs of C8 and T1 radiculopathy were observed. Neuroradiology examinations showed an osteolytic mass of the C6, C7, and T1 vertebral bodies, extending into the lateral masses and transverse processes. After surgical procedures, the patient had clinical improvement. INTERVENTION: Corpectomy of C6, C7, and T1 was performed through a cervicothoracic anterior approach. Anterior stabilization of the spine was obtained using an autologous iliac crest graft and osteosynthesis with an anterior plate. On a second procedure, posterior tumor resection and spinal stabilization were performed. After the 1-year follow-up examination, a new anterior procedure was performed because of tumor recidivity and spine instability. CONCLUSION: adamantinoma, an extremely rare lesion, is a locally aggressive tumor with slow growth and the potential to metastasize. Although it is an extremely rare occurrence in the spine, adamantinoma should be considered on the diagnosis of tumors of the vertebrae. Neuroradiological examinations are not specific in the differentiation of this tumor from other conditions. This fact, coupled with the limited experience that most physicians in general have in dealing with this tumor, makes the diagnosis and treatment of adamantinoma challenging.- - - - - - - - - - ranking = 9.9057028466483keywords = physical examination, physical (Clic here for more details about this article) |
10/22. Asystole during percutaneous ethanol injection of symptomatic vertebral haemangioma.Computed tomography guided percutaneous ethanol injection is frequently employed for treatment of symptomatic vertebral haemangiomas. The procedure is performed under monitored anaesthesia care in the prone position. It has several advantages over open surgery and other therapeutic modalities and is generally considered safe. There is no previous report of any significant haemodynamic disturbance attributable to alcohol ablation of vertebral haemangiomas. We report a case in which a patient of ASA physical status I developed asystole following injection of 100% alcohol into a vertebral haemangioma, and became apnoeic and unresponsive. He recovered following intravenous administration of atropine. All staff involved in this procedure should be aware of and prepared for, this rare but potentially life-threatening complication.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
| | Next -> |