A Clinical Analysis of Metastatic Spine Tumors

The authors analyed 27 cases of metastatic spine tumor in regard to diagnostic procedures, effects of radiation and their average survival time. Technetium-99m radiolabeled polyphosphate bone scans were superior to any other diagnostic procedures as a screening test for the early detection of spine metastases. Spinal CT scans with myelogram were useful to define the anatomic extent of destruction and cord comprssion. To prevent myelopathy, early radiation therapy was certainly helpful. The decompressive laminectomy alone have contributed little to the patients in regard to the prolongation of life and the correction of neurological deteriorations. The authors concluded that the one-stage laminectomy and adequate posterior stabilization with the use of internal fixation devices were the choice of treatment for control of pain and prevention of the complications from spinal instability in the following patients: 1) with early progressive myelopathy: 2) who were unable to move due to the pain evoked by motion; and 3) who showed the evidence of spinal instability radiologically and/or clinically.

Suprasellar Mass Lesions Presenting with Central Diabets Insipidus

Central diabetes insipidus(CDI) may result from any abnormalities in the supraoptic-neuropituitary axis. Since 1984, we have studied 7 suprasellar mass lesions presenting with CDI. There were 3 suprasellar germinomas including 1 pituitary stalk(infundibular) microgerminoma, 1 suprasellar lymphoma, 1 craniopharyngioma, 2 suprasellar mass lesions whose pathologies were not confirmed. In two case of germinoma, one at infundibulum and another at suprasellar region, the diagnosis was made on the basis of radiological and endocrinological findings and rapid disappearance of the mass after irradiation. The symptoms of CDI had improved within 2 months after the irradiation in all 3 cases of germinoma. Another 4 cases had been on DDAVP during follow-up periods more than one year. Primary tumorous lesions presenting with CDI always demonstrate pituitary stalk enlargement, suprasellar mass, or both. Among parasellar lesions presenting with CDI, germinoma and lymphoma are very sensitive to radiotherapy and have no need of surgery which and result in pituitary stalk damage and permanent CDI. And lesions of infectious and systemic disease also have no need of surgery. To avoid unnecessary surgery or biopsy, preoperative differential diagnosis of these lesions by CT scan findings and other systemic evaluations is important. In addition, elevation of serum prolactin level appeared to be related to infundibular lesions as a few authors suggested previously but not to aid differential diagnosis.