Application of intraoperative ultrasound and neuromonitoring in microsurgical treatment of intramedullary tumor in the superior cervical spinal cord / 中华显微外科杂志

Objective To analyze the effect of clinical application of ultrasound in microsurgical treatment of intramedullary tumors in the superior cervical spinal cord.Methods Retrospective study the clinical data of 15 patients with intramedullary tumors in the superior cervical spinal cord,which were underwent a laminectomy for microsurgical tumor resection during January,2014 and January,2018.Intraoperative ultrasound and neuromonitoring was accompanied by the whole surgical procedure for each case.The follow-up data was collected by outpatient department visits and telephone interviews.Results All the described patients were performed with microscopic tumor resection by using intraoperative neurophysiological monitoring and ultrasound.The pathological diagnosis was ependymocytoma (n=8) and astrocytoma (n=7).Gross total resections comprised 86.7％ of cases (n=13),and subtotal resections 13.3％ (n=2).The neurological outcome was as follows:Mc-Cormick scale grade Ⅰ,10 patients;grade Ⅱ,3 patients;grade Ⅲ,1 patient;and grade Ⅳ 1 patient;Follow-up was applied for (19.2±7.6) months in 13 cases and 12.0 months in 2 cases.Compared to the preoperative period,66.6％ of patients recovered postoperatively,20.0％ improved,6.7％ remained without deficit and deterioration persisted in 6.7％.Conclusion The microscopic resection of tumors is the effective way to cure this disease.By using intraoperative neurophysiological monitoring and ultrasound,the complete tumor resection and the minimal spinal cord injury were certainly achieved.

Neural Axis Metastasis from Metachronous Pulmonary Basaloid Carcinoma Developed after Chemotherapy & Radiation Therapy of Uterine Cervical Carcinoma / 대한신경손상학회지

Multiple primary or secondary malignancies after anticancer therapy were recently reported to be increasing in frequency. The authors describe a case of metachronous metastatic pulmonary basaloid carcinoma to the central nervous system that was discovered after chemotherapy and radiation therapy for cervical uterine carcinoma. Two different types of cancer developed within some interval. There's the possibility that a secondary pulmonary neoplasm developed after the chemotherapy and radiotherapy conducted as cervical cancer treatment.

Clinical Factors for Prognosis and Treatment Guidance of Spinal Cord Astrocytoma

STUDY DESIGN: Retrospective study. PURPOSE: To obtain information useful in establishing treatment guidelines by evaluating baseline clinical features and treatment outcomes of patients with spinal cord astrocytoma (SCA). OVERVIEW OF LITERATURE: The optimal management of SCA remains controversial, and there are no standard guidelines. METHODS: The study included 20 patients with low-grade and 13 with high-grade SCA surgically treated between 1989 and 2014. Patients were classified according to the extent of surgical resection. Survival was assessed using Kaplan-Meier plots and compared between groups by log-rank tests. Neurological status was defined by the modified McCormick scale and compared between groups by Mann-Whitney U tests. RESULTS: Surgical resection was performed for 19 of 20 low-grade (95%) and 10 of 13 high-grade (76.9%) SCA patients. Only nine patients (27.3%) underwent gross total resection, all of whom had low-grade SCA. Of all patients, 51.5% showed deteriorated neurological status compared to preoperative baseline. Median overall survival was significantly longer for low-grade SCA than that (91 months, 78% at 5 years vs. 15 months, 31% at 5 years; p=0.007). Low-grade SCA patients benefited from more aggressive resection, whereas high-grade SCA patients did not. Multivariate analysis revealed histology status (hazard ratio [HR], 0.30; 95% confidence interval [CI], 0.09-0.98; p<0.05) and postoperative neurological status (HR, 0.12; CI, 0.02-0.95; p<0.05) as independent predictors of longer overall survival. Adjuvant radiotherapy had no significant impact on survival rate. However, a trend for increased survival was observed with radiation cordotomy (RCT) in high-grade SCA patients. CONCLUSIONS: Aggressive resection for low-grade and RCT may prolong survival. Preservation of neurological status is an important treatment goal. Given the low incidence of SCA, establishing strong collaborative, interdisciplinary, and multi-institutional study groups is necessary to define optimal treatments.

Surgical Outcomes of High-Grade Spinal Cord Gliomas

STUDY DESIGN: A retrospective study. PURPOSE: The purpose of this study was to obtain useful information for establishing the guidelines for treating high-grade spinal cord gliomas. OVERVIEW OF LITERATURE: The optimal management of high-grade spinal cord gliomas remains controversial. We report the outcomes of the surgical management of 14 high-grade spinal glioma. METHODS: We analyzed the outcomes of 14 patients with high-grade spinal cord gliomas who were surgically treated between 1989 and 2012. Survival was charted with the Kaplan-Meier plots and comparisons were made with the log-rank test. RESULTS: None of the patients with high-grade spinal cord gliomas underwent total resection. Subtotal resection was performed in two patients, partial resection was performed in nine patients, and open biopsy was performed in three patients. All patients underwent postoperative radiotherapy and six patients further underwent radiation cordotomy. The median survival time for patients with high-grade spinal cord gliomas was 15 months, with a 5-year survival rate of 22.2%. The median survival time for patients with World Health Organization grade III tumors was 25.5 months, whereas the median survival time for patients with glioblastoma multiforme was 12.5 months. Both univariate and multivariate Cox proportional hazards models demonstrated a significant effect only in the group that did not include cervical cord lesion as a factor associated with survival (p=0.04 and 0.03). CONCLUSIONS: The surgical outcome of patients diagnosed with high-grade spinal cord gliomas remains poor. Notably, only the model which excluded cervical cord lesions as a factor significantly predicted survival.

Eosinophilic Myelitis in the Cervical Cord Mimicking Intramedullary Cord Tumor

Eosinophilic myelitis (EM) or atopic myelitis is a rare disease characterized by a myelitic condition in the spinal cord combined with allergic process. This disease has specific features of elevated serum IgE level, active reaction to mite specific antigen and stepwise progression of mostly the sensory symptoms. Toxocariasis can be related with a form of EM. This report describes two cases of cervical eosinophilic myelitis initially considered as intramedullary tumors. When a differential diagnosis of the intramedullary spinal cord lesion is in doubt, evaluation for eosinophilic myelitis and toxocariasis would be beneficial.

Intracranial and spinal ependymoma: series at Faculdade de Medicina, Universidade de São Paulo / Ependimoma craniano e de medula espinhal: casuística da Faculdade de Medicina da Universidade de São Paulo

OBJECTIVE: Ependymomas are rare intracranial neuroepithelial tumors and the most common location is intramedullary. The aim was to analyze the characteristics of these tumors to determine the patients' overall survival and the likelihood of recurrence. METHOD: Data of clinical presentation, tumor location, duration of symptoms, degree of resection and complementary treatment of 34 patients with intracranial ependymoma and 31 with intramedullary ependymoma who underwent surgery in the last ten years were collected and correlated with the recurrence time and overall survival. RESULTS: There was statistically significant correlation between the degree of resection and intracranial tumor location, although it is not a hallmark of recurrence. Data analyses of intramedullary ependymoma did not show correlation with overall survival and likelihood of recurrence. CONCLUSION: The location of the intracranial tumor is connected with the degree of resection; however it is not a predictive factor to overall survival.

OBJETIVO: Os ependimomas são tumores neuroepiteliais raros na localização intracraniana, porém um dos mais freqüentes na medula espinhal. Os autores analisaram as características destes tumores para determinar a sobrevida e probabilidade de recidiva nos pacientes. MÉTODO: Elementos da apresentação clínica, localização da lesão, duração de sintomatologia, grau de ressecção e tratamento complementar de 34 doentes com ependimoma intracraniano e 31 de medula espinhal operados nos últimos dez anos foram revisados e correlacionados com o período para a ocorrência da recidiva e a sobrevida. RESULTADOS: Houve correlação estatística apenas entre o grau da ressecção e a localização dos ependimomas intracranianos, embora, este não se tenha mostrado um marcador de recidiva. A avaliação dos dados clínicos dos pacientes com ependimoma medular não permitiu definir correlação com a sobrevida e sobre a probabilidade de recorrência. CONCLUSÃO: A localização do tumor intracraniano está relacionada ao grau de ressecção, entretanto isso não foi um fator preditivo para a sobrevida.

Remark about magnetic resonance imaging (MRI) characteristics of 2 common spinal intramedullary tumor types: ependymomas and astrocytomas

Studying 50 cases with spinal intramedullary tumor at Nerve Department of Bach Mai hospital to diagnose before surgering from 1998 to 2003. Among them, 6 cases with ependymomas and 3 with astrocytomas were taken magenetic resonance. Result showed that ependymomas and astrocytomas were two major typies in intramedullary tumors. Magenetic resonance imaging has some characterstics helping identify these typies according to considering different factors (ex age, site of tumor). Eoendymomas is more in adult. Astrocytomas is more in children.

Multiple Intramedullary and Intradural Epidermoid Cysts in the Conus Medullaris and the Lumbar Spine: Case Report

Intramedullary epidermoid tumors are rare. To our knowledge, this is the first description of a multiple intraspinal epidermoid tumor, including the intramedullary conus medullaris and an intradural lesion in the lumbar spine. The authors report the case of a 43-year-old woman presenting with progressive paraparesis. A thoraco-lumbar lesion was confirmed as an epidermoid cyst from histopathology. The clinical, radiological and surgical features, as well as a brief critical review of the literature are included.

Microsurgical treatment and survivin expression for intramedullary gliomas / 中华显微外科杂志

Objective To detect the expression of survivin protein in intramedullary gliomas and evaluated the clinical significance of the survivin expression. Method Seventeen cases of intramedullary gliomas were removed by using microsurgical technique.It composed of 8 cases of ependymomas and 9 ones of astrocytomas.The patients were followed up by MRI scanning periodically.The survivin protein expression of the intramedullary gliomas were examined by immunohistochemical stain (SP). Results Total resection of the tumor was obtained in 7 cases of ependymomas and subtotal resection was undertaken in the other one case.For 9 cases of astrocytomas,total resection of the tumor achieved in 3 cases,subtoal resection in 5 cases and partial resection in one case.Survivin expression was detected in 2 samples of ependymomas and 6 ones of astrocytomas.2 astrocytoma cases were moderate positive staining,who suffering from intracranial and vertebral subarachnoid dissemination of the tumor. Conclusion The result of microsurgical treatment for intramedullary ependymomas is satisfactory.The survivin expression in astrocytoma samples is significantly higher than that in ependymoma.Moderate positive staining may correlated with subarachnoid dissemination of the tumor.

Schwannoma e neurofibroma intramedular / Intramedullary schwannoma and neurofribroma

O neurofibroma e o schwannoma são neoplasias raras que envolvem a medula e suas raízes, correspondendo, respectivamente, a 3% e 27% dos tumores espinhais. Os autores apresentam dois casos de tumores intramedulares operados no Serviço de Neurologia e Neurocirurgia da Santa Casa de Belo Horizonte. O estudo anatomopatológico mostrou tratar-se de um schwannoma e de um neurofibroma, respectivamente. A partir desses achados é feita uma discussão sobre os aspectos clínicos e patológicos desses tumores, salientado a importância do diagnóstico diferencial entre eles. Atualmente, embora ainda não seja reconhecido de maneira universal, esses tumores são considerados como unidades distintas. Além do interesse teórico em diferenciar tais lesões,existe a importância clínica do prognóstico, pois a malignidade não ocorrenos schwannomas, e é extremamente rara nos neurofibromas solitários, ecomum nos múltiplos.

Spinal neurofibroma is one of the rarest neoplasm involving the spinal cordand roots. The intramedullary localization of schwannomas is rare, corresponding to 0,3% of all intraspinal tumors. The authors report two cases of cervico-toracic intramedullary tumors, respectively a schwannoma and a neurofibroma, surgically treated. The present study analysis the clinical and pathological aspects of these tumors and the importance of its differential diagnosis.

Conus Medullaris Hemangioblastoma

Conus medullaris hemangioblastoma is very rare. We report a hemangioblastoma which was removed after embolization in conus medullaris. It was associated with syringomyelia from cervical cord to conus medullaris. There was no manifestation of von Hippel-Lindau disease. The literature on conus medullaris hemangioblastoma is reviewed and the mechanism of the syringomyelia associated with the hemangioblastoma is discussed.

Metastatic Thoracic Intramedullary Small Cell Carcinoma: Case Report

The incidence of metastasis to the spinal cord in patients with systemic carcinoma has been extimated to be 0.9 to 8.5%. Attempts to aggressively remove intramedullary spinal cord tumor may cause increased neurologic deficits and a worsend outcome. The authors present the case of a multiple intramedullary meetastatic spinal cord tumor which had metastasized from the lung to the thoracic spinal level. Pathologic diagnosis of the small cell carcinoma was made from the tumor specimen obtained by stereotaxic-guided neddle biopsy after which the patient was treated with radiotherapy and chemotherapy.

Intramedullary Glioblastoma Multiforme: Report of 3 Cases

The authors report 3 cases of primary intramedullary glioblastoma multiforme which is relatively rare among spinal cord tumors. They were located at the thoracolumbar, cervical and conus medullaris region respectively. Clinical, radiographic and pathological material are presented and the literature is discussed.