ABSTRACT
Spinal Paragangliomas are rare tumors, most frequently involving the cauda equina and the filum terminale. We report the case of a 62-year old woman presenting with a one month's lower back pain, left sciatica and leg weakness. Spinal magnetic resonance imaging showed a extramedullary lesion at L3-L4 level, measuring 37 x 52 x 21 mm with contrast enhancement. It presented an unenhancing intradural cystic lesion in the upper pole. The patient underwent lumbar laminectomy, and with neurofisiologic monitorization the tumor was completely resected. Microscopic examination of the tumor revealed a paraganglioma. In a review of the literature, we found only five previous reported cases in which the tumor is accompanied by a cyst.
Los paragangliomas son tumores poco frecuentes que se localizan en la región de la cauda equina y filum terminal. Presentamos el caso de una mujer de 62 años con una historia de 1 mes de evolución de lumbalgia, ciática y debilidad en el miembro inferior izquierdo. Una resonancia magnética lumbar mostró una tumoración extramedular en el nivel L3-L4 que medía 37 x 52 x 21 mm que se realzaba con contraste. Presentaba así mismo una lesión quística en el polo superior del tumor. Se realizó una laminectomía lumbar y bajo control neurofisiológico se realizó una extirpación completa el tumor. El estudio microscópico revelo que se trataba de un paraganglioma. Realizamos una revisión de la literatura encontrando únicamente otros cinco casos de paraganglioma espinal con lesión quística acompañante
Subject(s)
Humans , Female , Middle Aged , Paraganglioma/surgery , Paraganglioma/diagnostic imaging , Spinal Cord Neoplasms/surgery , Spinal Cord Neoplasms/diagnostic imaging , Cysts/surgery , Cysts/diagnostic imaging , Magnetic Resonance Imaging , LaminectomyABSTRACT
We report a case of a 32-weeks pregnant woman in her early 30s. The patient experienced pregnancy-related low back pain and difficulty walking due to rapid muscular weakness in her lower limbs. She was diagnosed with lower limb paralysis caused by the spinal cord tumor and underwent emergency cesarean section for maternal indication, followed by laminectomy and tumor removal. After 3 days of surgery, rehabilitation interventions, including early mobilization, muscle strengthening training, balance training, and activities of daily living (ADL) training, were performed to improve voluntary movement and muscle strength in her lower limbs and ADL. Prior to rehabilitation, the patient showed lower limb muscle weakness in manual muscle test 1 (MMT1) due to motor paralysis, required assistance for walking, and expressed anxiety about the degree of recovery of her physical functions and her role as a mother. After approximately 1 month of rehabilitation, the patient was able to perform ADL independently and was discharged from the hospital with physical functions that allowed her to take care of her newborn baby. It is important to provide positive rehabilitation intervention from the early postoperative period, according to the guidelines for the disability caused by primary diseases, as well as care and movement guidance before discharge, considering the changes in mental and physical symptoms during the postpartum period in a woman with a spinal cord tumor.
ABSTRACT
We report a case of a 32-weeks pregnant woman in her early 30s. The patient experienced pregnancy-related low back pain and difficulty walking due to rapid muscular weakness in her lower limbs. She was diagnosed with lower limb paralysis caused by the spinal cord tumor and underwent emergency cesarean section for maternal indication, followed by laminectomy and tumor removal. After 3 days of surgery, rehabilitation interventions, including early mobilization, muscle strengthening training, balance training, and activities of daily living (ADL) training, were performed to improve voluntary movement and muscle strength in her lower limbs and ADL. Prior to rehabilitation, the patient showed lower limb muscle weakness in manual muscle test 1 (MMT1) due to motor paralysis, required assistance for walking, and expressed anxiety about the degree of recovery of her physical functions and her role as a mother. After approximately 1 month of rehabilitation, the patient was able to perform ADL independently and was discharged from the hospital with physical functions that allowed her to take care of her newborn baby. It is important to provide positive rehabilitation intervention from the early postoperative period, according to the guidelines for the disability caused by primary diseases, as well as care and movement guidance before discharge, considering the changes in mental and physical symptoms during the postpartum period in a woman with a spinal cord tumor.
ABSTRACT
ABSTRACT Objective: Hemangioblastoma is a rare vascular sporadically occurring CNS tumor that can be associated with von Hippel-Lindau disease. Hemangioblastomas account for 2-6% of all spinal cord neoplasms and rank third among intramedullary space-occupying lesions. Methods: This was the first time in our practice that we had dealt with paravertebral hemangioblastoma with the sandglass growth pattern. The world literature describes only 3 case of a tumor with this growth pattern. Surgical and diagnostic aspects of patient treatment are considered. Results: During the operation, we adhered to the following stages: localization of the feeding vessel and of the poles of the tumor, surface dissection of the tumor, en bloc resection of the tumor, and hemostasis of the tumor cavity. Conclusions: Hemangioblastoma of extradural localization is a very rare pathology. However, when MRI signs characteristic of a vascular lesion are identified, it is necessary to carry out additional examinations, which may include CT perfusion study and, if required, selective angiography. Level of Evidence 5; Case report.
RESUMO Objetivos: Hemangioblastoma é um tumor vascular raro do SNC, que ocorre esporadicamente e pode ser associada à doença de Von Hippel-Lindau. Hemangioblastomas são responsáveis por 2-6% de todas as neoplasias da medula espinal e na terceira posição entre lesões, ocupando espaço intramedulares da medula espinal. Métodos: Foi a primeira vez em nossa prática que lidamos com hemangioblastoma paravertebral com o padrão de crescimento ampulheta. As fontes da literatura mundial descrevem apenas 3 casos de um tumor com esse padrão de crescimento. Aspectos cirúrgicos e diagnósticos de tratamentos do paciente são considerados. Resultados: Durante a operação, aderiu-se às seguintes fases: o recipiente de alimentação foi encontrado, os pólos do tumor foram encontrados, a dissecação da superfície do tumor foi feita, o tumor foi removido por um único bloco e a hemostasia da cavidade do tumor foi realizada. Conclusões: Hemangioblastoma de localização extradural é uma patologia muito rara, no entanto, quando sinais de MRI característicos de uma lesão vascular são identificados, o que é necessário para levar a cabo um exame suplementar, o qual pode incluir o estudo de perfusão CT e, se necessário, angiografia seletiva. Nível de Evidência V; Relato de caso.
RESUMEN Objetivo: El hemangioblastoma es un tumor vascular raro del SNC que ocurre esporádicamente y que puede asociarse con la enfermedad de von Hippel-Lindau. Los hemangioblastomas representan el 2%-6% de todas las neoplasias de la médula espinal y están en el tercer lugar entre las lesiones intramedulares que ocupan espacio. Métodos: Esta fue la primera vez en nuestra práctica que tratamos el hemangioblastoma paravertebral con patrón de crecimiento de reloj de arena. La literatura mundial describe solo tres casos de un tumor con este patrón de crecimiento. Se consideran aspectos quirúrgicos y de diagnóstico del tratamiento del paciente. Resultados: Durante la operación, elegimos las siguientes etapas: localización del vaso de irrigación y de los polos del tumor, disección superficial del tumor resección en bloque del tumor y hemostasia de la cavidad tumoral. Conclusiones: El hemangioblastoma de localización extradural es una patología muy rara. Sin embargo, cuando se identifican signos característicos de lesión vascular en la RM, es necesario realizar exámenes adicionales, que pueden incluir estudio de perfusión por TC y, si es necesario, una angiografía selectiva. Nivel de Evidencia V; Reporte de caso.
Subject(s)
Humans , Hemangioblastoma , Spinal Cord Neoplasms , Spine/surgery , NeurosurgeryABSTRACT
Objective To investigate the correlation between clinical features and prognosis of patients with neurofibromatosis type 2(NF2)after operation.Methods The clinical features and prognosis of sixty patients with neurofibromatosis type 2(NF2)from 2000 to 2013 in Xi′an No.1 Hospital were analyzed.Cox proportional hazards regression model was used for variable analysis.Results The patients were followed up for 1-188 months,53 patients survived(88.3%,53/60),and 7 patients died(11.7%,7/60).Single factor analysis showed that the first symptom age,age of diagnosis,intracranial meningioma and spinal cord tumor were related to the prognosis of the patients(P<0.05).However,gender,genetic factors,skin lesions,eye diseases, postoperative hearing improvement and relief of dizziness after surgery were not correlated with the prognosis of patients(P>0.05).Spinal cord tumors or intracranial meningiomas were the independent risk factors for the prognosis of NF2 patients(P=0.042,0.037,95%CI=0.021-2.069,0.587-2.543,RR=2.475,3.663).The first symptoms age,age of diagnosis,ocular lesions were the risk factors for the occurrence of spinal cord tumors and intracranial meningiomas(P<0.05).Conclusion NF2 has many clinical symptoms,accompanied by spinal cord tumor and intracranial meningioma,which are the important prognostic factors in patients with poor prognosis.
ABSTRACT
Objective To investigate the correlation between clinical features and prognosis of patients with neurofibromatosis type 2(NF2)after operation.Methods The clinical features and prognosis of sixty patients with neurofibromatosis type 2(NF2)from 2000 to 2013 in Xi′an No.1 Hospital were analyzed.Cox proportional hazards regression model was used for variable analysis.Results The patients were followed up for 1-188 months,53 patients survived(88.3%,53/60),and 7 patients died(11.7%,7/60).Single factor analysis showed that the first symptom age,age of diagnosis,intracranial meningioma and spinal cord tumor were related to the prognosis of the patients(P<0.05).However,gender,genetic factors,skin lesions,eye diseases, postoperative hearing improvement and relief of dizziness after surgery were not correlated with the prognosis of patients(P>0.05).Spinal cord tumors or intracranial meningiomas were the independent risk factors for the prognosis of NF2 patients(P=0.042,0.037,95%CI=0.021-2.069,0.587-2.543,RR=2.475,3.663).The first symptoms age,age of diagnosis,ocular lesions were the risk factors for the occurrence of spinal cord tumors and intracranial meningiomas(P<0.05).Conclusion NF2 has many clinical symptoms,accompanied by spinal cord tumor and intracranial meningioma,which are the important prognostic factors in patients with poor prognosis.
ABSTRACT
A 25-year-old male patient with severe thigh and right side pain was presented. In the lumbar magnetic resonance images, there was a contrasting spinal cord tumor image with 1 cm in diameter at the level of the L3 vertebra. The patient was operated and the tumor was totally removed. All the pain of the patient recovered. The patient's postoperative two days were very comfortable and the patient was early mobilized. On the third postoperative day, the patient complained of severe headache, nausea and vomiting. Immediate cranial computed tomography (CT) images was performed. Cerebral pneumocephalus was present in CT. The patient was treated with definite bed rest and plenty of fluid replacement. After three days, the patient's complaints were completely improved. This improvement was confirmed by performing a cerebral CT scan. In the formation of pneumocephalus, air is compressed into the intradural space during operation and this passes to the cerebral space. Definite bed rest, abundant fluid replacement and, in addition, highly inspired oxygen therapy are sufficient to correct the condition.
Subject(s)
Adult , Humans , Male , Bed Rest , Headache , Nausea , Oxygen , Pneumocephalus , Spinal Cord Neoplasms , Spine , Thigh , Tomography, X-Ray Computed , VomitingABSTRACT
Objective To study intraoperative neural electrophysiological monitoring applied in lumbosacral spinal cord tumor resection.Methods We retrospectively reviewed the clinical data of 212 patients undergoing lumbosacral spinal cord tumor resection with or without intraoperative neural electrophysiological monitoring in our hospital.The patients were divided into two groups:124 patients in the monitored group received intraoperative neural electrophysiological monitoring while 88 ones in the control group did not.The monitoring was performed by recording the cortical somatosensory evoked potential (CSEP),dermatomal somatosensory evoked potential (DSEP) and electromyography (EMG).The patients were followed up for 3-6 months and their postoperative outcome was analyzed.Results There were significant differences in the outcome (P <0.05),but no difference was found in the incidence of complications between the monitored group and the control group.The sensitivity of CSEP +DSEP+EMG was 100%,and the specificity was 55.9% in the former group.Conclusion Combined monitoring with CSEP,DSEP and EMG during lumbosacral spinal cord tumor resection is valuable in protecting the spinal nerve roots and ensuring better operation safety.
ABSTRACT
Cistos neuroentéricos espinhais são anomalias do desenvolvimento, mais comumente encontrados no mediastino posterior e raramente presentes no sistema nervoso central. Geralmente localizados na coluna cervicotorácica. Principalmente encontrados em pacientes jovens e com predomínio no sexo masculino (2:1). Várias hipóteses têmsido sugeridas para explicar a embriogênese dos cistos neuroentéricos, entre elas a mais aceita seria uma incompleta separação entre o ectoderma e o endoderma. Manifesta-se principalmente como dorsalgia e déficit neurológico progressivo. Alguns pacientes apresentam surtos de dor e déficits transitórios. A ressecção completa da lesão, com esvaziamento do cisto e remoção do envoltório, é o tratamento de eleição. As principais complicações pósoperatórias são a recidiva da lesão, aracnoidite e piora do déficit neurológico.
Developmental abnormalities aremore commonly found in the posterior mediastinum and rarely present in the central nervous system. Usually located in the cervical and thoracic spine. Mainly found in young patients with predominance in males (2:1). Several hypotheses have been suggested to explain the embryogenesis of neuroentéricos cysts, including the most accepted would be an incomplete separation between the ectoderm and endoderm. It manifests primarily as back pain and progressive neurological deficits. Some patients experience bouts of pain and transient deficits. Complete resection of the lesion with dissection of the cyst and removing the wrap, is the treatment of choice. The main postoperative complications are recurrence of injury, arachnoiditis and worsening of neurological deficit.
Subject(s)
Humans , Female , Adult , Spinal Dysraphism , Neural Tube Defects/surgery , Neural Tube Defects/complications , LaminectomyABSTRACT
Although several cases of a dumbbell tumor of thoracic nerve roots have been reported, reports on the surgical procedures for a dumbbell tumor of the first thoracic (T1) nerve root are rare. Surgeons should be cautious, especially when performing a surgical procedure for a dumbbell tumor of the T1 nerve root because the tumor is anatomically located adjacent to important organs and because the T1 nerve root composes the lower trunk of the brachial plexus with the eighth cervical nerve root. We present cases with dumbbell tumors of the T1 nerve root that were treated with combined surgical treatment to remove the tumor. We first performed video-assisted thoracic surgery (VATS) to release the organs anteriorly and then performed posterior spinal surgery in the prone position. The combined VATS and posterior spinal surgery may become a standard surgical procedure for the treatment of dumbbell tumors of the T1 nerve root.
Subject(s)
Brachial Plexus , Prone Position , Spinal Cord Neoplasms , Minimally Invasive Surgical Procedures , Thoracic Nerves , Thoracic Surgery, Video-AssistedABSTRACT
STUDY DESIGN: It is a case series involving clinical presentation, radiological findings, surgical technique and long term outcome of Non-dysraphic intramedullary spinal cord lipomas in adults along with the review of the literature. PURPOSE: The purpose of the study is to find out from our series as well as from literature what determines the long term outcome and how it can be improved in patients diagnosed to have intramedullary spinal cord lipomas. OVERVIEW OF LITERATURE: Non-dysraphic spinal intramedullary lipomas in adults are extremely rare. Majority of cases occur in children and in cervico-dorsal regions. Only eight cases of dorso-lumbar spinal lipomas without spinal dysraphism in adults have been reported in the English literature till 2013. METHODS: Here we report our experience with three such cases in the dorsolumbar region and discuss the surgical technique and the long term outcome of such cases. RESULTS: Review of literature and from our own cases we conclude that long term outcome after surgery is determined by the preoperative neurological status. CONCLUSIONS: Earlier surgical intervention with preserved neurological status results in better outcome. Radical subtotal excision without producing iatrogenic postoperative neurological deficit should be the goal of the surgery and it stabilizes the disease process in the long run. When early clinico-radiological signs of recurrence develop, such patient's to be reoperated immediately to prevent them from developing a fixed neurological deficit.
Subject(s)
Adult , Child , Humans , Lipoma , Recurrence , Spinal Cord Neoplasms , Spinal Cord , Spinal DysraphismABSTRACT
Chronic, refractory abdominal pain without a metabolic or structural gastroenterological etiology can be challenging for diagnosis and management. Even though it is rare, it has been reported that such a recurrent abdominal pain associated with radicular pattern can be derived from structural neurologic lesion like spinal cord tumor. We experienced an unusual case of chronic recurrent abdominal pain that lasted for two years without definite neurologic deficits in a patient, who has been harboring thoracic spinal cord tumor. During an extensive gastroenterological workup for the abdominal pain, the spinal cord tumor had been found and was resected through surgery. Since then, the inexplicable pain sustained over a long period of time eventually resolved. This case highlights the importance of taking into consideration the possibility of spinal cord tumor in differential diagnosis when a patient complains of chronic and recurrent abdominal pain without other medical abnormalities.
Subject(s)
Humans , Abdominal Pain , Diagnosis , Diagnosis, Differential , Neurologic Manifestations , Spinal Cord NeoplasmsABSTRACT
OBJECTIVE: Recently, surgical outcomes of patients with intramedullary spinal cord tumors (IMSCT) have been improved due to advances of medicine. The purposes of our study were to evaluate the recent neurological outcomes after surgical treatment of IMSCTs. METHODS: We retrospectively reviewed 69 patients who underwent surgical treatment for IMSCT in our hospital between 1998 and 2013. Patient's age, sex, histological origin and grade, tumor location, tumor extension, preoperative neurological state, initial presenting symptom, and extend of tumor resection were analyzed to evaluate predictive factors that affect postoperative functional outcome. RESULTS: The neurological states at last follow-up were improved in 16 patients (23.2%), unchanged in 47 (68.1%), aggravated in 6 (8.7%). In all patients, the functional outcomes were good in 52 patients (75.4%), fair in 10 (14.5%), poor in 7 (10.1%). Preoperative good neurological state was the strongest positive predictor of good functional outcome (p<0.05). In tumor location, functional outcomes of thoracic tumors were poor than those in cervical and conus medullaris region (p=0.011). High-grade tumor shows poor outcome compare to low-grade tumor (p=0.03). CONCLUSION: The most reliable predicting factor of surgical outcome was the preoperative neurological state. In addition, IMSCTs in thoracic region and high-grade tumor showed relatively bad outcome and had a risk of postoperative morbidity.
Subject(s)
Humans , Conus Snail , Follow-Up Studies , Retrospective Studies , Spinal Cord NeoplasmsABSTRACT
Intradural extramedullary spinal ependymomas are extremely rare. Herein, we describe a lesion-type spinal ependymoma that followed a malignant course, and discuss its clinical presentation, etiopathogenesis, and treatment. We present a patient who was diagnosed with an intradural extramedullary spinal tumor at T4-T6. The patient underwent gross total resection of the tumor without damage to the spinal cord. Histological examination, classified the lesion as a World Health Organization (WHO)-grade 2 ependymoma. One and a half years later, magnetic resonance imaging detected a recurring tumor at T4-T5. The tumor was removed and classified as a WHO-grade 3 anaplastic ependymoma. The patient was started on a course of regional spinal cord radiotherapy. The patient achieved tumoral control and clinical stabilization after the recurrence. We must consider the differential diagnosis of intradural extramedullary spinal tumors. The best treatment for this lesion is gross total resection and adjunctive radiotherapy is necessary in cases of malignant-change.
Subject(s)
Humans , Diagnosis, Differential , Ependymoma , Magnetic Resonance Imaging , Recurrence , Spinal Cord , Spinal Cord Neoplasms , World Health OrganizationABSTRACT
Primary spinal cord melanoma is a rare central nervous system malignant tumor. Usually it resembles an intradural extramedullary (IDEM) nerve sheath tumor or melanoma. We experienced a patient with upper thoracic primary IDEM spinal cord melanoma who was diagnosed to be with hydrocephalus and without intracranial lesions. Initial symptoms of the patient were related to the hydrocephalus and the primary spinal cord melanoma was diagnosed eight months later. At the first operation, complete resection was impossible and the patient refused additional radiotherapy or chemotherapy. At 22 months after surgery, the patient revisited our institution with recurrent both leg weakness. Leptomeningeal dissemination was present in the whole spinal cord and only partial resection of tumor was performed. The symptoms slightly improved after surgery. Primary spinal cord melanoma is extremely rare but complete resection and additional radiotherapy or chemotherapy can prolong the disease free interval. Hydrocephalus or signs of increased intracranial pressure may be the diagnostic clue of spinal cord malignancy and progression.
Subject(s)
Humans , Central Nervous System , Drug Therapy , Hydrocephalus , Intracranial Pressure , Leg , Melanoma , Radiotherapy , Spinal Cord Neoplasms , Spinal Cord , SpineABSTRACT
Secondary intracranial hypertension (IH) is a syndrome with various etiologies, including a brain tumor, head trauma, hypoparathyroidism, hydrocephalus, meningitis, drug use, or venous obstruction. It is reasonably straightforward to diagnose secondary IH induced by these diseases. However, diagnosing secondary IH induced by unpredictable extracranial lesion is difficult, and is based largely on subtle neurological symptoms or signs and usually can be achieved by an extracranial evaluation. Here we describe four cases of secondary IH with unusual causes.
Subject(s)
Brain Neoplasms , Craniocerebral Trauma , Headache , Hydrocephalus , Hypoparathyroidism , Intracranial Hypertension , Meningitis , Spinal Cord NeoplasmsABSTRACT
A 31-year-old man presented with acute onset of paraplegia. The patient's history was significant for thyroid carcinoma that had been treated 2 years earlier by thyroidectomy. A magnetic resonance imaging scan showed an enhancing intramedullary lesion at T7-8. Patient underwent surgical treatment and a tumor with hematoma was resected via posterior midline myelotomy. Postoperatively, the patient's motor weakness was improved to grade 3. The lesion showed typical histologic features consistent with papillary thyroid carcinoma. Early diagnosis and microsurgical resection can result in improvement in neurological deficits and quality of life of patients with an ISCM.
Subject(s)
Adult , Humans , Carcinoma , Early Diagnosis , Hematoma , Magnetic Resonance Imaging , Neoplasm Metastasis , Paraplegia , Quality of Life , Thyroid Gland , Thyroid Neoplasms , ThyroidectomyABSTRACT
A 31-year-old man presented with acute onset of paraplegia. The patient's history was significant for thyroid carcinoma that had been treated 2 years earlier by thyroidectomy. A magnetic resonance imaging scan showed an enhancing intramedullary lesion at T7-8. Patient underwent surgical treatment and a tumor with hematoma was resected via posterior midline myelotomy. Postoperatively, the patient's motor weakness was improved to grade 3. The lesion showed typical histologic features consistent with papillary thyroid carcinoma. Early diagnosis and microsurgical resection can result in improvement in neurological deficits and quality of life of patients with an ISCM.
Subject(s)
Adult , Humans , Carcinoma , Early Diagnosis , Hematoma , Magnetic Resonance Imaging , Neoplasm Metastasis , Paraplegia , Quality of Life , Thyroid Gland , Thyroid Neoplasms , ThyroidectomyABSTRACT
A case of intradural extramedullary cavernous angioma is presented with headache, dizziness, and bilateral sensorineural hearing loss caused by an intracranial superficial hemosiderosis. It was incidentally found in a patient with a 3-month history of sustained headache, dizziness and a 3-year history of hearing difficulty. The neurological examination was unremarkable in the lower extremity. MR images showed an intracranial superficial hemosiderosis mostly in the cerebellar region. Myelography and MR images of the thoracolumbar spine revealed an intradural extramedullary mass, which was pathologically proven to be a cavernous angioma. T12 total laminoplastic laminotomy and total tumor removal were performed without any neurologic deficits. The patient's symptoms, including headache and dizziness, have been absent for three years. Intradural extramedullary cavernous angioma can present with an intracranial superficial hemosiderosis as a result of chronic subarachnoid hemorrhage.
Subject(s)
Humans , Dizziness , Headache , Hearing , Hearing Loss, Sensorineural , Hemangioma, Cavernous , Hemosiderosis , Laminectomy , Lower Extremity , Myelography , Neurologic Examination , Neurologic Manifestations , Spinal Cord Neoplasms , Spine , Subarachnoid HemorrhageABSTRACT
The first case of intracranial metastases of a cervical intramedullary low-grade astrocytoma without malignant transformation in adult is presented in this report. Seven years ago, a 45 year-old male patient underwent biopsy to confirm pathologic characteristics and received craniocervical radiation and chemotherapy for a grade II astrocytoma in the cervical spinal cord. Two years later, posterior fusion was necessary for progressive kyphosis in the cervical spine. He was well for approximately 7 years after the primary surgery. Two months ago, he presented with partial weakness and incoordination with gait difficulty. MRI Scan demonstrated multiple small lesions in the cerebellar vermis and left hemisphere. After suboccipital craniectomy and posterior cervical exposure, the small masses in the cerebellar vermis and hemispheres were excised to a large extent by guidance of an intraoperative navigation system. The tumor at the cervical and brain lesions was classified as an astrocytoma (WHO grade II). When a patient with low-grade astrocytoma in the spinal cord has new cranial symptoms after surgery, radiaton, and chemotherapy, the possibility of its metastasis should be suspected because it can spread to the intracranial cavity even without malignant transformation as shown in this case.