Study of intraoperative squash cytology of intracranial and spinal cord tumors.

Background: The aim was to study the cytomorphology of neoplastic lesions of brain and spinal cord by intraoperative squash cytology, compare it with the histopathological diagnosis on excision biopsy/surgical specimen and establish a correlation. The causes of erroneous diagnoses achieved at squash cytology of intracranial and spinal cord tumors were ascertained. Tumor types having the advantage of diagnostic certainty by squash cytology of intracranial and spinal cord lesions was also determined. Methods: Squash preparations of 70 patients suspected to have neoplasia were made and stained with rapid hematoxylin and eosin stain and rapid Papanicolaou stain. A few squash smears were also dry fixed and stained with Giemsa stain. The smears were typed according to the cytomorphological criteria and the cytodiagnoses was compared with the histopathological diagnoses and a correlation was established. Results: A positive predictive value for intraoperative squash cytology for diagnosis of intracranial and spinal cord tumors was seen to be 100% and a negative predictive value of 97.22% were established by this study. The sensitivity was found to be 97.22% and the specificity was 100%. Thus, the accuracy of the study was 98.57%. Conclusions: Squash smear cytology of the brain and spinal cord tumors performed intraoperatively for diagnostic consultation fulfills all the determinants of an excellent diagnostic modality.

Magnetic resonance evaluation of intra dural spinal tumors with histopathology correlation.

Background: Tumors of the spinal cord or canal constitute approximately 15% to 20% of central nervous system tumors. The differential diagnosis of spinal neoplasms is primarily based on location of the lesion relative to the spinal cord and the age, sex and clinical presentation. The aim and objective of the study was to determine the sensitivity of magnetic resonance imaging (MRI) in diagnosing intra spinal tumors and to correlate findings on MRI with histopathological diagnosis. Methods: This is a retrospective study. The study group included all the patients who presented to our hospital with progressive sensory or motor deficits, para or quadriperesis with or without bladder/bowel Involvement. Only patients with Intra dural lesions such as intradural extra medullary and Intra medullary lesions were included in the study. All the extra dural lesion cases such as vertebral tumors, degenerative/osteoporotic compressions and Trauma related cord compressions were excluded from the study. Results: Of the forty intradural tumors, 28 were extramedullary and 12 were intramedullary. Most of the tumors were located in the cervical and the dorsolumbar spine accounting for more than 50%. The most common tumor encountered in our study was schwannoma (22/40), followed by ependymoma (7/40), meningioma (4/40), astrocytoma (4/40), one each of Hemangioblastoma, Neuroentericcyst and Dermoid cyst. Ependymomas, Astrocytomas and hemangioblastoma were intramedullary lesions and the remaining lesions constituted Intra Dural extra medullary lesions. Conclusions: MRI was found to be a highly sensitive imaging procedure and the method of choice for intradural tumor evaluation and to differentiate extra medullary from Intra medullary lesions. It is not sensitive enough to differentiate the Intra medullary tumors. Nevertheless, definite diagnosis could be made by histopathology only.

Surgical Results after Unilateral Laminectomy for the Removal of Spinal Cord Tumors

OBJECTIVE: To reduce the risk of postoperative spinal instability or deformity, unilateral laminectomy (UL) has been recommended to remove spinal space-occupying lesions. The purpose of this study was to determine whether there were any advantages of UL for removal of spinal cord tumors. METHODS: From May 1995 to May 2010, 94 patients with spinal cord tumors, who underwent tumor removal via UL in our institute, were enrolled in this study. Intramedullary spinal cord tumors were excluded. Simple radiographs were obtained for accessing the restoration of the spinal column. Spinal magnetic resonance imaging (MRI) was also obtained during the follow-up period to evaluate tumor recurrence. RESULTS: There were 51 women and 43 men; their mean age was 47.8 years (range, 9-83 years). The mean follow-up period was 52.6 months (range, 24 month-16 years). The sites of the tumors were cervical in 21 cases, thoracic in 37, lumbar in 33, and sacral in 3. These cases included 85 intradural extramedullary (IDEM) and 9 extradural (ED) lesions. IDEM tumors consisted mainly of neurilemmomas (56.3%) and meningiomas (22.3%).Tumors were totally removed in 80 cases and subtotally removed in 14 cases. Postoperative neurological status was improved in 53 cases, unchanged in 31 cases, and worsened in 10 cases. During follow-up, MRI showed tumor recurrence in 4 patients. Histopathologically, three cases were meningiomas and one case was neurilemmoma. None of the patients showed spinal instability or kyphotic deformity at last follow-up. CONCLUSION: UL is an optimal approach for providing sufficient exposure of spinal cord tumors without development of postoperative spinal instability and regional sagittal imbalance in any location of spinal column. In cases of meningioma, careful long-term follow up is needed due to it's relatively high recurrence rate after removal via UL.

Hemilaminectomy for Removal of Extramedullary or Extradural Spinal Cord Tumors: Medium to Long-Term Clinical Outcomes

PURPOSE: Laminectomy is generally the treatment of choice for removal of spinal tumors. However, it has been shown that laminectomy may cause instability due to damage of posterior elements of the spinal column, which may induce subsequent kyphosis in the future. Therefore, to reduce the risk of deformity and spinal instability after laminectomy, hemilaminectomy has been used. However, the medium to long-term effects of hemilaminectomy on spinal sagittal alignment is not well understood. The present study was performed to evaluate the clinical outcomes, including spinal sagittal alignment of patients, associated with spinal cord tumors treated by surgical excision using hemilaminectomy. MATERIALS AND METHODS: Twenty hemilaminectomy operations at our institute for extramedullary or extradural spinal cord tumors in 19 patients were evaluated retrospectively with an average follow-up of 85 months (range, 40-131 months). Neurological condition was evaluated using the improvement ratio of the Japanese Orthopaedic Association Score (JOA score) for cervical, thoracic myelopathy, or back pain, and sagittal alignment by sagittal Cobb angle of the hemilaminectomied area. RESULTS: The mean improvement ratio of neurological results was 56.7% in the cervical spine (p < 0.01, n = 10), 26.3% in the thoracic spine (not significant, n = 5), and 48.6% in the lumbar spine (NS, n = 5). The sagittal Cobb angle was 4.3 +/- 18.0degrees in the preoperative period and 5.4 +/- 17.6degrees at the latest follow-up, indicating no significant deterioration. CONCLUSION: Hemilaminectomy is useful for extramedullary or extradural spinal cord tumors in providing fair neurological status and restoration of spinal sagittal alignment in medium to long-term follow-up.

Analysis of Clinical Features of Intramedullary Spinal Cord Tumors in Children / 实用儿科临床杂志

ObjectiveTo investigate the clinical features of intramedullary spinal cord tumors(IMSCT) in children.MethodsThe clinical data including sex,age,pathohistology,clinical manifestations and medical check-up collected from 16 children diagnosed as IMSCT in Shengjing Hospital Affiliated to China Medical University,were retrospectively reviewed and analyzed.ResultsThe study subjects inclu-ded 11 male and 5 female,with an average age of(8.55?4.28) years old,ranged from 15 months to 14 years old.The interval lasted 1 day to 9 years from onset of the syndrome to confirmed diagnosis of IMSCT.The first clinical manifestation was mostly pain.The main clinical mani-festations included limb dyskinesia in 14 cases,pain in 12 cases,urine and stool disturbance in 9 cases,gait irregularity in 8 cases,extremity atrophy in 3 cases.Medical check-up included abnormal tendon reflex in 14 cases,abnormal superficial reflex in 9 cases,sphincter dilatation in 6 cases,positive Babinski's signs in 5 cases,spinal deformity in 4 cases,region masses in 3 cases,paraesthesia in 2 cases,inequality of lower limb in 1 case,dermai sinus in 1 case,pigmentation in 1 case.The cases were evaluated by magnetic resonance imaging,which presented thickened spinal cord and intramedullary abnormal signals in all the cases.Pathological types: teratoma in 5 cases,dermoid cysts in 2 cases,epidermoid cyst in 2 cases.Misdiagnoses included urinary tract infections in 2 cases,rheumatoid arthritis in 1 case,and lumbar disc protrusion in 1 case.ConclusionsThe main pathohistology of pediatric IMSCT is congenital tumor.First clinical manifestation is pain.MRI can show a reliable evidence for the diagnosis.It is important to improve the outcomes of pediatric IMSCT by establishing the diagnosis and administering proper management as early as possible.

A Case of Intradural Spinal Lipoma

Intradural spinal lipomas are rare, primary genign tumor of the spinal canal. A case of intradural spinal lipoma with intramedullary extension is presented. Clinical feature was slowly progressing paraparesis. A subtotal excision was performed, and pathological studies confirmed the diagnosis.

External Beam Radiotherapy for Primary Spinal Cord Tumors / 대한치료방사선과학회지

Of 34 evaluated patients with primary spinal cord tumors, 32 were irradiated at our institution between 1969 and 1983. The results are reported of 32 patients,10 with ependymoma and 16 with astrocytoma, who were treated with post-operative external beam radiotherapy following biopsy or subtotal resection. Twenty-nine patients received 45~55 Gy megavoltage beam irradiation in 5~6 weeks and the remaining three patients received less than 40 Gy. Spinal cord was in the irradiated field for six patients who received more than 50 Gy. The minimum follow-up was five years. Five and ten year acturaial survival rates for entire group of patients were 73%(22/30) and 50%(8/16), including three patients who were salvaged by surgery after radiation failures. Corresponding five and ten year relapse free survival rates were 60%(18/30) and 32%(6/19), respectively. Of the 29 patients who received more than 45 Gy, relapse free survival at five years was 63%(17/27). Treatment failed in 13 patients and all of those failures were in the irradiated portal. Patients with ependymomas have significantly better relapse free survival than those with astrocytomas, 80% vs. 40%(p0.05). No radiotherapy related neurological deficit was noted with a maximum 20 year follow-up. This study confirms that external beam radiotherapy is a safe and effective treatment modality for primary spinal cord tumors.