Intradural extramedullary tumor causing compression of the thoracic and lumbar vertebrae in a 22-year-old male with Acute Myeloid Leukemia

@#Myeloid sarcoma, characterized by the presence of immature myeloid cells occurring at an extramedullary site, is a rare manifestation of acute myelogenous leukemia (AML). Spinal cord compression as an initial presentation of AML is very rare with only a few reported cases. We discuss a case of a 22-year-old male who presented with bicytopenia and paraplegia. Workups were consistent with AML with monocytic differentiation. Chromosomal analysis revealed loss of Y and t (8;21). Spinal cord MRI showed intradural extramedullary-enhancing soft tissue lesions at levels T2 to T7 and L5 to S1, suspected to be myeloid sarcoma. Patient, however, succumbed to severe nosocomial infection prior to initiation of chemotherapy and radiotherapy.

Giant Ganglioneuroma of Thoracic Spine: A Case Report and Review of Literature

Ganglioneuroma (GN) is a rare benign tumor of neural crest origin usually found in the abdomen, but may occasionally present at uncommon sites including the cervical, lumbar, or sacral spine. However, GNs of thoracic spine are extremely rare. In this report, we describe a 12-year-old girl with giant GN in the thoracic spine, who underwent successful resection (T1–4 level) of the tumor. Histopathological examination confirmed the diagnosis. GN should be considered in the differential diagnosis of any paraspinal mass. A high index of suspicion and correlation of clinico-radiological findings is necessary in differentiating a large benign tumor from a malignant growth. Complete surgical excision is the treatment of choice; however tumor size and location need to be considered for the surgical approach (one-step or multiple surgeries). Close follow-up after surgery is mandatory.

Laminoplasty and Recapping Procedure of C7 for Intradural Tumor Excision: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: To report laminoplasty and recapping procedure of C7 for intradural tumor excision SUMMARY OF LITERATURE REVIEW: Various surgical techniques have been attempted to decrease postoperative axial neck pain. MATERIALS AND METHODS: Kurokawa laminoplasty of C7 was performed. Autogenous bone graft material was harvested from partial T1 laminectomy. Intradural tumor was removed without any complications. Four mini plates were applied at hinge sites of laminoplasty and one lag screw was fixed at the longitudinally splitted lamina of C7. RESULTS: Early range of motion without braces was possible following laminoplasty and recapping procedure. Solid union was achieved at the hinge sites of laminoplasty at the 3-month postoperative follow-up. No instability was observed at the 2-year postoperative followup. The visual analog scale of axial neck pain at the 2-year postoperative follow-up was 2. CONCLUSIONS: Laminoplasty and recapping procedure might be a good option for intradural tumor excision to facilitate early range of motion and decrease postoperative axial neck pain.

Intradural Migration of a Sequestrated Lumbar Disc Fragment Masquerading as a Spinal Intradural Tumor

Intervertebral intradural lumbar disc herniation (ILDH) is a quite rare pathology, and isolated intradural lumbar disc herniation is even more rare. Magnetic resonance imaging (MRI) may not be able to reveal ILDHs, especially if MRI findings show an intact lumbar disc annulus and posterior longitudinal ligament. Here, we present an exceedingly rare case of an isolated IDLH that we initially misidentified as a spinal intradural tumor, in a 54-year-old man hospitalized with a 2-month history of back pain and right sciatica. Neurologic examination revealed a positive straight leg raise test on the right side, but he presented no other sensory, motor, or sphincter disturbances. A gadolinium-enhanced MRI revealed what we believed to be an intradural extramedullary tumor compressing the cauda equina leftward in the thecal sac, at the L2 vertebral level. The patient underwent total L2 laminectomy, and we extirpated the intradural mass under microscopic guidance. Histologic examination of the mass revealed a degenerated nucleus pulposus.

Clinical Characteristics and Surgical Results of Spinal Intradural Tumor

STUDY DESIGN: A retrospective study about spinal intradural tumor. OBJECTIVES: We analyzed clinical symptom, findings of MRI, and surgical outcome of spinal intradural tumor. SUMMARY OF LITERATURE REVIEW: Intradural tumors are not commonly reported and they show non-specific clinical features. MATERIALS AND METHODS: In this study, 18 patients who underwent surgical treatment and radiologically and pathologically diagnosed as spinal intradural tumor from 1997 to 2009 were reviewed. We evaluated pain, neurological symptoms, location of tumor as well as degrees of signal intensity and its enhancement of MRI(T1 and T2). And clinical outcomes were analyzed according to Klekamp-Samii scoring system and Visual Analogue Scale(VAS). RESULTS: All patients were clinically suffered from back pain and radiating pain of lower extremity including 3 patients with neurological symptoms. We radiologically found single tumor in 16 cases and masses more than two lesion in 2 cases. 1 case was located on cord level(T7), 14 cases cauda equine level, and 3 cases sacral level. We performed laminectomy in 18 cases and posterior instrumentation was applied to 8 cases. In clinical features, mean Klekamp-Samii score was improved from 21.6 to 23.5(p<0.05) and VAS was recovered from 5.2 to 3.0 (p<0.05). CONCLUSIONS: Spinal intradural tumor has non-specific clinical symptoms. Therefore we should perform MRI to find intradural tumor and active management including surgical treatment should be performed due to clinically good results.

Intradural Mature Teratoma in the Lumbar Spine found in Adult

Intradural spinal teratoma is a very rare entity, more prevalent in childhood, and may be associated with dysraphic defects. Moreover, mature teratoma in adult is extremely rare. The authors report on a 56-year-old man with right leg motor weakness and numbness and sensation of incomplete voiding. The lumbar radiograph showed spina bifida in L4, L5, and S1. Magnetic resonance image(MRI) showed a 6.4-cm intradural cystic mass on the L2 and L3 levels of the spinal canal and tethering of the spinal cord. We performed a total laminectomy at L2, L3, and partial laminectomy at L4 and removed the mass completely. Histopathologic diagnosis was mature teratoma. The patient's complaints were improved after the surgery.

Surgical Treatments of Spinal Intradural Tumor / 대한정형외과학회잡지

PURPOSE: This article aims at evaluating the results of treatment which excise the intradural extramedullary tumor using surgical microscope, mainly concerned by the field of orthopaedic surgery. MATERIALS AND METHODS: A retrospective review was carried out on 11 cases who were operated on for the excision of intradural extramedulary tumor in two hospitals from June 2001 to May 2007. Of the 11 cases, there were 3 males, and 8 females with an average age of 62.4 (33-78) years. Average follow-up period is 18.8 (1-78) months. Patients were diagnosed by MRI and pathological diagnosis was analyzed. The clinical evaluation was made by the index of VAS (visual analogue scale) and Cooper- Epstein grade. RESULTS: 7 cases were Schwannoma and 4 cases were meningioma. The VAS take a favorable turn from average 9.4 before practice to final follow-up 2.4, and the Cooper-Epstein grade take a favorable turn from average 2.4 to final follow-up 0.7 CONCLUSION: A fine result of excision of the intradural extramedullary tumor with using surgical microscope could be acquired even in the field of orthopedic surgery.

Surgical treatment of intradural tumor / 中国矫形外科杂志

[Objective]To investigate results of surgical treatment of intradural tumors of the cervical spinal cord.[Method]Twenty-one cases with cervical intradural tumor were treated surgically under posterior approach from 1999 to 2005,all patients were performed cervical laminae resection before tumor resection,and some received internal fixation.All patients were followed up for 8 months to 38 months respectively.All the clinical materials were analyzed retrospectively.[Result]All patients survived the operation,symptoms disappeared 13,relieved 7 and deteriorated 1.Total resection in 15 cases,subtotal 4 cases and partial 2 cases.[Conclusion]To succeed the operation,it is very important to make clear the location and size of the tumor and the relationship between the tumor and spinal cord;in order to gain total resection of tumor,both careful protection of spinal cord and vertebral artery and intraspinal cannal veins are essence.

A Case Report of Intradural Ruptured Lumbar Disc

Intradural ruptured discs are very rare occurrences and the incidence is reported to be 0.13% among total herniated discs, 90% of intradural ruptured discs are known to occur in the lumbar area. The symtoms and signs of the intradural disc are much more severe than those of the usual extradural herniated disc. MR imagings of the intradural disc demonstrate several typical findings, but intradural tumors must be ruled out. The authors present a case of intradural ruptured lumbar disc L4-L5 level in a 46-year-old female. Characteristic MR and operative findings of this case are reported. Pathogenetic mechanisms and differential diagnoses with certain intradural tumors and the extradural ruptured disc with similar MR findings are discussed.

Evaluation of Ultrasonic Aspiration in the Surgical Removal of Spinal Intradural Tumors

The cavitron ultrasonic surgical aspirator(CUSA) has been used for the surgical removal of 26 cases of spinal intradural tumors. In 26 patients, total removal was possible in 77% and there was no neurological deterioration due to surgical removal using CUSA. 21 of 26 patients(84%) showed neurological improvement at long term follow-up examination. The cavitron ultrasonic surgical aspirator had advantages in the surgical removal of spinal intradural tumors, as follows:1) precise removal of tumor without excessive meahcnical manipulation of normal tissue;2) rapidity of action relative to the consistency of the tissue;3) direct visualization of the tissue being removed and good proprioceptive feedback for the surgeon;4) preservation of large vessel and very little bleeding;5) lack of thermal injury. The limitation of CUSA was obscuring of operation field by large and straight hand piece.