Raízes nervosas redundantes da cauda equina: revisão da literatura / Redundant nerve roots of the cauda equina: review of the literature

A redundância das raízes nervosas da cauda equina é caracterizada, no diagnóstico por imagem, pela presença de raízes nervosas alongadas, espessadas e tortuosas junto a uma área de estenose do canal vertebral lombar. Não é uma entidade independente, mas acredita-se que ocorra como o resultado da compressão crônica ao nível da estenose do canal lombar e que, portanto, pode fazer parte da evolução natural da estenose. O objetivo deste trabalho é revisar a histopatologia, a eletrofisiologia, as características de imagem, especialmente na ressonância magnética, e o significado clínico desta entidade. Como a avaliação atual da estenose de canal e das compressões radiculares é realizada preferencialmente por meio da ressonância magnética, é nesse método de imagem que a redundância das raízes nervosas da cauda equina será identificada. O reconhecimento desta entidade nos exames de ressonância magnética é importante, principalmente para evitar equívocos que poderiam levar ao diagnóstico de outras afecções, particularmente de malformações arteriovenosas intradurais. A literatura é controversa a respeito da importância clínica da presença de redundância das raízes nervosas da cauda equina. Há artigos que sugerem que as alterações patológicas da raiz nervosa são irreversíveis no momento do diagnóstico e que os sintomas neurológicos não são mais suscetíveis de melhora com a descompressão cirúrgica, porém este conceito não é um consenso.

In imaging diagnosis, redundant nerve roots of the cauda equina are characterized by the presence of elongated, enlarged and tortuous nerve roots in close relationship with a high-grade lumbar spinal canal stenosis. This is not an independent entity, but it is believed to be a consequence of the chronic compression at the level of the lumbar canal stenosis and thus may be part of the natural history of lumbar spinal stenosis. The present paper is aimed at reviewing the histopathological, electrophysiological and imaging findings, particularly at magnetic resonance imaging, as well as the clinical meaning of this entity. As the current assessment of canal stenosis and root compression is preferably performed by means of magnetic resonance imaging, this is the imaging method by which the condition is identified. The recognition of redundant nerve roots at magnetic resonance imaging is important, particularly to avoid misdiagnosing other conditions such as intradural arteriovenous malformations. The literature approaching the clinical relevance of the presence of redundant nerve roots is controversial. There are articles suggesting that the pathological changes of the nerve roots are irreversible at the moment of diagnosis and therefore neurological symptoms are less likely to improve with surgical decompression, but such concept is not a consensus.

The Relationship between Spinal Stenosis and Neurological Outcome in Traumatic Cervical Spine Injury: An Analysis using Pavlov's Ratio, Spinal Cord Area, and Spinal Canal Area

BACKGROUND: This study examined the relationship between four radiological parameters (Pavlov's ratio, sagittal diameter, spinal cord area, and spinal canal area) in patients with a traumatic cervical spine injury, as well as the correlation between these parameters and the neurological outcome. METHODS: A total of 212 cervical spinal levels in 53 patients with a distractive-extension injury were examined. The following four parameters were measured: Pavlov's ratio on the plain lateral radiographs, the sagittal diameter, the spinal cord area, and the spinal canal area on the MRI scans. The Pearson correlation coefficients between the parameters at each level and between the levels of each parameter were evaluated. The correlation between the radiological parameters and the spinal cord injury status classified into four categories, A (complete), B (incomplete), C (radiculopathy), and D (normal) was assessed. RESULTS: The mean Pavlov's ratio, sagittal diameter, spinal cord area and spinal canal area was 0.84, 12.9 mm, 82.8 mm2 and 236.8 mm2, respectively. An examination of the correlation between the radiological spinal stenosis and clinical spinal cord injury revealed an increase in the values of the four radiological parameters from cohorts A to D. Pavlov's ratio was the only parameter showing statistically significant correlation with the clinical status (p = 0.006). CONCLUSIONS: There was a correlation between the underlying spinal stenosis and the development of neurological impairment after a traumatic cervical spine injury. In addition, it is believed that Pavlov's ratio can be used to help determine and predict the neurological outcome.

Multiple meningiomas within the spinal canal: case report with 23 tumors

Na maioria das casuísticas de neoplasias do canal espinhal, medula espinhal e leptomeninges, os meningiomas compreendem 25%. A incidência de meningiomas múltiplos é pequena quando comparada com sua freqüência isolada. Na maioria dos casos, a ocorrência múltipla é intracraniana e espinhal. Meningiomas múltiplos localizados exclusivamente no canal raqueano são extremamente raros. Relatamos o caso de homem de 33 anos com 23 tumores, localizados na região torácica espinhal.

Sacral perineural cyst presenting as chronic perineal pain: a case report.

We present an interesting case of sacral perineural cyst which caused chronic perineal pain. Perineural cyst is relatively rare, especially the sacral region. Chronic perineural pain is an often encountered problem that is difficult to evaluate and sacral perineural cyst may be the etiology of chronic perineal pain in many instances.

A Case of Multiple Schwannomas of the Trigeminal Nerves, Acoustic Nerves, Lower Cranial Nerves, Brachial Plexuses and Spinal Canal: Schwannomatosis or Neurofibromatosis?

In most cases, while schwannoma is sporadically manifested as a single benign neoplasm, the presence of multiple schwannomas in one patient is usually indicative of neurofibromatosis 2. However, several recent reports have suggested that schwannomatosis itself may also be a distinct clinical entity. This study examines an extremely rare case of probable schwannomatosis associated with intracranial, intraspinal and peripheral involvements. A 63-year-old woman presented with a seven-year history of palpable lumps on both sides of the supraclavicular area and hearing impairment in both ears. On physical examination, no skin manifestations were evident. Facial sensory change, deafness in the left ear and decreased gag reflex were revealed by neurological examination. Magnetic resonance imaging revealed multiple lesions of the trigeminal nerves, acoustic nerves, lower cranial nerves, spinal accessory nerve, brachial plexuses, and spinal nerves. Pathological examination of tumors from the bilateral brachial plexuses, the spinal nerve in the T8 spinal position and the neck mass revealed benign schwannomas. Following is this patient case report of multiple schwannomas presenting with no skin manifestations of neurofibromatosis.

Angiolipoma of the Posterior Mediastinum with Extension into the Spinal Canal: A Case Report

Angiolipoma is a rare benign soft tissue tumor, an unusual variant of lipoma,consisting of fatty and vascular components and located in the subcutis, usually in the trunk and extremities. We report a case of posterior mediastinal angiolipo-ma extending into the spinal canal and showing both fat and angiomatous fea-tures on CT scan.

Primary multiple intramedullary and intradural extramedullary hydatid cysts of lumbar spinal canal

A rare case is reported of a 42 year old male farmer who developed gradual paraparesis and incontinence following a radicular pain for which myelography at the L4- L5 interspace revealed complete block at L3. With a presumptive diagnosis of intradural spinal cord tumor he was operated and turned out to be a case of primary intramedullary and intradural extramedulary hydatid cyst of the terminal 2.5 cm of spinal cord and cauda equina. postoperatively he completely recovered and after seventeen years he is without neurological deficit or further manifestations of echinococcosis