Tumores primarios de médula espinal y cauda equina en adultos en el Hospital Nacional Edgardo Rebagliati Martins 2007-2011 / Primary tumors of spinal cord and cauda equina in adults at the National Hospital Edgardo Rebagliati Martins 2007-2011

PLANTEAMIENTO DEL PROBLEMA: Los tumores primarios de médula espinal representa 2 por ciento al 4 por ciento de todas las neoplasias del SNC, los tumores son generalmente los neurinomas y los meningiomas, en ellos la resección completa puede lograr frecuentemente la curación, la problemática sin embargo es la falta de estudios clínicos en general para los tumores del SNC y en particular para los tumores de la médula espinal. El objetivo de nuestro estudio es conocer la incidencia actual de tumores primarios de la médula espinal y cauda equina en adultos del servicio de columna vertebral y nervios periféricos del HNERM. Metodología: El presente estudio es de tipo retrospectivo, transversal y descriptivo, de los pacientes con el diagnóstico anátomo patológico de tumor primario de médula espinal y cauda equina, atendidos en el servicio de columna vertebral y nervios periféricos del HNERM, desde el 1 de Enero 2007 al 31 de Diciembre del 2011. Resultados: La incidencia de tumores primarios de médula espinal y cauda equina fue de 1.99 por ciento de los tumores del sistema nervioso central, el más frecuentemente fue neurinoma con el 41.46 por ciento, seguidos de los meningioma con el 34.15 por ciento, juntos representan más del 75 por ciento, seguidos de los astrocitomas con el 12.19 por ciento, predomina en el sexo femenino con el 65.85 por ciento, siendo el grupo etario más afectado entre 35-50 años, promedio 48.9 años, el tiempo de enfermedad al ingreso fue principalmente más de 9 meses 48.78 por ciento, se localizan más en el segmento torácico 51.23 por ciento, presentando al momento de ingreso dolor axial o radicular y debilidad de extremidades, con hipoestesia debajo del nivel de compresión y paraparesia, el procedimiento quirúrgico más frecuente fue laminectomía y resección microquirúrgica completa del tumor 78.05 por ciento, logrando función motora aceptable en el 70 por ciento, para neurinomas y meningiomas, a los 6 a 12 meses post quirúrgicos. Discusión: La...

Primary intraspinal ganglioneuroblastoma of the thoracic spine: A rare case report.

Cerebral ganglioneuroblastoma is an embryonal tumor of the central nervous system, which has been rarely encountered into the spinal cord. The standard treatment for ganglioneuroblastoma is complete surgical excision. A 15-year old boy was presented with cord compression. Magnetic resonance imaging revealed an intradural and intramedullar enhancing lesion over T2 spine. A histomorphological diagnosis was made in the presence of immature small round cells admixed with a good number of ganglion cells. The morphological diagnosis was verified by immunohistochemistry. This is the first reported case of compressive myelopathy in the thoracic region of the spine.

Congenital inclusion tumours in spinal dysraphism.

Objective. To review the presentation, diagnosis and management of children with spinal dysraphism and CIT. Methods. It is a retrospective review of 146 children of spina bifida over 9 years (2000-2008) and details the clinical course and outcome of seven with associated congenital inclusion tumors. Results. 7/146 (4.7%) had spina bifida with CIT, 5 dermoid cysts and 2 mature teratoma. The diagnosis was missed by the primary physician even in the presence of a neurocutaneous marker. Spinal imaging with MRI was conclusive. All were managed with multilevel laminectomy, near total/total excision of the CIT and detethering of cord. Intramedullary involvement and established neurological deficits at presentation were associated with persistent deficits. Conclusion. Early detection and comprehensive management of CIT with spinal dysraphism ensures social fecourinary continence, preserves renal function, achieves ambulation and enables patients to lead an acceptable quality of life.

Experience with 349 cases of intradural spinal tumors at Lady Reading Hospital Peshawar

To analyze the variables of patients operated for intradural spinal tumors at Lady Reading Hospital Peshawar. An analytical descriptive study Place and duration of study: Department of Neurosurgery Lady Reading Hospital Peshawar, from April 2003 to March 2010 [7 years]. Medical record of patients with spinal tumors were revised and patients suffering from intradural spinal tumors were searched. There were total 572 cases of spinal tumors, of which 349 had different intradural lesions. Their clinical features, radiological reports, peroperative findings and histological reports were analyzed in different aspects. Of the total 349 patients with intradural spinal tumors 201 were males and 148 female, with male to female ratio of almost 1.4:1. Age of the patients ranged between 2 years to 77 years, with median of 39.2 years. The common clinical features were backache, leg weakness, parasthesia and poor sphincters. Magnetic Resonance Imaging of the spine was the main [309 cases] diagnostic tool along with plain x-ray and myelography in limited cases [35 cases]. CT myelogram was done only in 5 cases. Dorsal spine was involved in 62.5% cases, lumber and cervical spine in 25.5% and 12% patients respectively. Neurofibroma was the commonest [51%] intradural spinal tumor, we also had meningioma in 30.66%. Other intraspinal lesions were dermoid, lipoma, ependymoma, astrocytoma, tuberculoma, arachnoid and hydatid cysts. Of all the spinal tumors intradural are more common [61%] than extradural. Neurofibroma and meningioma constituted majority of cases belonging to extramedullary intradural group, while ependymoma and dermoid were common intramedullary tumor. 3rd and 5th decade of life were the common age group for both intramedulary and extramedullary tumors. Intramedullary tumors were common in 3rd decade of life

Tumores intradurales extramedulares primarios tratados en el Instituto Nacional de Rehabilitación / Primary intradural extramedullary tumors treated at the National Institute of Rehabilitation (Mexico)

Introducción: Los tumores de la columna son lesiones poco comunes que afectan a una porción menor de la población, sin embargo, pueden causar morbilidad significativa y estar asociados a mortalidad. Representan 15 % de los tumores craneoespinales. El objetivo del presente trabajo fue definir la frecuencia de tumores intradurales extramedulares de columna vertebral en el Servicio de Cirugía de Columna Vertebral del Instituto Nacional de Rehabilitación, y su diagnóstico histopatológico definitivo. Material y métodos: Estudio retrospectivo de una serie de pacientes tratados quirúrgicamente entre 1996 y 2006 por diagnóstico de tumor intradural extramedular. Se evaluó sexo, edad, localización, sintomatología y tipo de tumor. Resultados: Se revisaron 27 pacientes, 11 hombres y 16 mujeres, con edad promedio de 47.33 años. Los síntomas principales fueron dolor y pérdida de la fuerza. La localización más frecuente fue la torácica seguida de la lumbar; el diagnóstico histopatológico indicó meningioma en 12 casos, schwannoma en 12 y neurofibroma en tres. Conclusiones: La sintomatología, localización y predominio de sexo son similares a los informados en la literatura. A diferencia de otras series, los tumores más frecuentes en la nuestra fueron schwannomas y meningiomas. Es importante el diagnóstico oportuno y tratamiento adecuado, que en nuestros pacientes consistió en resección total con laminoplastia, para evitar secuelas neurológicas permanentes.

BACKGROUND: Spine tumors are uncommon injuries affecting a low percentage of the population; however, these tumors can cause significant morbidity and may be related to mortality. They represent 15% of craniospinal tumors. The objective of this study is to determine the frequency of intradural extramedullary spine tumors treated in our Service and to report the definitive histopathological diagnosis. METHODS: This was a retrospective study in a series of patients treated surgically with a diagnosis of intradural extramedullary tumor in the Spine Service of the National Rehabilitation Institute (Mexico) from 1996 to 2006. The following variables were evaluated: gender, age, tumor localization, symptomatology and type of tumor. RESULTS: Files of 27 patients were reviewed. There were 11 men and 16 women with an average age of 47.33 years. The main symptoms were pain and motor weakness. The most frequent localization was thoracic followed by lumbar. Histopathological diagnosis reported 12 cases of meningioma, 12 cases of schwannoma and 3 cases of neurofibroma. CONCLUSIONS: Symptomatology, localization and gender predominance are similar to that reported in the literature. Different from other series, schwannomas and meningiomas were the most frequent tumors in our study. Appropriate diagnosis and opportune treatment consisting of total resection with laminoplasty are crucial in order to avoid permanent neurological consequences.

Patterns of malignant tumors of the brain and spinal cord in Bahrain: Fifty two year period

To review malignant neoplasms of the brain and spinal cord in Bahrain, and to compare the incidence with other parts of the world. A retrospective study. All Histopathology Departments in Bahrain. Data relating to all malignant CNS neoplasms which were diagnosed histologically in Bahrain were extracted from the relevant patient medical records. All tumors were histologically diagnosed in Bahrain between 1952 and 2004. There were 103 malignant CNS tumors representing 1.4% of all malignancies histologically reported during the same period. Of the 103 patients, 77 [74.8%] were Bahraini. Of the Bahraini patients, thirty-one [40.3%] were female and the male: female ratio was 1.48:1. Sixty-two of the 77 Bahraini tumors [80.5%] were primary brain tumors, nine [11.7%] were primary spinal cord tumors, and six [7.8%] were secondary tumors. Astrocytoma and medulloblastoma were the commonest primary malignant CNS neoplasms in both adults and children. The apparent incidence of malignant brain and spinal cord neoplasms in Bahrain is very low. The small Bahraini population, inefficient registration of cancers, and the lack of routine hospital autopsies are contributory factors for the low numbers observed

Surgical approach to C1-C2 nerve sheath tumors.

BACKGROUND: C1 and C2 nerve sheath tumors (NST) are unique in presentation, relationship to neighbouring structures and surgical approaches when compared to their counterparts in other regions of the spine. AIM: The strategies involved in the surgery for C1-C2 NST are discussed SETTING AND DESIGN: Retrospective study. METHODS: 21 patients with C1 (n=6) and C2 (n=15) NST were operated based on their position with respect to the cord i.e. anterior (4), anterolateral (10), posterolateral (5), and posterior (2). The tumors had extra- and intradural components in 20 patients; while in one, the tumor was purely intradural. The operative approaches included the extreme lateral transcondylar approach (3); laminectomy with partial facetectomy (5); laminectomy (11); and, suboccipital craniectomy and laminectomy (2). RESULTS: Total excision was performed in 13 patients; while in 7, a partial extraspinal component, and in 1, a small intradural component were left, in situ. Thirteen patients showed improvement by one or more grades in the Harsh myelopathy score; 2 patients with normal power had significant decrease in spasticity; while 5 maintained their grade. One poor-grade patient succumbed to septicemia. CONCLUSIONS: C1-C2 NST may have exuberant growth due to the capacious spinal canal and the absence of a "true" intervertebral foramen at this level. Surgical approaches are determined by its relationship to the cord. A "T incision" on the dura, the partial drilling of the facets, sectioning of the denticulate ligament, rotating the operating table 15 to 30 degrees, and at times sectioning the posterior nerve roots are all useful adjuncts for facilitating access.

A study of 70 cases of cutaneous metastases from internal carcinoma.

A retrospective analysis of 70 patients with metastatic cutaneous nodules, was conducted in the department of pathology, Kasturba Medical College, Mangalore. The available clinical records and histologic material of these cases were reviewed. In last few years fine needle aspiration cytology (FNAC) was being used as the main diagnostic tool. The commonest primary site of cutaneous metastasis in this study was gastro-intestinal tract (46.7%) in males and breast (32%) in females. Abdomen (including umbilical nodules) was found to be the most frequent site for metastatic cutaneous nodule.

Tumores raquídeos en pacientes pediátricos / Spinal tumors in pediatric patients

Los autores han revisado 14 casos de tumores raquídeos en pacientes pediátricos (0-15 años) controlados en el Instituto de Neurocirugía Asenjo, entre 1980 y 1992. Se encontraron diferentes tipos de tumores, sin predominar claramente ninguno de ellos, presentes también a diferentes niveles, predominando sobre todo a nivel dorsal (9 de 14 casos). La mayor frecuencia de presentación se encuentra en el grupo de edad entre 11 y 15 años y con un promedio de evolución previo a la primera consulta de 3-6 meses. Los tumores raquídeos son relativamente raros durante la infancia. En toda la literatura publicada existe controversia con los tumores raquídeos en la infancia, relacionada con el tipo de lesiones que deben ser incluídas y en relación al límite de edad considerado para el grupo pediátrico

Neurinomas e meningeomas intrarraquidianos: estudo comparativo de 23 casos / Intraspinal neurinomas and meningiomas: comparative study of 23 cases

Os autores apresentam estudo comparativo entre neurinomas e meningiomas intrarraquídeos. Analisam a incidência de acordo com a idade, sexo, localizaçäo, duraçäo dos sintomas e resultados

CT findings of seeding tumors.

From 1981 to 1989 there were 43 from 154 cases of metastatic brain tumors, which seeded along the CSF pathways found in the Department of Radiology, Siriraj Hospital Medical School, Bangkok. These seeding tumors were spread from both primary intracranial (25 cases) and extracranial neoplasms (18 cases). Among the primary intracranial tumors, pineal neoplasm was the most frequent site (48%). The next rank was ependymoma (20%), medulloblastoma (16%), glioma (12%) and others (4%). The majority of extracranial neoplasms that seed in the CSF pathways were malignancy of lung (44.4%), choriocarcinoma (22%) and breast (11%). Lateral ventricle was the most frequent site of seeding (65%). The remaining tumors seeded in cisterns, leptomeninge and spinal subarachnoid space. CT is sensitive in detecting seeding tumors but not specific for each type of tumor.

Central nervous system tumors among Koreans: a statistical study on 697 cases

A total of 697 cases of intracranial and intraspinal tumors was obtained from the pathology file of Seoul National University Hospital and Children's Hospital during the period of 8 years from 1980 to 1987. These tumors were classified according to WHO classification. This study was performed to understand the recent trend of the relative frequency of the central nervous system tumors among Koreans and to compare it with the previous studies in Korea and other countries. There were 663 intracranial tumors and 34 intraspinal tumors. More common intracranial tumors were pituitary adenoma, meningioma, astrocytoma and medulloblastoma, each representing 23.4%, 20.8%, 11.8%, and 5.6%, respectively. In juvenile age group (under 15 years of age), medulloblastoma, astrocytoma, ependymoma and craniopharyngioma were more commonly encountered to be 25.6%, 21.6%, 13.6% and 12%, respectively. Both sexes were equally affected among adult group, but male preponderance was observed among juvenile group (1.49:1). Nine cases of primitive neuroectodermal tumor, a unique tumor which is not listed in WHO classification, were observed and all of them occurred before the age of 20. There were 27 metastatic tumors. Our previous study encompassing previous 17 years, 1963 to 1979, showed similar overall results except for intraspinal tumors that were more commonly encountered in previous series.

Tumours of hte central nervous system: analysis of 476 cases observed at the University Hospital of the West Indies

A statistical survey of the incidence, age and sx distribution, and preferential sites of occurrence of tumours of the central nervous system observed at the University Hospital of the West Indies during a 15-year period is presented. Four hundred and seventy-six histologically confirmed neoplasms were recorded. Intracranial tumours were 7 times as common as those of the spinal cord. Of 416 intracrianl neoplasms, ther were 40% neuropithelial tumors, 21% meningiomas, 15% pituitary adenomas, 9% metastic lesions, 6% congenital tumours, 5% vasoformative tumours, 3% nerve sheath tumours and 1% unclassified neoplasms. Men and women were equally affected. Meningiomas and pituitary adenomas were more frequent than in otherreported series. Metastases were relatively more frequent in the spinal than in the intracranial group. Of the primary spinal tumours, those of nerve sheath origin were nearly three times as common as the meningiomas

Tumores raquimedulares / Spinal cord tumors

Se analizaran el cuadro clinico y los resultados del tratamiento, en especial del quirurgico, en 82 pacientes, con signos y sintomas de compresion raquimedular, ingrsados en un periodo de 10 anos. Los tumores espinales en la serie han tenido en terminos generales un comportamiento similar al de las otras series. El 16% de los tumores espinales son intramedulares, el resto es extramedular. Los tumores mas numerosos de localizacion extradural fueron las metastasis. El cuadro clinico, frecuencia de comienzo y desarrollo de la enfermedad, esta relacionado con el tipo histologico del tumor, al igual que las modificaciones en el post-operatorio. En casi todos los casos fue posible un diagnostico topografico preciso, durante el examen de ingreso. La tercera decada de la vida en adelante, fue la de mayor numero de casos, siendo el sexo masculino el mas afectado. En los tumores de localizacion, intradural extramedular, los mas numerosos fueron los meningiomas y schwamnomas; en los meningiomas, el sexo femenino fue el mas afectado. La mielografia con contraste positivo fue de gran utilidad, en el diagnostico topografico preciso. La escanografia aparece como un examen paraclinico de gran valor, en el diagnostico de los tumores del cordon espinal. Los resultados del tratameitno fueron buenos en general, y, aun casos con deficit motor acentuado mejoraron satisfactoriamente.