ABSTRACT
C2 spinal nerve schwannomas are rarely encountered, especially in children and young adults. Due to their localization surgical management encompasses a number of distinctive features. We describe two cases of C2 spinal nerve tumors, schwannoma and neurofibroma, in patients aged 13 and 17, respectively. Both patients presented with compressive cervical myelopathy due to large tumors at C1-C2 level with extra-intracanal hourglass extension. Despite prominent tumor size and location of their component ventrally to the spinal cord, our selected surgical approach allowed, in both instances, total tumor removal with minimum surgical trauma and no neurological deficit.
Subject(s)
Spinal Cord Compression , Spinal Cord Diseases , Spinal Cord Neoplasms , Cervical Vertebrae , Child , Humans , Spinal Cord Neoplasms/diagnostic imaging , Spinal Cord Neoplasms/surgery , Spinal Nerves , Young AdultABSTRACT
A 15-year-old female former gymnast with a history of pectus excavatum was reviewed due to unexplained paraparesis and urinary incontinence since age 10. Symptoms were commenced with intolerable upper back pain and development of a soft mass at the sacrum that remitted spontaneously. Brain and whole spine MRI imaging and blood and CSF testing were normal. The combination of skeletal, neurological, and bladder symptoms with normal lumbar MRI and abnormal urodynamic and neurophysiological studies led to the clinical suspicion of occult tethered cord syndrome (oTCS). Surgical cord "untethering" was performed leading to remarkable postoperative clinical improvement. oTCS is a recently defined functional disorder of the spinal cord due to fixation (tethering) of the conus medullaris by inelastic elements that may lead to severe neurological impairment. High clinical suspicion is required as oTCS is a treatable spinal cord disorder.
Subject(s)
Neural Tube Defects , Urinary Incontinence , Adolescent , Female , Humans , Magnetic Resonance Imaging , Neural Tube Defects/complications , Neural Tube Defects/diagnostic imaging , Neural Tube Defects/surgery , Paraparesis/diagnostic imaging , Paraparesis/etiology , UrodynamicsABSTRACT
PURPOSE: The aim of this study was to identify the factors relevant to the prognosis of the outcome of the surgical treatment of the tethered cord syndrome (TCS). METHODS: The results of surgical treatment performed on 58 children with TCS were analyzed, with follow-up periods ranging from 6 months to 5 years. The data of preoperative clinical and instrumental examinations, as well as those of intraoperative electrophysiological diagnostics and morphometry, were compared with the dynamics of the TCS clinical presentation. RESULTS: The recovery rate was significantly higher in children with filum terminale abnormality (p = 0.014), as well as grade I tethering (p = 0.0037), and when the spinal cord tracts at the level of intervention were intact (p = 0.018). Complete untethering (p = 0.04) and a low threshold value of amperage in direct stimulation (< 1 mA) (p = 0.016) were identified as factors for a favorable outcome. Worsening of neurological symptoms was more frequent in children operated over the age of 10 (p = 0.03), when the TCS was manifested exclusively through the pelvic dysfunction (p = 0.00004), if the F-wave block is less than 30% (p = 0.0045) and the stimulation threshold during root mapping ranged from 1 to 5 mA (p = 0.01). CONCLUSION: The operation is recommended when structural changes are minimal. In case of severe structural changes, if the spinal cord tracts are intact, the indications for operation are determined by the risk of irreversible structural changes due to the natural course of the disease, although the risks are substantially higher.
