Surgical Outcomes of High-Grade Spinal Cord Gliomas.

STUDY DESIGN: A retrospective study. PURPOSE: The purpose of this study was to obtain useful information for establishing the guidelines for treating high-grade spinal cord gliomas. OVERVIEW OF LITERATURE: The optimal management of high-grade spinal cord gliomas remains controversial. We report the outcomes of the surgical management of 14 high-grade spinal glioma. METHODS: We analyzed the outcomes of 14 patients with high-grade spinal cord gliomas who were surgically treated between 1989 and 2012. Survival was charted with the Kaplan-Meier plots and comparisons were made with the log-rank test. RESULTS: None of the patients with high-grade spinal cord gliomas underwent total resection. Subtotal resection was performed in two patients, partial resection was performed in nine patients, and open biopsy was performed in three patients. All patients underwent postoperative radiotherapy and six patients further underwent radiation cordotomy. The median survival time for patients with high-grade spinal cord gliomas was 15 months, with a 5-year survival rate of 22.2%. The median survival time for patients with World Health Organization grade III tumors was 25.5 months, whereas the median survival time for patients with glioblastoma multiforme was 12.5 months. Both univariate and multivariate Cox proportional hazards models demonstrated a significant effect only in the group that did not include cervical cord lesion as a factor associated with survival (p=0.04 and 0.03). CONCLUSIONS: The surgical outcome of patients diagnosed with high-grade spinal cord gliomas remains poor. Notably, only the model which excluded cervical cord lesions as a factor significantly predicted survival.

Transformation from asymptomatic to symptomatic of lower cervical spinal dural arteriovenous fistula.

A 60-year-old woman presented with a spinal dural arteriovenous fistula (SDAVF) located in the lower cervical region, which had been asymptomatic for 56 months after the initial detection. She underwent embolization of the SDAVF when she became symptomatic, but her neurological recovery was only partial. Cervical SDAVF is rare but sometimes discovered in an asymptomatic state. The natural history and validity of preventive treatment for asymptomatic SDAVF have not been fully established. Her unfavorable outcome demonstrates the potential advantages of adequate treatment at an early stage even for asymptomatic SDAVF.

[Case of cervical monostotic fibrous dysplasia with a large cyst].

We report a rare cervical monostotic fibrous dysplasia with a large cyst in the C2 region in a 55-year-old man complaining of headache. MRI revealed an expanding bony tumor at the C2 spinous process. Gd-DTPA MRI showed slight enhancement around a cystic mass. We performed C2 laminectomy and removed the tumor. It was comprised of soft tissue in the C2 spinous process and right lamina and contained a large septated cyst filled with xanthochromic fluid. Histopathology confirmed fibrous dysplasia with typical woven bony trabeculae. His postoperative course was uneventful and outpatient follow-up detected no deficits. Cervical fibrous dysplasia with a distinct cyst is a rare entity and few cases have been reported in the literature. Such cysts are considered to reflect a tumor regression process. Diagnosis based on MRI and CT study alone is difficult. We suggest that these lesions be surgically resected.

[Expansive duralplasty and subarachnoid reconstruction for spinal adhesive arachnoiditis using Gore-Tex surgical membrane].

Effective surgical treatment of adhesive spinal arachnoiditis has not been established because of its complex clinical manifestation. The authors present a new surgical technique to minimize the postoperative recurrence of adhesion after microlysis of adhesion to treat spinal adhesive arachnoiditis. After complete release and reconstruction of the spinal cord, a 0.1 mm Gore-Tex surgical membrane was placed over the cord and fixed to the lateral dural surface with stay sutures. Furthermore, maximal expansion of a subarachnoid space was performed by expansive dural plasty with a 0.3 mm Gore-Tex surgical membrane. We performed this surgical method in tree cases of spinal adhesive arachnoiditis. During a postoperative follow-up period ranging from 2 to 3 years, postoperative neurological deterioration did not occur in all cases, and postoperative MR imaging studied showed no adhesion spinal cord and reconstructed subarachnoid space. The authors believe that this procedure is an effective surgical treatment for spinal adhesive arachnoiditis.