Spinal intramedullary hamartoma with acute presentation in a 13-month old infant: case report.

True hamartomas of the spinal cord are very rare, and although several have been reported in the literature, there are few detailed radiological and pathological descriptions of the condition. There is also considerable overlap with other entities, the most common being spinal cord teratomas. The authors report the case of a 13-month-old child with a supragluteal sacral dimple who presented with acute neurological deterioration. MRI of the spine revealed a big intramedullary lesion with heterogeneous signal intensity. A near-total resection was performed, and histopathological examination demonstrated findings consistent with a spinal cord hamartoma. The authors believe that careful preoperative evaluation and rigorous pathological examination are mandatory to establish diagnosis and direct further management of cases in which such a lesion is suspected.

Extruded contents of colloid cysts after endoscopic removal.

OBJECTIVE Mineralized or desiccated colloid cysts pose some unique challenges to endoscopic removal. The extrusion of the solid matrix into the intraventricular compartment has not been previously reported and, as such, no guidance exists regarding its predilection, prevention, and fate. METHODS Postoperative imaging studies in a registry of patients undergoing endoscopic removal of colloid cyst were reviewed to detect any solid matrix within the ventricular compartment. Preoperative images and operative notes were used to determine if any features were predictive. Serial postoperative images and clinical notes were used to characterize the implications of these findings. RESULTS From a review of 94 patients, 10 (10.6%) patients had evidence of an extruded intraventricular solid fragment (median follow-up 4 months; range 0.5-115 months). Of the evaluable patients, 7 of 9 patients had T1-weighted hyperintense and T2-weighted hypointense cysts on preoperative scans. Seventy-eight percent of the extrusions were on the same side as the endoscopic entry. Three patients demonstrated early fragment migration, but not after 8 months of radiological follow-up. All evaluable patients demonstrated improvement in their hydrocephalus, and none suffered a complication attributable to the intraventricular extruded fragments. CONCLUSIONS Intraventricular extruded colloid fragments can occur after endoscopic resection, with the possible risk demonstrated as cyst hypointensity on preoperative T2-weighted images. The finding does not seem to result in any clinical morbidity, and radiographic involution is the rule. Migratory capacity, however, does exist and justifies a more frequent imaging surveillance schedule and consideration for removal.

Fecal incontinence as a predominant symptom in a case of multiply recurrent tethered cord: diagnosis and operative strategies.

Recurrent manifestations of tethered spinal cord after an initial operative intervention for a simple fatty filum terminale is fairly uncommon. The authors present the case of an unusual clinical course in which there were 3 distinct episodes of recurrence, each time presenting predominantly as fecal incontinence and resolving with operative intervention. Typical signs of tethering were absent on radiological evaluation, and operative intervention was based on clinical grounds. Intraoperatively, sacral nerve roots to the anal sphincter were found tethered to the filar stump with electrophysiological evidence of regained activity on disentanglement. To the best of the authors' knowledge, a similar clinical course or operative findings have not been reported.