Lymphoma of the lumbar nerve root: case report.

BACKGROUND AND IMPORTANCE: Lymphoma deposits in the spine are typically extradural. However, we report the case of a 38-year-old man who had a peripheral T-cell lymphoma with both intra- and extradural involvement. CLINICAL PRESENTATION: The patient presented with a 3-month history of right hip and thigh pain. Computed tomography and magnetic resonance imaging revealed features indistinguishable from those of a benign neurofibroma, except for a small area of T2-weighted signal abnormality in the third lumbar vertebral body. INTERVENTION: A solitary lesion of the right third lumbar root with normal surrounding bone and soft tissue was excised at surgery. At immunohistopathological evaluation, a diagnosis was made of peripheral lymphoma. Postoperative evaluation did not reveal lymphoma in the cerebrospinal fluid, abdomen, chest, blood, or bone marrow. This case illustrates that lymphomas can grow in patterns indistinguishable from a tumor of a nerve root. Therefore, other treatment modalities would have been considered had the diagnosis of lymphoma been made preoperatively. CONCLUSION: Involvement of a solitary nerve root by lymphoma, although rare, should be suspected in all cases of nerve root neurofibroma, and magnetic resonance imaging should be performed. Even minor signal abnormalities in adjoining vertebrae signal the possibility of malignancy. Percutaneous biopsy of suspicious bony lesions and systemic evaluation can demonstrate other sites of involvement, enabling the confirmation of the diagnosis and appropriate treatment without recourse to surgery.

Surgical excision of meningiomas involving the clivus: preoperative and intraoperative features as predictors of postoperative functional deterioration.

Neurological deterioration is commonly seen after surgical excision of clival meningiomas; however, an understanding of the risk factors associated with postoperative deterioration can lead to improvements in outcome. In 75 patients with clival meningiomas operated on over a 7-year period, the following data were studied; preoperative variables such as presenting Karnofsky scale score, age, sex, and prior operations or radiation therapy. Radiological findings on magnetic resonance imaging or arteriography, such as the development of the arachnoidal cleavage plane between tumor and the brain stem, brainstem edema, tumor size, extent of compression on the brain stem, vascular encasement, and blood supply from the basilar artery were among other data studied. In addition, intraoperative findings such as development of the arachnoid plane, vascular encasement, and the difficulty of dissection were noted. Finally, each patient's neurological and functional statuses were recorded at 1 week postoperatively and at follow-up examinations. Early postoperative functional deterioration occurred in 45 patients (60%) and ranged from mild (30 patients) to severe (three patients). Significant improvement had occurred by the time of follow-up examination in all but four patients; however, permanent postoperative dysfunction was present in 12 patients. Statistical analysis revealed significant correlations between early functional deterioration and preoperative Karnofsky scale scores, male gender, radiological findings of the absence of an arachnoid plane, edema of the brain stem, and arteriographic supply from the basilar artery. Operative features included difficulty with dissection, an absent arachnoidal cleavage plane, and incomplete tumor resection. Permanent functional deterioration was statistically associated with the following: blood supply from the basilar artery, difficulty of dissection, incomplete tumor resection, and early postoperative dysfunction. Logistical regression analysis revealed that the most important risk factor for early postoperative deterioration was tumor size. Patients with large or giant tumors had a 6.7 to 13 times greater risk of functional deterioration, respectively, than patients with small- or medium-sized tumors. Excluding tumor size, the most important factor for permanent deterioration was blood supply from the basilar artery. Patients in this category had a 4.4 times greater risk of permanent functional deterioration. Three stages of tumor relationship to the brainstem arachnoid and pial membranes are proposed. Based on the results of this clinical study of clival meningiomas, suggestions are made for changes in the management strategy of these difficult lesions.

Giant aneurysm of internal carotid artery in a four-year-old child: a case report.

A case of giant saccular aneurysm in early childhood is reported. An internal carotid aneurysm presenting with episodic headache was successfully clipped with complete relief of symptoms. The patient was also investigated for a possible collagen deficiency which proved negative. Clinical features and pathogenesis of this rare lesion are discussed.