Surgical treatment of primary spinal tumors in the conus medullaris

Objective: The objective of this study was to evaluate the characteristics and surgical outcome of the conus medullaris tumors. Methods: We retrospectively reviewed 26 patients who underwent surgery for conus medullaris tumor from August 1986 to July 2007. We analyzed clinical manifestation, preoperative MRI findings, extent of surgical resection, histopathologic type, adjuvant therapy, and outcomes. Results: There were ependymoma (13), hemangioblastoma (3), lipoma (3), astrocytoma (3), primitive neuroectodermal tumor (PNET) (2), mature teratoma (1), and capillary hemangioma (1) on histopathologic type. Leg pain was the most common symptom and was seen in 80.8% of patients. Pain or sensory change in the saddle area was seen in 50% of patients and 2 patients had severe pain in the perineum and genitalia. Gross total or complete tumor resection was obtained in 80.8% of patients. On surgical outcome, modified JOA score worsened in 26.9% of patients, improved in 34.6%, and remained stable in 38.5%. The mean VAS score was improved from 5.4 to 1.8 among 21 patients who had lower back pain and leg pain. Conclusion: The surgical outcome of conus medullaris tumor mainly depends on preoperative neurological condition and pathological type. The surgical treatment of conus medullaris tumor needs understanding the anatomical and functional characteristics of conus meudllaris tumor for better outcome.ope

Conus Medullaris Enterogenous Cyst

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147142/1/pmr2698.pd

Spinal Cord Tumors of the Thoracolumbar Junction Requiring Surgery: A Retrospective Review of Clinical Features and Surgical Outcome

PURPOSE: A retrospective review of medical records and imaging studies. To investigate characteristic clinical features and surgical outcomes of spinal cord tumors (SCTs) of the thoracolumbar junction (TLJ). The spinal cord transitions to the cauda equina in the TLJ. The TLJ contains the upper and lower motor neurons of the spinal cord and cauda equina. As a result, the clinical features of lesions in the TLJ vary, and these anatomical characteristics may affect surgical outcome. MATERIALS AND METHODS: Pathological diagnosis, clinical features, neurological signs, and surgical outcomes were investigated in 76 patients surgically treated at our institute for SCTs arising from T11 to L2. The patients were divided into epiconus (T11-12, n=18) and conus groups (L1-2, n=58). RESULTS: Patients in the epiconus group had hyperactive deep tendon reflexes (DTRs), while those in the conus group had hypoactive DTRs (p < 0.05). Nine patients were misdiagnosed with intervertebral disc diseases (IVDs) before correct diagnoses were made. It was impossible to definitively determine the exact cause of symptoms in four patients who had both SCTs and IVDs. CONCLUSION: Among SCTs of the TLJ, the epiconus group displayed upper motor neuron syndrome and the conus group displayed lower motor neuron syndrome. SCTs of the TLJ were frequently misdiagnosed as IVDs due to symptomatic similarities. SCTs of the TLJ should be included in differential diagnosis of back and leg pain, and it is highly recommended that routine lumbar magnetic resonance imaging include the TLJ.ope

Magnetic resonance evaluation of intra dural spinal tumors with histopathology correlation

Background: Tumors of the spinal cord or canal constitute approximately 15% to 20% of central nervous system tumors. The differential diagnosis of spinal neoplasms is primarily based on location of the lesion relative to the spinal cord and the age, sex and clinical presentation. The aim and objective of the study was to determine the sensitivity of magnetic resonance imaging (MRI) in diagnosing intra spinal tumors and to correlate findings on MRI with histopathological diagnosis.Methods: This is a retrospective study. The study group included all the patients who presented to our hospital with progressive sensory or motor deficits, para or quadriperesis with or without bladder/bowel Involvement. Only patients with Intra dural lesions such as intradural extra medullary and Intra medullary lesions were included in the study. All the extra dural lesion cases such as vertebral tumors, degenerative/osteoporotic compressions and Trauma related cord compressions were excluded from the study.Results: Of the forty intradural tumors, 28 were extramedullary and 12 were intramedullary. Most of the tumors were located in the cervical and the dorsolumbar spine accounting for more than 50%. The most common tumor encountered in our study was schwannoma (22/40), followed by ependymoma (7/40), meningioma (4/40), astrocytoma (4/40), one each of Hemangioblastoma, Neuroentericcyst and Dermoid cyst. Ependymomas, Astrocytomas and hemangioblastoma were intramedullary lesions and the remaining lesions constituted Intra Dural extra medullary lesions.Conclusions: MRI was found to be a highly sensitive imaging procedure and the method of choice for intradural tumor evaluation and to differentiate extra medullary from Intra medullary lesions. It is not sensitive enough to differentiate the Intra medullary tumors. Nevertheless, definite diagnosis could be made by histopathology only.

Intramedullary capillary hemangioma of the thoracic spine: case report and review of the literature

Capillary hemangiomas are benign vascular neoplasms. When associated with the spine, these growths frequently involve the vertebral body, but rarely have they been reported to occur as intradural lesions, while even more rarely occurring in a true intramedullary location. We report a rare case of an intramedullary capillary hemangioma of the thoracic spinal cord and a review of the literature

Surgical Treatment of Benign Spinal Cord Tumors

Benign spinal cord tumors (SCTs) are uncommon neoplasms that can arise within or adjacent to the spinal cord. Depending on their anatomical location, benign SCTs can be categorized as intramedullary, intradural-extramedullary, and extradural. The three most common benign SCTs are meningioma, nerve sheath tumors, and ependymoma. Both meningioma and nerve sheath tumors develop in the intradural-extramedullary compartment, while ependymoma occurs in the intramedullary space. Spinal meningiomas derive from arachnoidal cells and most commonly occur within the thoracic segment of the spine. Nerve sheath tumors, including schwannomas and neurofibromas, are closely associated with spinal nerves. Half of the spinal cord ependymomas arise in the lumbosacral segment or the filum terminale. Surgical treatment of large or symptomatic benign SCTs concentrates on total or subtotal resection of the tumors, which should be cautiously individualized based on the tumor location and histopathology. A curable complete resection should be achieved if possible while preserving the nervous function of the spinal cord and minimizing potential complications. Thoracic spinal roots may be sacrificed to acquire a total resection, yet cervical and lumbar nerve roots should be preserved prudently. Due to the vulnerable and complex anatomic nature of the spinal cord, maximal resection of the tumors can be achieved with the aid of appropriate intraoperative neural monitoring and meanwhile preserve nervous function

Relationship between Spinal Hemangioblastoma Location and Age

Study DesignRetrospective case series.PurposeTo investigate the relationship between tumor location and clinical characteristics.Overview of LiteratureHemangioblastoma is a rare disease that develops in the central nervous system. Magnetic resonance imaging (MRI) is useful to evaluate hemangioblastomas. Hemangioblastoma's location is designated as intramedullary, intramedullary+extramedullary, or extramedullary by MRI.MethodsWe analyzed 11 patients who underwent surgery for spinal hemangioblastoma. Using T1 contrast axial MRI data, the cases were divided into three groups (intramedullary, intramedullary+extramedullary, and extramedullary). Patient demographics, MRI findings, and preoperative neurological status were analyzed and compared for each group.ResultsThe average age of patients with intramedullary, intramedullary+extramedullary, and extramedullary hemangioblastoma was 34.0, 64.4, and 67.5 years, respectively. Patients in the intramedullary hemangioblastoma group were younger than the other groups. Extramedullary cases had a smaller syrinx compared to the other groups.ConclusionsAge may play an important role in the hemangioblastoma tumor location and the subsequent diagnosis by an MRI

Extramedullary Myxopapillary Ependymoma of the Filum Terminale Associated With Syringomyelia: A case report

Aim: Ependymomas compose the majority of all intradural intramedullary spinal lesions. Filum terminale lesions are rarely associated with syringomyelia. Here we describe a case of extramedullary myxopapillary ependymoma associated with extensive syringomyelia located in the filum terminale.Material and Methods: A 34-year-old man admitted to our clinic with complaints of bilateral leg weakness, back pain and urinary dysfunction. The magnetic resonance imaging (MRI) of the patient showed us a contrast enhanced intraspinal mass at the level of L2 with a syringomyelia extending from L2 level to Th7 level.Results: The patient was operated via lumbar laminoplasty and tumor was totally resected.Conclusion: The removal of tumor is also sufficient for the resolution of syringomyelia and no additional procedure is essential for the treatment of syringomyelia in such cases. This is the first case of extramedullary tumors of the cauda equine with extensive syringomyelia