Spinalni epiduralni hemangiom pješčanog sata: jednokratna 2-stupanjska posteriorna mikrokiruška i transtorakalna endoskopska resekcija - prikaz slučaja i pregled literature

Spinal dumbbell tumors are defined by a narrowing at the point where they penetrate the intervertebral foramina or dura mater, assuming an hourglass or dumbbell shape. Dumbbell-shaped spinal hemangiomas are extremely rare. We describe a dumbbell spinal tumor (epidural cavernous hemangioma) resected by a 2-stage single-sitting combined approach. We also conduct a substantial literature review of the subject. We present a case of a 78-year-old male who was found to have a homogeneously enhancing, dumbbell-shaped, intraspinal, extradural tumor mass extending into the left chest cavity. The tumor was resected with a single-sitting 2-stage posterior technique: a microsurgical approach, followed by endoscopic resection via a thoracoscopic approach. There are several reports in the literature on the combined approach for dumbbell tumors of the spinal cord. Our case is the first to describe 2-stage combined surgery in 1 sitting for dumbbell hemangioma with the patient in the lateral decubitus position for the thoracoscopic part of the surgery; and the use of a fat pad, which was applied in the neuroforamen via the posterior route, as a marker for resection during the transthoracic procedure.Spinalni tumori pješčanog sata definirani su suženjem na mjestu gdje prodiru u intervertebralni foramen ili dura mater, uz pretpostavku da imaju oblik pješčanog sata ili bućice. Spinalni hemangiomi u obliku bućice su iznimno rijetki. Opisuje se spinalni tumor pješčanog sata (epiduralni kavernozni hemangiom) reseciran dvostupanjskim kombiniranim pristupom, uz opsežan pregled literature. Prikazuje se slučaj 78-godišnjeg muškarca za kojeg je utvrđeno da ima homogeno pojačanu intraspinalnu, ekstraduralnu masu u obliku bućice koja se širi u lijevu prsnu šupljinu. Tumor je reseciran jednokratnom 2-stupanjskom posteriornom tehnikom: mikrokirurški pristup, nakon čega slijedi endoskopska resekcija putem torakoskopskog pristupa. U literaturi postoji nekoliko izvješća o kombiniranom pristupu za tumore bućice kralježnične moždine. Naš je slučaj prvi koji opisuje 2-stupanjsku kombiniranu kirurgiju u 1 sjedenju za hemangiom pješčanog sata u bolesnika u lateralnom dekubitusnom položaju za torakoskopski dio operacije; i uporabu masnog jastučića koji je primijenjen u neuroforamenu preko stražnjeg puta, kao marker za resekciju tijekom transtorakalnog postupka

Glioma - Contemporary Diagnostic and Therapeutic Approaches

The past three decades have been marked with huge enthusiasm from scientists and professionals in an effort to find a cure for glioma disease. Methods to confirm the kinds and grades of glioma have taken a path from classical macro- to microscopic pathohystological confirmation of tumors, through morphological-histological, molecular, and genetic diagnosis. Surgically, progress was made possible with the development and use of technological aids, for example neuronavigation, cortical mapping, electrocorticography, neuromonitoring, functional and intraoperative MRI, magnetoencephalography, etc. Great hope was placed on the extension of tumor resection and popular supratotal resection. Significant progress has been made generally in glioma treatment with the use of modern radiotherapy and new chemotherapeutics. What do we want to see for the future? By way of stem cells, a specific medicine will be produced, individualized for the particular patient, and by using a microcapsule it will be implanted into the brain zone affected by the tumor by way of robot surgery and injection needle. This is not at all an unrealistic expectation in the next decade or two

Association of Increased Body Mass Index with Chiari Malformation Type I and Syrinx Formation in Adults

OBJECT: In this paper the authors describe an association between increased body mass index (BMI) and Chiari malformation Type I (CM-I) in adults, as well as its relationship to the development of syringomyelia. METHODS: In the period between January 2004 and December 2011, the senior author reviewed the data for all CM-I patients with or without syringomyelia and neurological deficit. Analyzed factors included clinical status (headaches and neurological signs), radiological characteristics of syringomyelia (diameter and vertical extent of syrinx), BMI, and relationship of age to BMI, syrinx diameter, and vertical extent of syrinx. RESULTS: Sixty consecutive adults had CM-I, 26 of whom also had syringomyelia. The mean BMI among all patients was 30.35 ± 7.65, which is Class I obesity (WHO), and was similar among patients with or without syringomyelia. Extension of the vertical syrinx was greater in overweight patients (p = 0.027) than in those with a normal body weight. Evidence of de novo syrinx formation was found in 2 patients who gained an average BMI of 10.8 points. After repeated decompression and no change in holocord syrinx width or vertical extent, a reduction in the syrinx was seen after BMI decreased 11.7 points in one individual. No correlation was found between patient age and BMI, age and vertical extension of the syrinx, and age and diameter of the syrinx. CONCLUSIONS: An association between increased BMI and CM-I in adults was recognized. Gaining weight may influence the de novo creation of a syrinx in adults who previously had minimally symptomatic or asymptomatic CM-I, and reducing weight can improve a syrinx after unsuccessful surgical decompression. Therefore, a reduction in body weight should be recommended for all overweight and obese patients with CM-I

Cerebellar Glioblastoma Multiforme Presenting as Hypertensive Cerebellar Hemorrhage: Case Report

Background: Cerebellar glioblastoma multiforme (GBM) is rare and presents with increased intracranial pressure and cerebellar signs. The recommended treatment is radical resection, if possible, with radiation and chemotherapy. Clinical Presentation A 53-year-old man presented with hypertensive cerebellar bleeding and a 2-day history of severe headaches, nausea, vomiting, gait instability, and elevated blood pressure. Computed tomography (CT) showed a left cerebellar hematoma with no obstruction of cerebrospinal fluid and no hydrocephalus. CT angiography showed no signs of pathologic blood vessels in the posterior cranial fossa. The patient was observed in the hospital and discharged. Subsequent CT showed complete hematoma resorption. Two weeks later, he developed headaches, nausea, and worsening cerebellar symptoms. Magnetic resonance imaging (MRI) showed a 4-cm diameter tumor in the left cerebellar hemisphere where the hemorrhage was located. The tumor was radically resected and diagnosed as GBM. The patient underwent radiation and chemotherapy. At a follow-up of 1.5 years, MRIs showed no tumor recurrence. Conclusion Hypertensive cerebellar hemorrhage may be the first presentation of underlying tumor, specifically GBM. Patients undergoing surgery for cerebellar hemorrhage should have clot specimens sent for histologic examination and have pre- and postcontrast MRIs. Patients not undergoing surgery should have MRIs done after hematoma resolution to rule out underlying tumor

Cerebellar Glioblastoma Multiforme Presenting as Hypertensive Cerebellar Hemorrhage: Case Report

Background Cerebellar glioblastoma multiforme (GBM) is rare and presents with increased intracranial pressure and cerebellar signs. The recommended treatment is radical resection, if possible, with radiation and chemotherapy. Clinical Presentation A 53-year-old man presented with hypertensive cerebellar bleeding and a 2-day history of severe headaches, nausea, vomiting, gait instability, and elevated blood pressure. Computed tomography (CT) showed a left cerebellar hematoma with no obstruction of cerebrospinal fluid and no hydrocephalus. CT angiography showed no signs of pathologic blood vessels in the posterior cranial fossa. The patient was observed in the hospital and discharged. Subsequent CT showed complete hematoma resorption. Two weeks later, he developed headaches, nausea, and worsening cerebellar symptoms. Magnetic resonance imaging (MRI) showed a 4-cm diameter tumor in the left cerebellar hemisphere where the hemorrhage was located. The tumor was radically resected and diagnosed as GBM. The patient underwent radiation and chemotherapy. At a follow-up of 1.5 years, MRIs showed no tumor recurrence. Conclusion Hypertensive cerebellar hemorrhage may be the first presentation of underlying tumor, specifically GBM. Patients undergoing surgery for cerebellar hemorrhage should have clot specimens sent for histologic examination and have pre- and postcontrast MRIs. Patients not undergoing surgery should have MRIs done after hematoma resolution to rule out underlying tumor

Astrocitom kralježničke moždine niskog stupnja malignosti u odraslih: prikaz osobne serije bolesnika i pregled literature

Astrocytoma is the second most common intramedullary tumor of predominantly low-grade malignancy in adult patients. Adult astrocytomas have better-quality prognosis compared with astrocytomas in children. Although a standardized surgical management protocol for spinal cord glioma is currently unavailable, surgery of low-grade astrocytoma should be aimed at gross total resection to preserve neurological function and to improve the outcome. Herein, we present a personal case series of four consecutive adult spinal cord astrocytoma patients who were operated on during the last few years. Tumor resection was performed in all patients utilizing microsurgical technique and intraoperative neurophysiologic monitoring. We also provide a literature review of the treatment of intramedullary astrocytoma in adults and discuss contemporary surgical management and prognosis.Astrocitom kralježničke moždine je tumor pretežito niskog stupnja malignosti koji je po učestalosti drugi intramedularni tumor u odraslih u kojih je njegova prognoza znatno povoljnija u usporedbi s prognozom u djece. Unatoč tomu što standardizirani protokol za kirurško liječenje gliomskih tumora kralježničke moždine zasad ne postoji, cilj ovakvog liječenja trebao bi biti usmjeren ka uklanjanju tumora u cijelosti kako bi se očuvala neurološka funkcionalnost i poboljšala uspješnost liječenja. U ovom radu dajemo prikaz osobne serije tijekom nekoliko posljednjih godina susljedno operiranih četvero odraslih bolesnika s astrocitomom kralježničke moždine u kojih je tumor mikrokirurški uklonjen uz pomoć intraoperacijskog neurofiziološkog praćenja. U radu također donosimo pregled literature o liječenju intramedularnih astrocitoma u odraslih, raspravljajući o suvremenom kirurškom liječenju ovakvih tumora i prognozi bolesti

Cerebellar Glioblastoma Multiforme Presenting as Hypertensive Cerebellar Hemorrhage: Case Report

Background: Cerebellar glioblastoma multiforme (GBM) is rare and presents with increased intracranial pressure and cerebellar signs. The recommended treatment is radical resection, if possible, with radiation and chemotherapy. Clinical Presentation A 53-year-old man presented with hypertensive cerebellar bleeding and a 2-day history of severe headaches, nausea, vomiting, gait instability, and elevated blood pressure. Computed tomography (CT) showed a left cerebellar hematoma with no obstruction of cerebrospinal fluid and no hydrocephalus. CT angiography showed no signs of pathologic blood vessels in the posterior cranial fossa. The patient was observed in the hospital and discharged. Subsequent CT showed complete hematoma resorption. Two weeks later, he developed headaches, nausea, and worsening cerebellar symptoms. Magnetic resonance imaging (MRI) showed a 4-cm diameter tumor in the left cerebellar hemisphere where the hemorrhage was located. The tumor was radically resected and diagnosed as GBM. The patient underwent radiation and chemotherapy. At a follow-up of 1.5 years, MRIs showed no tumor recurrence. Conclusion Hypertensive cerebellar hemorrhage may be the first presentation of underlying tumor, specifically GBM. Patients undergoing surgery for cerebellar hemorrhage should have clot specimens sent for histologic examination and have pre- and postcontrast MRIs. Patients not undergoing surgery should have MRIs done after hematoma resolution to rule out underlying tumor

Anterior Cervical Discectomy with Instrumented Allograft Fusion: Lordosis Restoration and Comparison of Functional Outcomes among Patients of Different age Groups

OBJECTIVE: To investigate clinical parameters of anterior cervical discectomy and fusion (ACDF) treatment and outcomes using osseous allografts in different age groups, study the postoperative results of restoration of lordosis, and evaluate the utility of bone allografts for ACDF, including graft subsidence. METHODS: We reviewed data from 154 patients with clinical symptoms and radiologic signs of disc herniation and/or cervical spondylosis. Decompression was achieved through discectomy, osteophyte ablation, endplate drilling, and foraminotomy. Fusion was achieved with allografts, demineralized bone matrix, and cervical plates/screws. The relationships between preoperative and postoperative cervical spine configuration (ie, Benzel’s criteria), pain intensity, and neurologic status were analyzed. RESULTS: The mean patient age was 51 years, and the median duration of symptoms was 6 months. The mean age differed significantly between the patients with diabetes and those without diabetes. The mean body mass index (BMI) was 30.36. Fifty-two patients had disc herniation, and 102 had spondylosis. Surgery was performed on a total of 313 levels. The median duration of follow-up was 24 months. Marked improvements in postoperative spine configuration or preservation of lordosis were recorded. Overall, 122 patients were neurologically intact, and 32 patients experienced residual postsurgery neurologic deficits (minor, n [ 22; moderate, n [ 9; severe, n [ 1). Postoperative pain intensity and neurologic status were significantly improved. Outcomes were excellent in 66 patients, good in 61, fair in 24, and poor in 3 (no mortality). No significant differences in patient age, smoking habits, diabetes, or BMI were seen among outcomes, or between patients with soft disc herniation or spondylosis. CONCLUSIONS: Osseous allografting can excellently restore cervical lordosis regardless of age and is an excellent graft choice for ACDF. Patients of advanced age with comorbidities should not be denied surgery

Spinal Dumbbell Epidural Hemangioma: Two Stage/Same Sitting/Same Position Posterior Microsurgical and Transthoracic Endoscopic Resection – Case Report and Review of the Literature

Spinal dumbbell tumors are defined by a narrowing at the point where they penetrate the intervertebral foramina or dura mater, assuming an hourglass or dumbbell shape. Dumbbell-shaped spinal hemangiomas are extremely rare. We describe a dumbbell spinal tumor (epidural cavernous hemangioma) resected by a 2-stage single-sitting combined approach. We also conduct a substantial literature review of the subject. We present a case of a 78-year-old male who was found to have a homogeneously enhancing, dumbbell-shaped, intraspinal, extradural tumor mass extending into the left chest cavity. The tumor was resected with a single-sitting 2-stage posterior technique: a microsurgical approach, followed by endoscopic resection via a thoracoscopic approach. There are several reports in the literature on the combined approach for dumbbell tumors of the spinal cord. Our case is the first to describe 2-stage combined surgery in 1 sitting for dumbbell hemangioma with the patient in the lateral decubitus position for the thoracoscopic part of the surgery; and the use of a fat pad, which was applied in the neuroforamen via the posterior route, as a marker for resection during the transthoracic procedure