Intramedullary epidermoid cyst: preoperative diagnosis and surgical management after MRI introduction. Case report and updating of the literature.

Many patients with spinal tumours of developmental origin do not receive preoperative diagnosis and the surgical management, especially as for capsule resection, is often unplanned. Like other uncommon tumours, the intramedullary epidermoid cyst is often an operative or histological finding. Since magnetic resonance imaging (MRI) introduction, evidence has accumulated that they may be preoperatively suspected. In reporting the case of a young patient with a T3-T4 intramedullary epidermoid cyst, the authors present an overview of the clinical, radiological and surgical aspects of such tumors and review the latest literature in which MRI and microsurgical excision were performed. Despite the introduction of new diagnostic and surgical instrumentation, the preoperative diagnosis and surgical management of such tumours need further discussion

Epidemiologic and Economic Burden Attributable to First Spinal Fusion Surgery: Analysis From An Administrative Database

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Acute brainstem dissection of syringomyelia associated with cervical intramedullary neurinoma.

Abstract Intramedullary tumors and syringomyelia typically present with slowly progressing deficits. More rarely, they are characterized by acute presentation or worsening, at timesmimicking othermore common etiologies. The acute onset of syringomyelia is most likely attributable to an acute increase in cerebrospinal fluid and epidural venous pressure that results in impulsive fluid movement and, ultimately, in the rupture of the syrinx and dissection into the spinal cord or brainstem. Reported here is a case of acute presentation of a small cervical intramedullary neurinoma due to the upward dissection of its associated syrinx. Critical questions are: (1) how can a small tumor produce a large syrinx? and (2) in the absence of craniospinal interferences, which mechanismunderlies the acute expansion of the cavity, resulting in a rapid onset? The authors examined the pathophysiology of syrinx formation and enlargement in intramedullary tumors and reviewed the literature, emphasizing the relationship between spinal cordmovements and intramedullary pressure. On the basis of current pathogenetic concepts, the authors concluded that tumor-related syringomyelia might be caused by an association of mechanisms, both from within (obstruction of perivascular spaces; increase in extracellular fluid viscosity due to the tumor itself; intramedullary pressure gradients among different cord levels and between the cord and the subarachnoid space) and from without (the cerebrospinal fluid entering the tissue). All these factors may be amplified, as in the reported case, by a tumor located dorsally at the cervical level.Abnormal postures of the spine, such as a prolonged and excessive flexed neck position,may ultimately contribute to the acute dissection of the syrinx. Keywords Acute presentation . Intramedullary neurinoma . Intramedullary tumors . Syringobulbia . Syringomyeli

Epidermoid and dermoid tumors

The authors report their experience in the surgical treatment of intracranial dermoid and epidermoid tumors. These lesions are rare but may, in most of the occasions, be completely resected allowing a complete cure of the patient. The usefulness of the most recent diagnostic tools is discussed and the surgical indications, complications and results are reviewed in comparison to the most significant literature reports

Upper cervical spine fracture : treatment options

Program BooK pag 2

Cervical spine biomechanics following implantation of a disc prosthesis

This study presents a finite element model of the C4-C7 segment in healthy conditions and after implantation of a disc prosthesis at a single level, in order to investigate of the influence of disc arthroplasty on the biomechanics of the cervical spine. A nonlinear finite element model of the C4-C7 segment in intact conditions was developed and run in flexion and extension. A detailed model of the Bryan disc prosthesis, including contacts between the different components of the device, was built and positioned at C5-C6. The calculated segmental motion resulted preserved after disc arthroplasty, with respect to the model of the intact spine, in both flexion and extension. A general preservation of the forces transmitted through the facet joints was obtained; a minor force increase at the implanted level was detected. The analysis of the instantaneous centers of rotation (ICR) in flexion-extension showed the preservation of a physiological kinematics. The mechanical behaviour showed an asymmetry between flexion and extension, probably due to the removal of the anterior longitudinal ligament and the anterior part of the annulus fibrosus, and the preservation of the posterior structures. In general, the disc prosthesis showed to be able to reproduce a nearly physiological motion. However, other important mechanical aspects, such as the possible micromotion at the bone-implant interface and the possible degenerative conditions of the spine, need to be evaluated before drawing a conclusion about total disc arthroplasty from an engineering point of view