Exophytic ependymomas of the spinal cord

Summary Intramedullary ependymomas of the spinal cord with exophytic components are rare outside the filum or conus region. Two cases of combined intradural intramedullary and extramedullary ependymomas of the spinal cord are presented. At operation, the tumours proved to be primarily intramedullary but had a contiguous exophytic component that extruded either through a defect in the ventral pia to encase the anterior spinal artery in one patient, or through the dorsal root entry zone in the second patient. When removing intramedullary spinal tumours with an exophytic component, separate removal of the intramedullary and extramedullary components is recommended, rather than en bloc resection, to prevent possible injury to the vascular supply of the spinal cord.     

Multicentric gliomas of brain and spinal cord

The clinical and histopathological findings in a child suffering from both cerebral and spinal gliomas of differing histological types are described. There was a family history of von Recklinghausen's neurofibromatosis. The possibility of overlooking the symptoms and signs pointing to a spinal cord lesion in the presence of a known intracranial tumour is stressed.     

Progressive cystic degeneration of the spinal cord following spinal cord injury

From a group of 520 spinal cord injury patients treated at Rancho Los Amigos Hospital, two cases of progressive myelopathy secondary to cystic degeneration of the spinal cord have been identified. The cyst may dissect proximately to produce progressive neurologic deficit. Surgical treatment with shunting can allow stabilization and improvement with return of newly lost function.     

A study of spinal cord ischemia during aortic cross-clamp--evoked spinal cord potential and histological analysis of the spinal cord

The relationship between the evoked spinal cord potential (ESP) and the histological findings of the spinal cord after thoracic aortic cross-clamp was studied. Thoracic aorta was cross-clamped in 23 dogs and ESP was monitored before, during, and after cross-clamping. Incidence of paraplegia and histological findings were studied after the dogs recovered from the procedure. Aortic cross-clamp was maintained for 60 minutes in 20 dogs (Group A). And cross-clamp was released 10 minutes after the amplitude of ESP became lower than 20% of control in 3 dogs. (Group B). In group A, three types of ESP changes were detected; ESP became lower or lost during cross-clamping in type 1 response, ESP remained unchanged in type 2 response, and ESP returned after transient loss during cross-clamping in type 3 response. Four of five dogs with type 1, none of nine with type 2, two of five with type 3 response showed paraplegia. One of the dogs with type 2 response showed paraparesis. ESP could not detected in one dog, in which traumatic spinal cord injury during laminectomy caused paraplegia. In Group B, all dogs showed type 1 response and paraplegia. Characteristic histological finding of the spinal cords of the dogs with paraplegia was the ischemic necrosis mainly in the gray matter. Necrotic foci were limited in the posterior horn in mild, in the anterior and posterior horn in moderate changes. And neurons were lost in entire gray matter in severe histological changes. In the spinal cords of the dogs with spastic paraplegia, severe histological changes were limited in the lower lumbar region.(ABSTRACT TRUNCATED AT 250 WORDS)     

Experimental study on spinal cord monitoring--changes in spinal cord evoked potentials during vertical direction distraction of the spinal cord

Experiments were carried out on 18 adult dogs ranging from 9.0 to 11.5 kg. The dogs were intubated and anesthetized with Halothene oxygen, and then mounted on a stereotaxic spinal apparatus. Facetectomies and a discectomy between L1 and L2 vertebrae were performed readily to give traction force to the spinal cord. Spinal cord function was monitored by the first and second negative deflections (I and II, respectively) of the descending spinal cord evoked potentials (descending SCEP) elicited at T7 and recorded at L4 through bipolar catheter electrodes. Both of them were inserted at the midline of the dorsal epidural space. The study was conducted in two parts. In the first part, the cyclic distraction-release program was carried out until motor function was impaired. Distraction was increased in increments of 5 mm, each time maintained for 10 minutes and then totally released for 10 minutes. If neurological deficits in the hind limbs were confirmed by the wake-up test, which was performed every 10 minutes after distraction and release, the 10 minutes' release period was extended for a total period of 30 minutes. The first change in the experimental protocol was transient augmentation of the amplitude of the II deflection which was always observed on a slight distraction, while the I deflection did not change in its amplitude and latency. Each distraction produced a reversible slight reduction of the amplitudes with delay of latencies of the I and II deflections before motor disturbance occurred. However, at a certain traction level paraparesis accompanied by irreversible decrease of amplitudes and delay of latencies was observed, which was confirmed by the wake-up test. At this point, which was designated as the critical point, SCEPs were so time dependent that only a slight amplitude reduction was noted immediately after distraction, but it decreased quickly in a short time during this traction level. Histopathology and microangiography did not show any hemorrhage in the spinal cord of any of the specimens, although there were formation of perivascular space, rupture of a part of nerve fibers in the white matter and findings of acute degeneration in the grey matter. In the second part of this study, a small amount of distraction was introduced until the amplitude of the II deflection depicted transient augmentation, which had a mean amplitude of 167.8 per cent as compared to the control. This enhancement returned approximately to the normal value within 10 minutes by total release.(ABSTRACT TRUNCATED AT 400 WORDS)     

Oligodendrogliomas of the spinal cord

Summary The clinical, surgical, and pathological data from 35 published cases of oligodendroglioma and of one personal case are analysed and compared with those from other tumours of the cord and from cerebral oligodendrogliomas. Oligodendroglioma of the cord has a slightly lower average age than other gliomas and is closer to that of glioblastoma. In oligodendroglioma of the cord, as of the brain, acute onset or aggravation of the symptoms and an oscillating course are frequent. Two correlated data are particularly worth noting: a) the mean CSF protein content in oligodendroglioma of the cord is higher than in any other glioma; b) intracranial hypertension, in the form of papilloedema or hydrocephalus, or both, was present in 31% of cases. This signifies cerebral oligodendrogliomatosis, which was found in 6 out of 10 necropsied cases. At operation most oligodendrogliomas of the cord appear as infiltrating gelatinous tumours, though a minority have a firm consistency and apparently clearcut contours, which seem to be associated with a better prognosis. Postoperative radiotherapy seems to be useful.     

Ganglioneuroma of the spinal cord

This report describes a 2-year-old boy who harbored an intramedullary ganglioneuroma involving almost the entire length of the spinal cord. The terminology, pathology, and neurobiological behavior of this tumor is discussed.     

Schistosomiasis of the spinal cord

Involvement of the central nervous system is a rare complication of schistosomiasis. A case is reported which manifested as a granulomatous, transverse myelitis in a 13-month-old child. Removal of the granuloma resulted in return of motor function.