Chronic posttraumatic lumbar intradural arachnoid cyst with cauda equina compression: case report

An unusual case of a chronic posttraumatic lumbar intradural arachnoid cyst causing compression of the cauda equina is reported. The etiological, pathological, and clinical features are discussed. Emphasis is placed on the importance of a correct interpretation of radiological findings.     

马尾神经吻合治疗截瘫的应用解剖学研究

目的：观察马尾神经的形态特征，为胸腰椎骨折脱位所致截瘫患者的神经根吻合术提供解剖学依据。方法：取24具成人脊柱标本，暴露T11节段以下脊髓神经根，观察马尾神经的形态特征：测量T11～S3各神经根穿出相应脊髓节的中点与不同损伤平面（T11、T12椎体下缘平面）之间的距离；观察脊髓圆锥下极位置变异情况。结果：马尾神经根的排列位置很有规律，各神经根可以辨别。T11、T12椎体下缘平面以上可利用的神经根分别主要为T11～L1、T11～L4神经根，损伤平面以上可利用的神经根数目与损伤平面高低呈负相关．与脊髓圆锥位置高低呈正相关。结论：损伤平面以上有一些残存的神经根可供利用，椎管内神经根吻合需考虑损伤平面高低与脊髓圆锥下极位置的关系。     

Nerve fibre counts for an intercostal nerve to cauda equina nerve root anastomosis

Mean nerve root diameters of thoracal, lumbal and sacral roots have been determined and the corresponding cross section areas calculated. The myelinated axons of these roots have been counted and the axon densities calculated. The myelinated axons of 3 lower intercostal nerves have also been counted. One intercostal nerve has with about 9,000 myelinated fibres enough axons for the regeneration of the ventral (3,000) and dorsal (16,000) myelinated fibres of the sacral roots 3 and 4 together. One intercostal has enough nerve fibres to reconstruct urinary bladder and bowel function on one side. The importance of performing a nerve anastomosis which considers functional aspects has been emphasized.     

Redundant nerve roots of the cauda equina

Summary Two cases of redundant nerve roots syndrome are presented. Both cases displayed coiled and elongated nerve roots of cauda equina, associated with proliferated fibrous tissue on the ligamentum flavum or with spondylosis and disc protrusion compressing the caudal dural sac. The pathogenesis of the syndrome of redundant nerve roots is briefly discussed.     

Redundant nerve roots of the cauda equina

Summary One further case of redundant nerve roots of the cauda equina is described, and a review of eleven comparable cases in the literature is provided. In the authors' opinion, this disease appears to be a congenital anomaly, frequently but not necessarily associated with spinal changes.     

Redundant nerve roots of the cauda equina

Summary Five personally examined cases of redundant nerve roots of the cauda equina are added to the 13 hitherto on record. Except for segmental neurological deficits, intermittent claudication-like symptoms of the cauda equina dominated the histories of four of our five cases. The diagnosis was confirmed at surgical exploration, which included laminal and dural decompression. At follow-up (two months-three years) the neurological deficit, or the intermittent claudication, or both, had improved in all our patients. The pathogenesis of root redundancy is obscure. It seems that the symptoms arise through the action of at least two factorsviz compression of the spinal content and the existence of one or more redundant roots. Wider use of diagnostic aids and surgical exploration would probably show that redundant roots are more common than hitherto supposed.     

Redundant nerve roots of the cauda equina

Four cases of redundant nerve roots of the cauda equina are reported, and the pertinent literature is reviewed. This disorder mainly affects males. The clinical history ranges from months to decades. The illness often starts with low back pain or sciatica, or both. Motor and sensory impairment of the legs dominate the further course of the disease. Serpentine filling defects in the column of contrast are a characteristic (but inconstant) feature on myelograms. Abatement of signs and symptoms occurs following adequate decompression of the redundant roots.     

Nitric oxide induced ectopic firing in a lumbar nerve root with cauda equina compression

Nitric oxide is thought to be involved in the pathophysiology of radiculopathy attributable to herniated intervertebral disc, but its effect on ectopic firing, which is the main source of sciatica, has not been investigated. The authors investigated whether ectopic firing is elicited when the lumbar nerve root is exposed to nitric oxide using rats with and without cauda equina compression. A group of animals had partial L3 laminectomy, and a silicone tube was inserted in the epidural space to compress the cauda equina. A sham operation group and nontreated control group also were prepared. Seven days later, ectopic firing of the nerve root was recorded from the sural nerve. The animals with cauda equina compression showed significantly higher spontaneous firing rates than other groups. After a lumbar epidural administration of sodium nitroprusside, only the animals with cauda equina compression showed a marked increase in the firing rate. These results showed that the nerve roots became hyperexcitable under compression as indicated by increased spontaneous firing and marked sensitivity to nitric oxide. This mechanism may play an important role in the development of sciatica.     

Intradural cyst with compression of the cauda equina in ankylosing spondylitis

A cauda equina syndrome complicating long-standing ankylosing spondylitis was found to be due to a large multiloculated cyst. This differed from posterior dural diverticula identified in similar cases in that the cyst filled the lumbar canal with erosion of the upper lumbar vertebral bodies and chronic inflammatory changes were evident in the cyst wall. Cauda equina compromise in ankylosing spondylitis has several possible mechanisms including fibrosis following arachnoiditis, root damage by dural diverticula, and direct compression by arachnoid cyst.     

Microsurgery for intradural epidermoid cyst at cauda equina level in a 9-year-old child: A case report

Introduction and importanceEpidermoid cysts are rare benign tumors. Here, we present a case of spontaneous intradural epidermoid cyst at cauda equina level in a 9-year-old patient, which we believed the first case to be reported in Vietnam.Case presentationA 9-year-old boy presented with 4 months of spontaneous left lower extremity muscle weakness and paresthesia. The MRI images suggested the diagnosis of intradural epidermoid cyst at cauda equina level. The patient underwent L5–S1 laminectomy and durotomy for tumor resection. The histology confirmed the diagnosis of epidermoid cyst. Post-operative images demonstrated total cyst removal.Clinical discussionThe epidermiology, presentation and diagnosis and strategy of treatments as well as their outcomes were discussed.ConclusionDiagnosis of spinal epidermoid cyst is often delayed for its obscure presentation. Microsurgical dissection along with intra-operative mobile C-Arms enable total tumor resection while preserving spinal stability and neurological function. Follow-up with post-operative magnetic resonance imaging and tumor marker are helpful.     

Treatment strategies of space-occupying intradural metastases of the cauda equina of nonneurogenic origin

Background  Compressive intradural metastases of the cauda equina are a rare site of metastatic spread in systemic cancer. So far, only few reports have been published with conflicting statements concerning a surgical versus nonsurgical approach. Method  Five patients with symptomatic space-occupying intradural metastases of the cauda equina were analyzed retrospectively, focusing on the influence of surgical intervention on pain relief, neurological outcome and thus the patients’ quality of life. Findings  At the time of diagnosis, all patients were in an advanced metastatic state. Surgical resection was the primary treatment in four patients and radiotherapy in one. Despite infiltration of the cauda rootlets, gross total tumour resection could be achieved in two of the four patients treated surgically. Functional outcome was beneficial in these patients with marked and immediate relief of pain and improvement of motor function even following incomplete tumour resection. Conclusions  Surgical treatment of compressive intradural metastases of the cauda equina seems to be feasible with low operative risk and with the potential benefit of an immediate relief of pain and improvement in motor function and thus an increase in quality of life.     

Primary cauda equina epidermoid cyst. A case report

A primary epidermoid cyst of the cauda equina was diagnosed in an eleven-year-old boy. The patient had a previous two months history of lumbar pain with unilateral L 4 radicular pain. The diagnosis of an epidermoid cyst of the cauda equina, suspected by MRI, was confirmed by histology following surgery. Wide tumor resection, as complete as possible, was performed with minimum trauma. Presence of an epidermoid cyst in the filum terminale is a rare finding, few cases have been reported in the literature. However, surgical treatment and favorable post-operative course are similar to that observed in intraspinal localizations. MRI is helpful for the preoperative and differential diagnosis and for post-operative follow-up.