Primary spinal leptomeningeal gliomatosis presenting visual disturbance as the initial symptom: Case report

Summary We report a case of diffuse leptomeningeal gliomatosis which spread from the cervical to the sacral spine. A 60-year-old man was admitted with visual disturbance due to papilledema. Magnetic resonance imaging revealed holocord leptomeningeal gliomatosis without a definite intraparenchymal lesion, and the patient's neurological examination was unremarkable except for papilledema. Intracranial hypertension secondary to spinal tumor is well known but unusual, and the mechanism is still unclear. In our case, an elevated protein concentration of cerebrospinal fluid is suggested as the cause of intracranial hypertension.     

Atypical teratoid/rhabdoid tumour with leptomeningeal dissemination in an adult

Summary A 22-year-old man presented with a rare case of atypical teratoid/rhabdoid tumour (AT/RT). Magnetic resonance imaging showed a left cerebellar mass with leptomeningeal dissemination. Partial resection was performed. Histological examination revealed AT/RT. Postoperatively, whole neuraxis and local irradiation were performed. Three-drug chemotherapy with ifosfamide, cisplatin, and etoposide, and adjuvant intrathecal administration of methotrexate were repeated. Near complete response was achieved, and no tumour recurrence/progression has been noticed during the follow up of 24 months. Intensive radiochemotherapy can successfully control AT/RT, even with leptomeningeal dissemination.     

Symptomatic leptomeningeal metastases preceding other manifestations of occult primary brain tumors

Rarely, primary brain tumors may present with signs and symptoms due to diffuse multifocal leptomeningeal spread of tumor. These false localizing signs divert attention from the primary tumor, which remains relatively silent. The two patients reported here exemplify the confusing clinical pictures that may result.     

Leptomeningeal dissemination of malignant gliomas. Incidence,diagnosis and outcome

Summary To understand the clinicopathology features of leptomeningeal dissemination of malignant gliomas, a total of 157 consecutive patients treated between 1978 and 1989 were analysed. Twenty-two patients (14%) were judged to have dissemination. In 20 patients, the dissemination was diagnosed antemortem. Eleven patients had neurological deficits due to dissemination, whereas the other 9 without these had CT or myelographic evidence of dissemination. The peak incidence of dessemination was seen in the first and second decades of life. The mean age of 22 patients with dissemination was 31 years, significantly lower than that (44.5 years) of patients without dissemination. Fifteen patients developed dissemination within one year after diagnosis (early dissemination), 60% of them were less than 30 years of age. All patients with late dissemination (more than one year after diagnosis) underwent a second craniotomy for tumour removal before dissemination, while none of the 15 patients with early dissemination did. Survival after diagnosis in patients with dissemination was shorter, although statistically not significant, than that of patients without dissemination. Survival after dissemination was limited in all patients (mean 19 weeks, range 2–39 weeks). Immunohistochemical study revealed that the disseminated tumour expressed less glial fibrillary acidic protein than the primary tumour.Our results suggest that dissemination does not seem to result from extended survival of the patients, but may occur at any time in malignant gliomas. Some malignant gliomas, especially in younger patients, have a capability to acquire biological characteristics suitable for dissemination in the earlier stage of the disease.     

Spinal dissemination following operation on cerebral oligodendroglioma

Summary This paper concerns two cases of cerebral oligodendroglioma (intraventricular in one case, right temporal in the other), with spinal dissemination (cervical and upper thoracic respectively), manifested clinically 2 years and 14 months respectively after removal of the cerebral tumour. Anatomical examination confirmed the diagnosis of disseminated oligodendroglioma in the leptomeninges in both cases and also in the parenchyma in the second case.     

Pilomyxoid astrocytoma of the spinal cord in an adult

Summary  We report a 45-year old woman with a pilomyxoid astrocytoma (PMA) of the cervical spinal cord with a rapid clinical course and fatal outcome. Moreover, two family members of the patient were reported to have brainstem tumours with similar histopathological features. This may be the first report of familial PMAs. Correspondence: Dr. Ali Sajadi, MD, PhD, Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.     

Intraventricular and leptomeningeal dissemination of a pilocytic cerebellar astrocytoma in a child with a ventriculoperitoneal shunt: case report

Dissemination of a pilocytic cerebellar astrocytoma is a very rare occurrence. So far only eight cases have been reported in the literature and in only one of these cases had the tumour spread into the ventricles. We report a case of a child who presented with communicating hydrocephalus and a small cerebellar lesion. The patient was initially treated by a ventriculoperitoneal (VP) shunt and the lesion was followed-up. Two years later, intraventricular and leptomeningeal dissemination of the tumour which proved to be a pilocytic astrocytoma was documented. The role of the VP shunt in diverting metastasizing tumour cells into the ventricles is discussed.     

原发灶不明脊柱转移癌的诊断和手术治疗

目的探讨原发灶不明脊柱转移癌的诊断和手术治疗的临床疗效. 方法对46例原发灶不明脊柱转移癌进行回顾性分析,其中手术为主的综合治疗24例,非手术治疗22例.结果随访1～4年,手术患者1年存活率22.7%(5例),3年存活率9.1%(2例),4年内全部死亡,平均生存期为6.2个月.疼痛消失或缓解20例;6例不全瘫痪患者,术后神经功能1例完全恢复,2例部分恢复,3例无改变;完全瘫痪者则无一例恢复;14例无瘫痪患者术后3例发生截瘫,较同期无瘫痪未手术者的截瘫发生率低.结论原发灶不明脊柱转移癌预后差,手术为主的综合治疗能减轻或缓解疼痛、维持或改善神经功能、稳定脊柱,减少截瘫的发生,从而改善患者的生活质量.     

射频消融联合经皮椎体成形术治疗脊柱转移瘤

目的探讨射频消融(RFA)联合经皮椎体成形术(PVP)治疗脊柱转移瘤的临床疗效。方法将62例脊柱转移瘤患者按治疗方法不同分为对照组(行单纯PVP治疗,30例)和观察组(行RFA联合PVP治疗,32例)。比较两组疼痛VAS评分、ODI、KPS评分、骨水泥渗漏率。结果患者均获得随访,时间3~12个月。两组术后各时间点VAS评分、ODI、KPS评分均明显优于术前(P<0.05);术后7 d及1、3个月VAS评分及ODI观察组均明显低于对照组(P<0.05);骨水泥渗漏率观察组明显低于对照组(P<0.05)。结论RFA联合PVP较单纯PVP治疗脊柱转移瘤能更有效地缓解患者疼痛、减轻其功能障碍并降低骨水泥的渗漏率。     

经皮椎体成形术治疗脊柱转移癌

目的探讨经皮椎体成形术治疗脊柱转移癌的效果。方法对17例脊柱转移癌患者的共33个椎体进行椎体成形手术,观察其疗效及并发症。结果33个椎体均穿刺成功,每个椎体平均注入骨水泥3.5ml,4例发生渗漏,渗漏率为12.1%(4/33),术后患者疼痛迅速缓解,均恢复日常生活。结论椎体成形术是一种治疗脊柱转移癌的安全、有效的方法,止痛效果满意,可以明显提高患者的生活质量。     

Severe delayed diffuse cerebral vasospasm and cerebral infarctions following spinal subdural hemorrhage

Background. We report a rare case of severe delayed cerebral vasospasm with cerebral infarctions after spinal subdural hemorrhage.Case report. A 56-year-old woman presented with an acute onset of paraplegia. MR-imaging revealed an extensive intraspinal hemorrhage reaching from T1 to L1. The hematoma was evacuated via a T8-laminectomy. At the 7^th postoperative day the patient developed visual disturbances. MR-scanning revealed extensive infarctions and cerebral angiography showed severe diffuse vasospasms.Interpretation. This case demonstrates that cerebral vasospasm may be caused by a spinal subdural hemorrhage, supporting the hypothesis that cerebral vasospasm may be triggered by factors from a remote site and that a direct contact of blood clots with the vessel is not mandatory.     

Subarachnoid haemorrhage induced proliferation of leptomeningeal cells and deposition of extracellular matrices in the arachnoid granulations and subarachnoid space

Summary Subarachnoid haemorrhage (SAH) often leads to subarachnoid fibrosis and resultant normal pressure hydrocephalus; however, how subarachnoid fibrosis occurs is unknown. We examined the changes within arachnoid granulations (AGs) and the subarachnoid space (SAS) chronologically at the parasagittal region obtained from patients with SAH at autopsy and made comparison with controls by immunostaining for cytokeratin, specific marker for leptomeningeal cells and by the elastica Masson-Goldner methods. Within a week some AGs were torn, and many inflammatory cells filled the AGs and SAS. Cytokeratin positive cells were scarce. During the next two weeks cytokeratin positive cells increased. After three weeks, AGs and SAS were filled by dense deposits of extracellular matrices surrounded by multiple layers of leptomeningeal cells.     

Spinal metastases of cerebral glioma. Case report

We report a case of multiple spinal leptomeningeal metastases from an intracerebral glioblastoma and the original tumor having been an oligoastrocytoma (WHO II). Three time resection of this right frontal tumor with opening of the lateral ventricle preceded intraventricular spread. Diagnosis of spinal dissemination was based on the previous history and Gadolineum-DTPA enhanced MR.The diagnostic and therapeutic implications are discussed.     

Intramedullary spinal cord metastasis in breast cancer: clinical features, diagnosis, and therapeutic consideration

Intramedullary spinal cord metastases (ISCMs) are very rare, but can cause devastating complications from underlying breast cancer. We report the case of a woman with known metastatic breast cancer and progressive neurologic deterioration caused by an ISCM. The epidemiology, pathogenesis, clinical presentation, diagnostic considerations, and therapeutic options are discussed.     

经皮椎体后凸成形术治疗脊柱转移性肿瘤

目的探讨经皮椎体后凸成形术(PKP)治疗脊柱转移肿瘤的临床效果。方法应用PKP治疗脊柱转移肿瘤36例,共60个椎体。单个椎体注射骨水泥2.5～6(3.5±0.5)ml。术后行X线等影像学检查并评估临床效果。结果术后患者症状均减轻,其中1 h止痛5例,12 h后止痛22例,24 h后止痛9例。生活质量明显提高,无严重并发症发生。VAS评分由术前平均81分±3分降至术后平均20分±2分。随访3～41(28.5±0.8)个月,随访期内因肿瘤复发死亡12例;无PKP注射部位复发疼痛的病例。结论 PKP治疗脊柱转移肿瘤具有微创、迅捷、止痛效果满意等优点,是一种安全、有效的方法。     

跳跃性脊柱骨折并脊髓损伤的治疗

目的：探讨跳跃性脊柱骨折的诊断和治疗方法。方法 22例手术治疗12例,保守治疗10例,结果 漏诊率达22．7％,按Frankel功能分级,手术治疗和保守治疗脊髓功能均有恢复但差异不明显。结论 对该类损伤要明确受伤机制,仔细检查,以防漏诊。适当放宽手术指征,警惕其他脏器合并伤。