Spinal arteriovenous fistulae with a concomitant cauda equina schwannoma.

BACKGROUND: Perimedullary spinal arteriovenous malformations or direct spinal arteriovenous fistulaes (AVFs) may be associated with other vascular abnormalities, such as arteriovenous malformations, venous ectasis, and aneurysms, but rarely have been reported with intraspinal intradural tumors. PURPOSE: The authors present an interesting case of type IV-A spinal AVF concomitant with a cauda equina schwannoma. STUDY DESIGN: The diagnostic procedures and surgical outcome were described. METHODS: The patient underwent surgery, the vessel feeding the AVFs was identified and cauterized, and the spinal tumor was removed. The fistula was small and located inside the tumor. The pathology revealed AVF and schwannoma, respectively. RESULTS: After surgery, the patient's symptoms began to improve and subside. Two years after surgery, follow-up magnetic resonance imaging showed no vascular lesion and tumor in the spinal canal. CONCLUSIONS: The association of spinal AVFs and cauda equina schwannoma has not been reported previously in any literature. The patient presents the symptoms of myelopathy associated with a spinal vascular lesion; it has to be noted that a concomitant and related intradural spinal tumor may exist.     

Spinal subarachnoid hemorrhage due to neurinoma of the cauda equina

A case of neurinoma of the cauda equina which showed spinal subarachnoid hemorrhage was reported. A 39-year-old man was admitted to our hospital because of left lumboischialgia, on August 7, 1987. Myelography disclosed a round mass at L2, and cerebrospinal fluid was slightly xanthochromic. MRI demonstrated a round isointensity mass by T1 weighted image, and slightly high intensity by T2 weighted image. On August 26, 1987, the patient developed sudden onset of headache, but his headache disappeared under medication. On August 27, 1987, laminectomy L1-3 and total removal of the tumor were carried out. At operation, marked subarachnoid hemorrhage was discovered. He was discharged with slight hypesthesia of the dermatome of left S2.     

Spinal subarachnoid hemorrhage attributable to schwannoma of the cauda equina

BACKGROUND: Cauda equina syndrome occurring as a result of spontaneous spinal subarachnoid hemorrhage (SAH) from a spinal tumor is reported to be rare. CASE DESCRIPTION: A 28-year-old woman presented at our clinic with a history of severe back pain for 10 days, progressive paraparesis, and urinary retention. Her physical examination revealed a mass located intradurally at the level of L1-2 and a massive SAH. An L1-L2, laminectomy and a hemilaminectomy from D9 to D12 were performed and the SAH was evacuated and the cord was decompressed. CONCLUSION: At the first year follow-up, her restricted dorsal and plantar flexion continued. Post-gadolinium magnetic resonance imaging revealed no mass.     

Spinal subarachnoid haematoma after stab injury of the cauda equina

An unusual case of an anterior stab injury, involving the cauda equina, with a progressive neurological deterioration is presented. Myelography showed a filling defect and surgery revealed a subarachnoid clot. Good recovery followed removal of the clot.     

Claudication of the cauda equina.

The term "claudication of the cauda equina" is examined. It has arisen from semantic errors, and a belief in ischaemia for which there is no scientific evidence. Its use tends to hamper rather than assist the investigation of patients with obscure pain in the lower limb. A preferable alternative term, "atypical sciatica", is suggested.     

Spinal cord and cauda equina compression in 2 patients with beta-thalassemia intermedia

Spinal cord compression as a consequence of mass lesions due to extramedullary hematopoiesis is a well described but rare syndrome occurring in thalassemia and some other hematologic conditions. The authors report two cases of patients with a genetic variant of beta-thalassemia, who suffered from a progressive compression of the spinal cord in one case, of the cauda equina in the other caused by epidural hematopoietic tissue. The first patient recovered after partial surgical removal of this tissue and subsequent radiotherapy. The second one recovered after only radiotherapy.     

Intradural cauda equina schwannoma

Intradural schwannoma is an uncommon tumor, especially in the cauda equina. The value of postmyelographic computed tomography is discussed in this case.     

A giant schwannoma of cauda equina.

A case of giant schwannoma occurring in a woman 23 years of age with deformity of the foot developing at the age of five years is reported. The gross radiological changes of increased interpedicular distance and erosion of the posterior surface of the vertebra suggested the massive size of the tumour (6' x 21/2' x 11/2'). Successful surgical excision of such a large size schwannoma has not been reported previously.     

Cystic lymphangiomas of the cauda equina.

BACKGROUND CONTEXT: Lymphangiomas, benign hamartomatous lesions of the lymph tissue, result from a failure of lymph channels to communicate with the venous system or normal lymph channels. Previously, two reports described lymphangiomas arising in the peripheral nerve (ulnar nerve and posterior tibial nerve). PURPOSE: To report a rare case of cystic lymphangiomas of the cauda equina not previously reported. STUDY DESIGN: Case report. PATIENT SAMPLE: A 56-year-old Japanese man. METHODS: Not applicable. RESULT: The patient recovered from most of his symptoms after tumor extirpation. He had no symptoms at a 5.8-year follow-up. CONCLUSIONS: We believe this is the first case report of lymphangiomas originating from the cauda equina, which was effectively treated by surgery.     

Spinal hemangioblastoma of cauda equina origin not associated with von Hippel-Lindau syndrome--case report

A 50-year-old male presented with a rare case of hemangioblastoma of cauda equina origin, without clinical signs of von Hippel-Lindau syndrome, manifesting as pain radiating from the back to the left thigh. Magnetic resonance imaging before surgery revealed an intradural spinal tumor at the L3-L4 levels with serpentine flow voids of tortuous and convoluted vessels, which appeared to be continuous with the left L5 nerve root. Surgical removal of the tumor was successfully accomplished via the posterior unilateral approach, and the histological diagnosis was hemangioblastoma. Clinical symptoms resolved dramatically after surgery, although the patient developed mild dysesthesia of the left L5 area early after surgery which was gradually improved late after surgery.     

A case of traumatic spinal subarachnoid hematoma causing compression of the cauda equina]

A case of traumatic spinal subarachnoid hematoma causing compression of the cauda equina is reported here. The patient, a 76 year-old woman, who had fallen down by accident 1 month before, was admitted to our hospital presenting lumbar pain radiating into her right thigh, monoplegia of the right leg and urinary incontinence. Myelography and metrizamide CT demonstrated a filling defect mimicking intradural extramedullary tumor at the level of L1 and L2. Magnetic resonance imagings (MRI) revealed a subacute or chronic hematoma compressing the conus medullaris and the cauda equina. Operation was performed and an old hematoma, which occupied most of the spinal subarachnoid space and compressed the conus and cauda equina from right to left, was removed. No definite bleeding point was detected and no traumatic change was seen on the cord. Neither tumor nor abnormal vessel was detected. After surgery, the symptoms improved partially. On a review of the literature, we found only 4 cases of traumatic spinal subarachnoid hematoma, all of which occupied the cervical or thoracic portion of the spine. Our case is the first report, except for the cases following lumbar spinal tap, of traumatic spinal subarachnoid hematoma causing compression of the cauda equina. Though usually blood in CSF diffuses immediately, a clot may be formed when a large amount of bleeding obstructs the spinal canal. In our case, furthermore, deformity and narrowing of the spinal canal had preceded for many years, following lumbar vertebral compressed fracture related with osteoporosis. This might have promoted the process of canal obstruction and clot formation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ganglioneuroblastoma of the cauda equina

A 39-year-old lady presented with low back pain and neurogenic claudication. Magnetic resonance imagining revealed an intradural neoplasm in the cauda equina region. The patient underwent lumbar laminectomy and total excision of the neoplasm. Biopsy showed it to be a ganglioneuroblastoma, which is rare in the spinal canal and so far does not appear to have been reported in the region of the cauda equina. Its management is discussed.     

Giant cauda equina schwannoma. A case report

STUDY DESIGN: Case report. OBJECTIVES: To present a rare case of a giant schwannoma of the cauda equina. SUMMARY OF BACKGROUND DATA: Giant spinal schwannoma of the cauda equina, which involves many nerve roots, is rare and there is usually no ossification in the schwannoma. It is unknown whether or not complete excision is preferable if the tumor is located in the lumbar lesion. METHODS: A 57-year-old woman had a 10-year history of low back pain. Scalloping of the posterior surface of the vertebral bodies from L3 to the sacrum was found. Magnetic resonance imaging disclosed a giant cauda equina tumor with multiple cysts. Central ossification revealed by computed tomography and an unusual myelogram made the preoperative diagnosis difficult. RESULTS: The patient underwent incomplete removal of the tumor, decompression of cysts, and spinal reconstruction. The tumor was proved to be a schwannoma. The postoperative course was uneventful and she has been almost free from low back pain for 3 years and 4 months. CONCLUSIONS: Giant schwannoma in the lumbar spine region is usually excised incompletely, because complete removal had the risk of sacrificing many nerve roots. In spite of the incomplete removal of the tumor, the risk of recurrence is low.     

Spinal subarachnoid hematoma compressing the conus medullaris and associated with neurofibromatosis type 2

STUDY DESIGN: Report of a case of subarachnoid hematoma associated with neurofibromatosis type 2 (NF2) in a 10-year-old girl. OBJECTIVE: To report a rare case of subarachnoid spontaneous hematoma associated with NF2, with no evidence of trauma. SETTING: Gifu, Japan. METHODS: The patient presented with severe leg pain. MRI revealed a subarachnoid hematoma at the level of L2 and a spinal cord tumor at the level of T6. The subarachnoid hematoma had low and high heterogeneous signal intensity on the T1-weighted image and low signal intensity on the T2-weighted image, indicating the presence of extracellular methemoglobin. The tumor and hematoma were resected. RESULTS: Pathological analysis demonstrated that the surgical specimen removed from the area of L2 was a hematoma and the specimen from T6 was a neurinoma. At follow-up 1 year after surgery, the girl remained neurologically asymptomatic. CONCLUSIONS: This rare case of spinal subarachnoid hematoma was associated with NF2. MRI was useful in establishing the diagnosis.