Ganglioglioma of conus medullaris: A case report

A case of a ganglioglioma of the conus medullaris extending between T-12 and L2 segments is reported. The tumor was succesfully removed by third stage operation. Ganglioglioma located in the conus medullaris is extremely rare. The best treatment of spinal cord ganglioglioma is totally tumor excision even when multiple stage operations are necessary.     

磁共振成像脊髓圆锥与椎体的位置关系

目的通过分析成人脊髓圆锥位置分布及性别差异性,指导临床麻醉及腰椎穿刺。方法对3742例成人患者(其中男1818例,女1924例)进行下腰段脊柱磁共振(MRI)扫描,测定脊髓圆锥末端相应的脊椎位置。所得结果进行统计学处理。结果 3742例患者脊髓圆锥末端位置在L1椎体上缘796例(21.27%),L1椎体平面1918例(51.26%),L1～2椎体间隙的有672例(17.96%),L2椎体上3/4有344例(9.19%),L2椎体下缘有3例(0.08%),L2～3椎体间隙有9例(0.24%)。女性圆锥位置低于男性(P<0.05)。其中在L1椎体上缘男性高于女性(P<0.05),L1～2椎体间隙,L2椎体上3/4男性低于女性(P<0.05)。结论成人脊髓圆锥末端大部分在L1椎体水平,但仍有极少部分(0.32%)低于L2椎体下缘。成年女性的脊髓圆锥末端位置低于男性。熟悉脊髓圆锥末端位置的正常范围,对帮助临床腰椎穿刺定位、指导临床麻醉有重要意义。     

Intramedullary spinal tuberculoma presenting as a conus tumor: a case report and review of the literature

Intramedullary spinal tuberculoma is a rare form of central nervous system tuberculosis. Although tuberculosis is unusual in the west, it is still prevalent in Asia and Africa. We report a case in which the diagnosis was made histologically without evidence of symptoms of systemic tuberculosis. The lesion, located in the conus medullaris, mimicked a conus tumor. The patient was a 20-year-old man who presented with a history of progressive leg weakness, urinary urgency, and impotence. There was no history of, or recent contact with, tuberculosis. A diagnosis of an intramedullary tumor in the conus medullaris was made by MRI. The patient underwent a T11-L1 laminectomy and total resection of the lesion with microsurgical technique. Histologic examination revealed a granulomatous lesion containing Langhans’ giant cells, inflammatory cells, and caseating necrosis. Antituberculous medication was instituted as soon as the diagnosis was made. Neurologic symptoms and signs slowly improved postoperatively. A combination of microsurgical resection and antituberculous chemotherapy should be the choice of treatment for intramedullary tuberculomas. Received: 11 January 1997 Revised: 1 April 1997 Accepted: 17 April 1997     

青少年特发性脊柱侧凸大弯度患者脊髓圆锥位置的MRI研究

目的探讨青少年特发性脊柱侧凸(AIS)患者的脊髓圆锥位置及其与患者年龄、性别、侧凸严重程度和侧凸模式之间的关系。方法对202名 Cobb 角40°以上的 AIS 患者和52名对照组青少年进行腰椎 MRI 扫描,在矢状面自旋回波 T1WI 序列图像上,观测脊髓圆锥末端的位置,并根据圆锥末端与相邻的椎体的上、中、下1/3和椎间盘的对应关系进行定位。结果 AIS 组和对照组青少年的圆锥位置范围分别为 T_(12)中1/3～L_(2/3)椎间盘和 T_(12)下1/3～L_2下1/3,平均位置则均为 L_1下1/3水平。两组间圆锥位置分布无统计学差异。这两组青少年的圆锥位置不受年龄和性别的影响。在AIS 组内,圆锥位置与侧凸的严重程度和侧凸模式无显著相关性。结论 AIS 患者的圆锥位置分布与对照组相当,圆锥位置不受年龄、性别、侧凸严重程度和侧凸模式等影响。这提示,圆锥位置的改变不能用于对 AIS 的发病及进展的研究。     

Intramedullary lesions of the conus medullaris: differential diagnosis and surgical management

The medullary conus represents a distinct entity of the spinal cord regarding its anatomical, clinical and microsurgical features. An overview of the pathologic processes of this region is provided. Epidemiological, clinical and neuroradiological characteristics of neoplastic (glial tumors, non-glial tumors, metastasis, primary melanomas) and non-neoplastic lesions (granulomatous lesions, abscess, parasitic infections, vascular, demyelinating and dysembryogenetic lesions) are discussed. Main MR imaging characteristics used to differentiate neoplastic from non-neoplastic lesions consist in pathological spinal cord expansion, gadolinium-enhancement and tumoural cyst formation. Management strategies differ substantially, depending on the kind of lesion. According to the suspected pathological entity radical resection, biopsy or conservative treatments are reasonable options. Intraoperative electrophysiological monitoring is a fundamental part of the surgical setting.     

Co-existence of L5-S1 disc herniation and conus medullaris ependymoma

INTRODUCTION

The lumbar disc herniations are seen very common than spinal ependymomas in the neurosurgery polyclinic routine.

PRESENTATION OF CASE

In our case, both pathologies were seen at the most frequently located levels compatible with the literature.Aim of this case report is, to remind once more that, different pathologies can be found at the same time in a single patient; differential diagnosis must be done very carefully.

DISCUSSION

The routine Computed Tomography (CT) imaging for low back pain can not show the conus medullaris pathology. Spinal tumors or other similar pathologies should be kept in mind for differential diagnosis. A good medical history and a good physical examination must be completed before the final diagnosis.

CONCLUSION

Viewing of spinal canal with Magnetic Resonance Imaging (MRI) will be useful for the patients who we intend to do disc surgery.     

Intramedullary tuberculoma of the conus medullaris: case report and review of the literature

OBJECTIVE: To illustrate the dilemmas in the diagnosis and management of intramedullary tuberculomas of the spinal cord. METHODS: Case report of a 32 year-old man with tuberculous meningitis. The presence of unexplained urinary retention and progressive weakness in the legs led to the discovery of an additional tuberculoma of the conus medullaris. SETTING: Dicle University Diyarbakir, Turkey. RESULTS: The patient was on a 1-year course of isoniazid, pyrazinamide and rifampicin, and responded well to conservative treatment. Our patient's unique features were represented by the worsening of neurological symptoms while being treated with adequate anti-tuberculous medication. CONCLUSION: We present a case of intramedullary tuberculoma of the conus medullaris to illustrate the dilemmas in the diagnosis and management of this curable disease, and review of the literature to date.     

Extremely rare glioblastoma multiforme of the conus medullaris with holocord and brain stem metastases, leading to cranial nerve deficit and respiratory failure: a case report and review of the literature

BACKGROUND: Spinal glioblastoma multiforme (GBM) is an uncommon entity and metastases are extremely rare. Glioblastoma multiforme of the conus medullaris is a rare and highly aggressive entity that can quickly progress to a dismal state. Proper diagnosis via histopathologic and immunochemical staining with close clinical and radiological follow-up is important for the management of this very aggressive tumor. CASE DESCRIPTION: The authors report the clinical features, histopathologic and immunochemical staining characteristics, as well as the radiographic evidence of a case of primary GBM of the conus medullaris with metastases to the whole spinal cord and brain in a 20-year-old man who presented with low back pain and bilateral lower extremity weakness and numbness. Review of the pathology slides using histopathologic and immunochemical staining showed GBM. Serial magnetic resonance scans, performed after the initial surgery, demonstrated enlargement of the primary GBM in the conus medullaris with metastases to the thoracic and cervical spinal cord as well as to the brain. CONCLUSIONS: Glioblastoma multiforme of the conus medullaris with such clinical findings is extremely rare. We analyze similar cases in the literature and discuss the importance of monitoring the progression of such an entity as well as the need for aggressive management of the different complications as they arise to maintain a good quality of life.     

Intramedullary spinal cord cavernous malformations: report of ten new cases

Spinal cord cavernous malformations (SCCM), once thought to be extremely rare, have been diagnosed more frequently since the advent of MRI. In addition to the six personal cases surgically treated between 1992 and 1993 and already described in the literature, the authors report here a further ten cases operated on between April 1993 and January 2001. These involved five males and five females whose ages at operation ranged from 12 to 69 years. The SCCM were thoracic in five patients and cervical in five. In seven cases, the malformations bulged on the surface of the pia mater, while in the other three there was subpial discoloration due to the presence of hemosiderin. Removal was total in all cases. After surgery, two patients presented transient worsening of preoperative paraparesis. At follow-up ranging from 2.2 to 9.2 years (mean 5.7), nine patients had made complete motor recovery while one, in whom preoperative paraparesis had been severe, remained stationary. At least one follow-up MRI investigation was performed in each patient 6 to 12 months after operation. As previously reported, the authors confirm that the treatment of choice for symptomatic SCCM is total surgical excision in order to avoid recurrences and the possibility of further hemorrhage. Surgical outcome combines low mortality with a high probability of functional recovery, especially when paraparesis is not severe and of relatively recent onset.     

Intramedullary spinal tuberculoma: a case report

STUDY DESIGN: A case report showing an intramedullary thoracic spinal tuberculoma secondary to pulmonary tuberculosis in a 16-year-old patient with findings of subacute spinal cord compression. OBJECTIVES: The significance and the use of magnetic resonance imaging in the diagnosis of intramedullary tuberculoma, and the treatment of the patient that involves surgically the excision of intramedullary lesion followed by appropriate antituberculous therapy. SUMMARY OF BACKGROUND DATA: Tuberculomas of spinal cord are rare entities. The possibility of intramedullary tuberculoma should be seriously considered when an intraspinal mass is found, provided that pulmonary tuberculosis is present in the history of the patient. METHOD: Th4-Th5 laminectomy was performed. Intramedullary tuberculoma was excised through a myelotomy. Antituberculous treatment was applied after the surgery. RESULTS: Excellent clinical outcome was obtained with a combination of both medical and surgical treatments. CONCLUSION: The intramedullary spinal tuberculoma, although a rare entity, must be considered in the differential diagnosis of the spinal cord compression in patients with a history of tuberculosis, human immunodeficiency virus, and those who have a bad socioeconomic condition and bad nutrition habit. When confronted with a progressing neurologic deficit, a combination of microsurgical resection and antituberculous chemotherapy with the avoidance of steroids should be the choice of treatment for intramedullary tuberculomas.     

颈椎髓外硬膜下结核瘤1例

患者,男,38岁,以颈项部疼痛1个月,突发左上肢麻木无力3d入院。1个月前,无明显诱因,出现颈部疼痛,无双上肢感觉障碍,无活动受限,无头晕头痛,就诊于当地医院(具体治疗不详),症状无改善。3d前突然出现左上肢麻木无力,右上肢麻木感,排尿无力。既往:3年前无明显诱因出现颈部皮肤溃烂     

Bilateral elastofibroma dorsi: A case report

INTRODUCTION

Elastofibroma dorsi(EFD) is slow-growing, benign, soft tissue tumor of unclear pathogenesis, typically located at the subscapular region of elderly people. It may be unilateral or bilateral. As it exhibits benign behavior, it should be surgically removed only in symptomatic patients. Magnetic resonance imaging (MRI) is a useful tool for assessment of EFD and can potentially help avoid the need for unnecessary biopsy and surgery.

PRESENTATION OF CASE

A 62-year-old woman presented with 2 years complaint of back pain, particularly aggravated with shoulder movements and swelling with bilateral elastofibroma dorsi. Both masses were totally excised with bilateral posterolateral subscapular incision. Symptoms were completely controlled and significant discomfort from the surgical procedure was completely resolved with in a few weeks interval from the operation.

DISCUSSION

The pathogenesis of the EFD still remains unclear. Elastofibroma dorsi has an unspecific clinical presentation and can be confused with other tumors of the periscapular region Imaging studies are useful for diagnosis.

CONCLUSION

Elastofibroma dorsi is benign soft tissue tumor mostly observed in the subscapular regions of elderly female patients. The surgery is indicated in symptomatic cases and must be confined to simple excision of the lesion.     

Conus medullaris syndrome due to an intradural disc herniation: A case report

A 70-year-old male patient developed acute paraplegia due to conus medullaris compression secondary to extrusion of D12-L1 disc. After negative epidural examination intraoperatively, a durotomy was performed and an intradural disc fragment was excised. Patient did not regain ambulatory status at two-year follow-up. Intraoperative finding of negative extradural compression, tense swollen dura and CSF leak from ventral dura should alert the surgeon for the possibility of intradural disc herniation. A routine preoperative MRI is misleading and a high index of suspicion helps to avoid a missed diagnosis.     

Primary angiitis of the spinal cord presenting as a conus mass: long-term remission

BACKGROUND: Primary angiitis of the central nervous system (CNS) is a rare vasculitic disorder that typically involves the brain and, less frequently, the spinal cord without involvement of the blood vessels outside the CNS. CASE DESCRIPTION: We present a case of a 52-year-old woman who developed a conus syndrome linked to an enhancing mass of her lower thoracic spinal cord, lumbar cord, and conus. Spinal cord biopsy performed for diagnostic purposes in the setting of progressive neurological deficit confirmed angiitis of the spinal cord. Therapy with steroid and cyclophosphamide was associated with long-term (3 years) clinical and imaging remission of the lesion. CONCLUSIONS: The prognosis of primary CNS angiitis is dismal with most cases progressing to death. Long-term remission is unusual. Aggressive therapy with steroid and cytotoxic agents may improve survival.     

Intravascular large B-cell lymphoma presenting as an isolated cauda equina–conus medullaris syndrome – A case report

Context: Intravascular large B-cell lymphoma (IVLBCL) is a rare form of Non-Hodgkin lymphoma. The central nervous system, skin and hematopoietic system are the most commonly affected sites. We report a case of IVLBCL presenting as a combined conus medullaris–cauda equina syndrome.

Findings: A 55-year-old Caucasian male presented with signs and symptoms of a combined conus medullaris–cauda equina syndrome confirmed by MRI and needle EMG. PET scan revealed a hyperactive focus in the adrenal gland, and biopsy showed evidence of IVLBCL. Therapy with R-CHOP resulted in improvement of weakness.

Conclusion: A high index of suspicion and consideration of IVLBCL in the differential for patients with these isolated spinal cord symptoms and CSF findings may help initiate early and suitable therapy which has been proven to be beneficial.     

Intramedullary spinal tuberculoma: report of one case

Neurological symptoms of tuberculosis are rare, even if there this pathology has been on the rise for a number of years because of HIV. Intramedullary tuberculoma is an exceptional location. We report the case of a patient with no HIV or immunodepression symptoms with intramedullary tuberculoma, revealed by a clinical presentation of insidious onset of myelopathy. We will discuss the diagnosis, treatment and clinical functional follow-up. The optimal treatment seems to be a combination of microsurgical resection and antibiotic therapy.     

脊髓圆锥末端位置与蛛网膜下腔阻滞引起脊髓损伤的关系

国内外很多学者通过核磁共振观察统计脊髓圓锥末端位置的水平,发现其变化范围为T_(12)-L_3椎体,并与年龄、性别、体位、脊髓发育异常等多方面因素有关,而蛛网膜下腔阻滞时常选择L_2/L_3间隙穿刺,此法会增加脊髓损伤的风险并且有明确病例报道并提供了直接证据.蛛网膜下腔阻滞引起脊髓损伤与定位不准、穿刺针因素、穿刺技术和脊髓解剖位置有关.了解脊髓圆锥末端的位置与蛛网膜下腔阻滞的关系对于避免和预防脊髓损伤尤为重要.