Subarachnoid hemorrhage due to intraspinal tumors

Five cases of subarachnoid hemorrhage arising from an intraspinal tumor are presented, Three of these were ependymomas in the region of the cauda equina. One was a neurofibroma at L1. The fifth was a hemangioblastoma in the upper lumbar region. The literature dealing with subarachnoid hemorrhage due to intraspinal lesions is reviewed. The majority of cases of spinal subarachnoid hemorrhage are due to arteriovenous malformations, but 50 cases in which the bleeding developed from a neoplasm have been reported.     

Mobile neurinoma of the cauda equina

Summary A mobile neurinoma arising from a redundant nerve root of the cauda equina is reported. The abnormal length of the nerve root allowed the neoplasm to move in the cranio-caudal direction along two segments of the spine.     

Paraganglioma of the cauda equina: case report and review of the literature.

A rare paraganglioma of the cauda equina is reported. The clinical, radiological and histological features of this neoplasm are described. Diagnosis was resolved by the absence of glial fibrillary acid protein and electron microscopic evidence of neurosecretory features. Relevant literature is reviewed.     

An unusual neoplasm of the cauda equina with gangliomatous and ependymomatous elements

A unique intradural neoplasm of the cauda equina is presented. The tumor was composed of two neoplastic populations: ependymal cells in a papillary pattern and ganglion cells occurring individually or in clusters. The patient remains asymptomatic 1 year after resection of the tumor.     

腰椎间盘突出症致马尾神经损伤的原因与防治

目的 了解腰椎间盘突出症合并马尾神经损伤的发病原因,由此探讨其预防及治疗的措施。方法 对腰椎间盘突出症合并马尾神经损伤21例进行分型、手术治疗和随访,并对发病原因及术中所见进行分析。结果 腰椎间盘突出症合并马尾神经损伤好发于腰椎间盘突出症反复多次发作者,多有外伤、不合理治疗等诱因。术后恢复优5例,良11例,可4例,差1例。结论 腰椎间盘突出症反复多次发作者其马尾神经损伤比例增加,对此类病人应避免腰部损伤,避免做重手法推拿、大重量牵引等加重腰部损伤的治疗,发现有马尾神经损伤者应作早期手术治疗。     

Atypical teratoid rhabdoid tumour of the spine: report of a case and literature review

Atypical teratoid rhabdoid tumour (ATRT) is a rare and highly aggressive malignant neoplasm of the central nervous system (CNS), which occurs predominantly in children less than 2 years of age. There are less than 50 cases described in adult. We report a case of primary spinal ATRT in a 65-year-old male who presented to us with cauda equina syndrome. To the best of our knowledge, our patient is the (1) second oldest patient to be diagnosed with ATRT and only the third case of adult spinal ATRT report in the literature; (2) first reported case of CNS ATRT occurring in a patient with non-rhabdoid renal cancer; (3) first adult patient of ATRT to present with cauda equina syndrome.     

Nutritional supply to the cauda equina in lumbar adhesive arachnoiditis in rats

Laminectomy-induced cauda equina adhesion has been proved by rat experiments and postoperative serial MRI in humans. A degenerative change of the cauda equina has been proved when cauda equina adhesion has been prolonged. Since it has not been reported how the nutritional supply is changed in such a condition, we evaluated the glucose supply to the adhered cauda equina in rats. Wistar rats were divided into the following three groups: the control group which received no operation, the laminectomy group which underwent L5-L6 laminectomy only, and the koalin group which received 5 mg of kaolin on the dorsal extradural space following L5-L6 laminectomy. Based on ³H-methyl-glucose uptake study, we analyzed (1) glucose transport from the intraneural vessels to the nerve tissue, and (2) glucose transport from the cerebrospinal fluid to the nerve tissue. We evaluated the relation between the severity of cauda equina adhesion and ³H uptake into the cauda equina. Cauda equina adhesion was observed in 2 of 12 rats in the control group, in 3 of 12 rats in the laminectomy group, and in 18 of 20 rats in the kaolin group. In the ³H-methyl-glucose uptake study, at 12 weeks the glucose transport to the cauda equina from the vessels increased by 44%, and that from the cerebrospinal fluid decreased by 64% in the kaolin group compared with thecontrol group. In the condition of complete cauda equina adhesion, the glucose transport to the cauda equina from the vessels increased by 53% and that from the cerebrospinal fluid remarkably decreased by 72% compared with the normal cauda equina. Considering the greater nutritional importance of the cerebrospinal fluid in the cauda equina, it is most likely that the impairment of nutritional supply to adhered cauda equina may lead to eventual neural degeneration. Received: 8 September 1998 Revised: 28 December 1998 Accepted: 10 February 1999     

Atypical teratoid rhabdoid tumour of the spine: report of a case and literature review

Atypical teratoid rhabdoid tumour (ATRT) is a rare and highly aggressive malignant neoplasm of the central nervous system (CNS), which occurs predominantly in children less than 2 years of age. There are less than 50 cases described in adult. We report a case of primary spinal ATRT in a 65-year-old male who presented to us with cauda equina syndrome. To the best of our knowledge, our patient is the (1) second oldest patient to be diagnosed with ATRT and only the third case of adult spinal ATRT report in the literature; (2) first reported case of CNS ATRT occurring in a patient with non-rhabdoid renal cancer; (3) first adult patient of ATRT to present with cauda equina syndrome.

     

Experimental nerve root compression. A model of acute, graded compression of the porcine cauda equina and an analysis of neural and vascular anatomy

Nerve root compression has been suggested as one important pathogenetic factor in low-back pain syndromes and sciatica. The underlying pathophysiologic mechanisms are, however, incompletely known, partly because of the lack of experimental data on this topic. In the present study, a model for experimental compression of the porcine sacrococcygeal cauda equina is presented. The model consists of surgical exposure of the cauda equina and compression of the cauda equina toward the ventral aspect of the spinal canal by an inflatable balloon fixed to the spine. This compression system was shown to have a high accuracy in pressure transmission from the balloon to the cauda equina. The gross and microscopic neural anatomy and the vascular anatomy of the porcine cauda equina were analyzed with light microscopic and ink-perfusion techniques. The porcine cauda equina showed a close anatomic resemblance to the human lumbosacral cauda equina. The presented model offers unique possibilities for experimental studies on nerve root compression injury because of the easy surgical exposure and the sufficient length of the nerve roots. In separate studies, this model, along with investigations of solute transport to the nerve tissue and of impulse propagation, has been used to analyze the effects of acute, graded compression on blood flow and edema formation in the cauda equina. The porcine cauda equina would also be particularly suitable for chronic compression studies because any neurologic deficit acquired would be restricted to the tail.     

腰椎间盘突出症致马尾神经综合征的外科治疗

目的：根据马尾神经综合征发病机制的临床研究和临床治疗现状,提出外科干预的术式,提高其手术疗效。方法：致压物摘除、神经根节部的无创减压是治疗马尾神经综合征主要的外科技术。结果：马尾神经综合征改良术可在到神经根节内的即刻减压,时机得当,能迅速缓解主要病理变化。结论：马尾神经综合征的改良术式将是提高马尾神经综合征治疗效果的重要方法。     

Subarachnoid haemorrhage due to cauda equina haemangiopericytoma

A case of cauda equina haemangiopericytoma presenting with spinal subarachnoid haemorrhage is reported. The tumour had been asymptomatic until 2 weeks prior to presentation, and resulted in complete paraplegia below L3. The authors underline the uncommon association of spinal subarachnoid haemorrhage and cauda equina tumour and the rare finding of a cauda equina haemangiopericytoma.     

Magnetic resonance image findings of primary intradural Ewing sarcoma of the cauda equina: case report and review of the literature

Background contextInvolvement of the cauda equina in Ewing sarcoma (ES) is extremely rare, and only few cases are reported in literature. However, ES of cauda equina shares some neuroradiological features with other neoplasms that can involve the intradural space. Therefore, differential diagnosis with other tumors of cauda equina should be considered by neuroradiologists and neurosurgeons to provide appropriate treatment.PurposeTo present a rare case of intradural extramedullary primary ES.Study designCase report.MethodsWe report a case of a 44-year-old woman presenting with the rapid onset of cauda equina syndrome. Radiological analysis showed multiple intradural masses, extending from L1 to S3 level. After radical surgery, lesions were histologically defined as ES. We present a literature review, analyzing magnetic resonance image (MRI) features of primary intradural ES of the cauda equina.ResultsFour cases of primitive ES arising from the cauda equina have been reported in the literature.ConclusionsBecause of the low number of reported cases, it is not possible to describe pathognomonic MRI findings for intradural ES of the cauda equina. However, few tumors show similar MRI features. Therefore, despite its rarity, intradural ES should be taken into account in the differential diagnosis of spinal tumors involving cauda equina.     

腰骶神经损害致马尾神经综合征的临床分期及早期诊断

目的: 探讨马尾神经综合征临床发病特点, 分析其分期。方法: 分析马尾神经综合征患者的临床表现、实验室检查和影像学检查的变化规律。结果: 马尾神经综合征的临床主要表现为鞍区感觉、大小便、性功能障碍,首发症状为感觉功能的障碍, 继而出现括约肌功能及性功能的障碍。临床表现出现前BCR (bulbo cavernosus reflex)、ICR (ischio cavernosus reflex) 等已有明显异常。影像学研究认为, 大部分表现为多节段椎管狭窄。结论: 马尾神经综合征分前期、早期、中期、晚期。电生理改变和鞍区感觉的功能改变是早期诊断的指标。在前期、早期诊断马尾神经综合征称为早期诊断。     

Cauda Equina Intradural Extramedullary Cavernous Haemangioma: Case Report and Review of the Literature

Cavernous haemangioma (cavernoma) is a benign vascular lesion, exceptionally located in cauda equina. We report a case, diagnosed and operated in the Department of Neurosurgery from Pitesti County Emergency Hospital, of a 60-year-old woman with history of lumbar region distress, who presented with low back pain, paravertebral muscle contracture, and bilateral lumbar radiculopathy, with sudden onset after lifting effort. The preoperative diagnosis was done using computed tomography (CT) and magnetic resonance imaging (MRI), and the patient underwent surgery—two level laminectomy, dural incision, and tumor dissection from the cauda equina nerve roots under operatory microscope. Histopathological examination confirmed the positive diagnosis of cavernoma of cauda equina. The patient''s outcome was favorable, without postoperative neurological deficits.     

腰椎骨折脱位患者马尾神经修复的临床观察

目的：观察腰椎骨折脱位后马尾神经损伤修复的临床效果。方法：对8例L2或L3骨折脱位伴损伤平面以下全瘫的患者行手术整复固定骨折脱位后用纤维蛋白胶粘合断裂的马尾神经，观察患者神经功能恢复情况。结果：新鲜的腰椎骨折脱位患者马尾神经损伤修复后大腿肌肉功能都有恢复，膝关节以下肌肉没有恢复；陈旧性损伤无任何恢复。感觉均无任何恢复。结论：为提高神经功能的恢复，腰椎骨折脱位后马尾神经的损伤应给予修复，用纤维蛋白胶粘合断裂的马尾神经是一种可行的方法。     

Spinal stenosis: assessment of motor function,VEGF expression and angiogenesis in an experimental model in the rat

Reduction of blood flow in compressed nerve roots is considered as one important mechanism of induction of neurogenic intermittent claudication in lumbar spinal canal stenosis. Vascular endothelial growth factor (VEGF) is a potent stimulator of angiogenesis, and is increased in expression in hypoxic conditions. The objective of this study was to examine if cauda equina compression affects motor function and induces expression of VEGF and angiogenesis. The cauda equina was compressed by placing a piece of silicone rubber into the L5 epidural space. Walking duration was examined by rota-rod testing. The compressed parts of the cauda equina and L5 dorsal root ganglion (DRG) were removed at 3, 7, 14, or 28 days after surgery, and processed for immunohistochemistry for VEGF and Factor VIII (marker for vascular endothelial cells). Numbers of VEGF-immunoreactive (IR) cells and vascular density were examined. Walking duration was decreased after induction of cauda equina compression. The number of VEGF-IR cells in the cauda equina and DRG was significantly increased at 3, 14, and 28 days after cauda equina compression, compared with sham-operated rats (P < 0.05). Vascular density in the cauda equina was not increased at any of the time points examined. Cauda equina compression decreased walking duration, and induced VEGF expression in nerve roots and DRG.     

Metastatic Grawitz's tumor to the cauda equina: case report

A case of Grawitz's tumor metastasizing to the cauda equina is presented. A 51-year-old male was hospitalized due to severe low back pain radiating to the left lower extremity. Neurological examination showed only hyporeflexia of the left patella reflex and positive Lasegue's sign. MRI showed intradural mass at the L4 level. Preoperatively, we diagnosed a cauda equina tumor. A laminectomy of both L3 and L4 was performed, and total removal of the cauda equina tumor was performed. Microscopically, the tumor cells were large, the appearance of the cytoplasm ranging from optically clear with sharply outlined boundaries, to deeply granular, with many transitional forms. These histological findings were typical findings of Grawitz's tumor, and were the same as those of this patient's renal tumor. Finally, we diagnosed Grawitz's tumor metastasizing to the cauda equina. Metastatic cauda equina tumor from outside the central nervous system is very rare and only 7 cases have been reported. This case is the first one of Grawitz's tumor spreading to the cauda equina.     

Paraganglioma of the Cauda Equina Region – Report of two Cases and Review of the Literature

Summary  A paraganglioma of cauda equina region is extremely rare and except for secreting tumour, the pre-operative diagnosis of paraganglioma is very difficult. Two cases of non-functional paragangliomas of the cauda equina region are reported, one was attached to the filum terminale and the other to a rootlet looking very much like a vascular neurinoma. Both were successfully removed by surgery. An extensive review of the literature permits one to find 77 other cases. The clinical, radiological, pathological (ultrastructural and immunohistochemical) features and surgical findings of all theses cases are discussed. Surgery remains the treatment of choice. No effect of radiotherapy on recurrence prevention has ever been demonstrated.     

急性重度犬马尾压迫模型诱导脑源性神经营养因子的合成

目的研究实验性犬急性重度马尾神经压迫48h的相关脊髓和背根神经节(dorsal root ganglion,DRG)内脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)蛋白表达水平。方法成年雄性杂种犬(n=8),随机分为实验组和对照组。实验组(n=4)行多重马尾压缢,其中第1根束缢线使整个马尾束缢了50%~75%,另3根束缢线使马尾束缢了25%~50%。对照组(n=4)仅行马尾暴露而未行马尾束缢。于术后48h取相应脊髓及DRG行HE染色、BDNF的免疫组织化学分析。结果多重马尾束缢后48h可在相应下腰骶髓和DRG神经元群体内诱导出显著的BDNF增量调节;而脊髓、DRG和神经纤维内相关结构亦见BDNF阳性表达。结论多重马尾束缢犬模型形成急性重度马尾综合征(cauda equine syndrome,CES)时,BDNF可能有神经保护作用和炎性痛、神经痛的作用。