Thoracolumbar spine fracture complicated by simple conus medullaris injury

Spinalcordinjuryaccountedfor0.3percentoftotalinjuriesand20percentofspinefractures:ljWiththedevelopmentofscienceandtechnologyandtheutilizationofhigh--speedconveyer,theincidenceofspinefracturescomplicatedbyspinalcordinjuryhasbeenbecominghigherandhigher,butthoracolumbarspinefracturecomplicatedbysimpleconusmedullarisinjuryhasnotbeenreceivingenoughattention.TherehavebeenfewreportswithrespecttoclassficationandtreatmentofthisInjury.Betmeen1990and1996,15patientswiththisinjurywereadmittedtoourhospital.…     

腰骶部椎管内肿瘤83例报告

报告脊髓圆锥马尾肿瘤83例,男52例,女31例。神经纤维瘤最多见,占37.4％;其次为表皮、皮样囊肿,占26.5％;畸胎瘤等占35.1％。肿瘤位于脊髓圆锥者占46例,位于马尾者占37例。临床表现以神经根性疼痛为最常见,占68例(81.9％);其次为膀胱和直肠功能障碍,占48例(57.8％)。早期明确诊断,及时手术切除肿瘤是提高本病治疗效果的关键。     

小儿脊髓圆锥内畸胎瘤1例

0　引言　脊髓内畸胎瘤罕见 ,多位于脊髓圆锥部 .最近 ,我院收治 1例 ,现报道如下 .1　病例报告　患者 ,女性 ,14岁 ,主因腰骶部疼痛伴双下肢进行性麻木 2 m o入院 .查体 :腰骶部压痛 ,会阴部及右下肢温痛觉减退 ,肌力 IV级 .行 MRI检查示脊髓圆锥部增粗 ,可见一梭形、边界清晰的肿块 ,呈混杂信号 ,其内可见脂肪成分及钙化灶信号 ,无强化 .伴脊髓低位、圆锥分隔畸形及腰 5隐性脊柱裂 . MRI诊断 :脊髓圆锥畸胎瘤 .术中见脊髓圆锥肿胀 ,病灶位于圆锥内向外生长 ,下端与马尾神经粘连 .切开瘤壁见豆渣样内容物 ,混有黄色脂肪成分和一钙化灶 …     

成人脊髓圆锥位置的磁共振变化

目的：通过MRI图像研究无脊柱脊髓畸形的成人人群圆锥位置的变化。方法：用1．5T MRI机使用T1加权、正中矢状位自旋回波扫描，对1179例病人圆锥末端的位置进行观察。根据其与相应椎体的上、中、下1／3及椎间盘的对应关系定位。结果：圆锥末端的平均位置为L1的下1／3（范围：T12的中1／3－L3的上1／3），圆锥末端的位置呈正态分布，女性圆锥位置低于男性（P＜0．001），各年龄段无差异（P＞0．05）。结论：本组成人人群中圆锥末端的位置从T12的中1／3－L3的上1／3，女性圆锥位置低于男性，对麻醉和手术有重要意义。     

实验性马尾神经综合征家兔骶髓前角细胞凋亡的观察

目的：观察马尾神经综合征（CES）个体骶髓前角细胞的病理改变，以探讨其可能的发生机制。方法：选用纯种健康雄性新西兰兔80只，将压迫装置置于其S2－S3棘突之间压迫马尾神经制备CES模型。取出现CES后不同时期（发病后1／4，1／2，3，7，30d)的动物麻醉后，用生理盐水和4％多聚甲醛心脏灌注固定，取脊髓圆锥包埋，以5μm厚度连续切片，进行H－E染色和DNA片段原位末端标记（TUNEL）法检测，结合其形态学改变进行凋亡细胞计数，并作对比研究。结果：出现CES后1／ 4,TUNEL法检测示骶髓前角细胞发生凋亡改变；至1／2d时，凋亡细胞明显增多，且以早期凋亡细胞为主，与对照组比较有显著差异，H－E染色示骶髓前角细胞形态发生改变；以后凋亡细胞逐步减少，但仍高于对照组水平。结论：CES时骶髓前角细胞病理改变的主要方式是细胞凋亡；随着病情的发展，大部分凋亡细胞由凋亡早期进入死亡期（不可逆期），这可能是该病临床症状难以恢复的重要原因之一。     

脊髓拴系致脊髓圆锥下移与脊髓牵拉缺血性损伤的关系

目的 探讨ＭＲＩ脊髓拴系致脊髓圆锥下移与脊髓牵拉缺血性损伤的关系。材料与方法 对临床及ＭＲＩ明确诊断的２０例成人脊髓拴系牵拉缺血性损伤,在ＭＲＩ上确定脊髓圆锥下移的锥体平面。并测量脊髓缺血性损伤的范围及前后径。统计分析后二者相关关系。结果脊髓前后径变细与脊髓缺血性损伤的范围。二者直线方程Ｙ＝－２．０４Ｘ＋２２．８３,相关关系ｒ＝－０．６８６,呈负相关,Ｐ〈０．０１,差异非常显著。结论 脊髓拴系至     

多模式超声成像技术观察脊髓圆锥在胎儿隐性脊柱裂诊断的应用价值

目的探讨运用超声检查的二维模式结合三维成像的骨骼模式、VCI模式观察胎儿脊髓圆锥的位置及其形态对胎儿隐性脊柱裂的诊断价值。方法选取2013年1月至2015年12月行产前系统筛查孕妇51 896例,运用多模式超声成像技术分析产前超声提示隐性脊柱裂胎儿6例的脊髓圆锥位置及其形态的变化声像图,且经产后高频超声检查或出生后MRI证实。结果 6例隐性脊柱裂胎儿中产前超声均发现其脊髓圆锥位置明显低于肾盂水平,失去正常的鼠尾状形态,其中1例合并软腭裂(产前漏诊)。产前超声胎儿脊髓圆锥位置及其形态100%可以显示。结论产前多模式超声成像技术是观察胎儿脊髓圆锥位置及其形态的首选方法,它能够提供重要的有价值的信息。     

Transferring superior gluteal nerve to pudendal nerve in reconstructing functional impairment in simple conus medullaris or pudendal nerve injury

Objective: To study the anatomical basis of transferring the superior gluteal nerve to the pudendal nerve in reconstructing the functional impairment in simple conus medullaris or pudendal nerve injury. Methods: Superior gluteal nerve and pudendal nerve were observed and measured by the gross and microsurgical anatomical methods in 62 sides of 31 adult cadavers. Results:Superior gluteal nerve came out of the superior foreman of piriformis as 1 to 4 branches (29.03%,56.45%,12.90% and 1.61% respectively) and the pelvic-leaving points were mainly in the middle 1/3 (85.48%) of the line from the posterior superior iliac spine to the ischial tuberosity. The length of the inferior branch of the superior gluteal nerve was more than 5cm, and the distance between the pelvic-leaving points of the superior gluteal nerve and pudandal nerve was about 4cm only. The pudendal nerve left the pelvis mainly in the middle 1/3 (48.39%) of the line from the posterior superior iliac spine to the ischial tuberosity, or at the junction of its inferior-middle 1/3 (46.77%). In clinic, we have successfully made the operation transferring the superior gluteal nerve to the pudendal nerve in 3 patients suffered from the injury of conus medullaris. Conclusion: Distance between the pelvic-leaving points of the superior gluteal nerve and the pudendal nerve is close, so the inferior branch of the gluteal nerve can be anastomosed with the pudendal nerve directly. Transferring the superior gluteal nerve with higher spinal segemental origin to the pudendal nerve of a lower spinal segemental origin is practical and easy.     

Accidental conus medullaris injury following combined epidural and spinal anesthesia in a pregnant woman with unknown tethered cord syndrome

In most adults,the conus medullaris ends at around the inferior margin of the first lumbar (L1) vertebral body)However,location of terminus of the conus medullaris is variable and even extends more distally in patients with diseases such as tethered cord syndrome (TCS).Here,we reported a conus medullaris injury following combined spinal and epidural anesthesia (CSEA) in a pregnant woman with unknown TCS.     

圆锥马尾部黏液乳头型室管膜瘤继发中枢神经系统表面铁沉积症1例报道及文献复习

中枢神经系统表面铁沉积症(superficial siderosis of the central nervous system, SSCNS)是由于慢性反复性出血进入脑脊液而导致过多的铁沉积在脑干、小脑、脊髓乃至部分脑神经表面所致的神经系统损害,较为罕见,肿瘤是出血源之一。目前国内在其诊治方面存在以下不足:认识较晚,诊断病例较少,长期随访资料匮乏,病因诊断不够重视,漏诊率较高,治疗水平较国外存在较大差距。SSCNS典型临床表现为:双侧进行性神经性耳聋、小脑共济失调和锥体束征阳性,称为SSCNS三联征,但同时具备三联征的患者较少,给及时诊断带来一定困难。MRI对确诊该病有重要意义,铁沉积在小脑、脑干、脊髓等表面呈特征性线状低信号,SE-T₂WI呈细线条,GE-T₂WI及磁敏感加权成像序列(susceptibility weighted imaging,SWI)呈显著粗线条。唯一有效的治疗方法是确定出血源并清除,MRI检查同样有助于寻找出血源,因此,如果考虑SSCNS,必须进行脑、脊柱MRI检查以寻找病因。本文报道1例37岁男性SSCNS患者,临床主要表现为共济失调、神经性耳聋和嗅觉减退,MRI表现有典型的中枢神经系统表面T2加权低信号,病因追查发现脊髓下端及马尾、终丝部巨大占位病变,经手术切除并组织病理学检查提示黏液乳头型室管膜瘤(myxopapillary ependymoma,MPE)。结合文献复习探讨了MPE继发SSCNS的机制,并对SSCNS的病因、临床表现、诊断以及治疗进行综述,以提高临床医师对该病的认识及诊断水平,尤其强调对该病病因的查找有利于治疗方案的准确制定。     

Ancient cystic pelvic schwannoma presenting as a right iliac fossa mass

Schwannoma is rare in pelvis. Ancient schwannoma is rarer histological subtype of schwannoma. We report a very rare case of pelvic schwannoma presenting with right sciatica and right iliac fossa pain. Clinical and imaging findings were suggestive of Peritoneal Hydatid cyst. The tumour was resected completely with marked clinical improvement. Histopathological examination showed Ancient cystic schwannoma.     

Schistosoma mansoni of the conus medularis: case report

A six year old girl was admitted to the Kenyatta National Hospital paediatric unit with history of headaches, fever, neck stiffness and paraesthesias of the lower limbs. She was empirically commenced on antimeningitic treatment. Her neurological state deteriorated over a period of two months to paraparesis and paraplegia of the lower limbs with urinary and stool incontinence. A neurology review revealed a sensory level at T10 with power grade 2 in the lower limbs. A myelogram revealed a block of contrast at T12. An impression of cord compression by an intraspinal tumour was made. Laminectomy and posterior midline myelotomy was performed. At operation a greyish-white intramedullary mass lesion was found. Histology revealed a schistosoma mansoni ovum surrounded by granulomatous tissue with giant cells and polymorphoneuclear leucocytes. The child was commenced on paziquantel 1000 mg and dexamethasone 24 mg per day in divided doses. There was marked neurological improvement and the patient went home one month later. She was able to walk without support and was continent of urine and stool at the time of discharge.     

Congenital plexiform schwannoma of the clitoris

Schwannomas are slow-growing nerve sheet neoplasms which are rarely found in the female genital system. In this article, we present a patient with Antony A congenital plexiform schwannoma of the clitoris. A 6-year-old girl was brought to our hospital with the history of a firm non-cystic clitoral mass from birth, which had been growing more rapidly during the previous year. The patient was scheduled for surgery. Histological studies revealed plexiform schwannoma of the clitoris post-operatively. Therefore, schwannoma should be considered in the differential diagnosis of clitoral masses.     

Unusual presentation of schwannoma

Schwannomas are slow growing benign tumours arising from the nerve sheath. Two cases of schwannoma arising from the vagus nerve are presented here. One case was found in a 6-year-old boy and another one in a 30-year-old man. In the first case the tumour was detected on the left side of the neck just below the angle of the mandible, and in the second case it was found on the lower part of the right side of the neck. Histopathology confirmed the diagnosis as first one to be of Antoni-A type and the second one to be of Antoni-B type. Both the tumours were excised and on follow-up the patients were doing well.     

Unusually large cellular schwannoma of the foot

This article presents a case of an unusually large cellular schwannoma of the foot. This uncommon lesion of the lower extremity is described with regard to clinical appearance, radiologic evaluation (including magnetic resonance imaging), histologic characteristics, and intraoperative findings.     

Facial nerve schwannoma of the internal auditory canal

Background  

Facial nerve schwannoma of the internal auditory canal is a very rare tumour.