CyberKnife stereotactic radiotherapy for mass lesions of the spinal cord and spine

Introduction of a novel technology of stereotactic radiation treatment using linear accelerators, refining of systems for visualization and guidance provided rapid development of extracranial radiosurgery. Nowadays there is a possibility of precise stereotactic irradiation of lesions with different size and localization. One of the most actual and promising indications for radiosurgery are different primary and metastatic lesions and arteriovenous malformations of spinal cord and spine. Radiosurgery and hypofractionated radiotherapy with precise dose delivery during one or several sessions allow effective and safe treatment of neoplasms with any degree of radioresistance. This paper contains analysis of the first Russian experience of stereotactic radiation treatment of lesions of spinal cord and spine using robotized system CyberKnife (Accuray Inc., USA).     

Imaging of congenital spine and spinal cord malformations

This article reviews normal embryologic development of the spine and spinal cord and the imaging features of congenital abnormalities of the spine and spinal cord, with particular focus on magnetic resonance imaging. The authors discuss spinal dysraphisms, a heterogeneous group of congenital abnormalities of the spine and spinal cord, and provide information to expand understanding of these complex entities.     

Intramedullary mass lesions of the spinal cord

Intramedullary tumors form 10% of all the spinal cord tumors. Majority of them are gliomas and rarely benign tumors are encountered. Twenty five cases of intramedullary mass lesions are studied regarding their clinical presentation, radiological features, surgical aspects and outcome following the surgery and radiotherapy. There were six benign lesions where the outcome was excellent. There were 11 patients with astrocytoma and 8 cases with ependymoma. In all, arrest of the disease or improvement could be achieved in 20 cases. Extent of surgical resection and role of radiotherapy, which are still controversial, are discussed.     

Diagnostic imaging of spinal cord lesions

Magnetic resonance imaging (MRI) has greatly facilitated morphologic evaluation of spinal cord lesions. Eleven cases representative of inflammatory, demyelinating, neoplastic and vascular diseases, are presented which illustrate and summarize important abnormal features in spinal cord imaging, particularly MR findings. Recently, specialised techniques such as MR angiography, fat-inhibiting methods, dynamic MRI and functional imaging have been developed. These methods have facilitated not only lesion diagnosis but also qualitative assessment, and are being used to analyze pathophysiology. Comprehensive diagnoses based on such modalities may be important in determining indications for surgery or defining the extent of surgery or the intensity of other treatments.     

Tactics in radical operations on the spine and spinal cord

The authors discuss the tactics in the surgical approach in radical operations on the spinal cord, cauda and spine. The discussion is based on 1972 operations on the spine and spinal cord. The group of radical operations comprises 192 cases. The operative mortality in this material was 1%. The authors believe that the surgical tactics in these diseases should be considerate but also as radical as possible.     

Delayed radiation lesions of the human spinal cord

Summary A report is given on patho-anatomical findings in five adult patients with cervical myelopathy following X-irradiation of hypopharyngeal cancer. The findings were largely consistent with those of earlier reports; however, telangiectases were found in all cases. The pathogenesis of the damage is briefly discussed in relation to experimental work on postirradiation lesions of the central nervous system. A vascular lesion is held to be the most important pathogenetic factor.

---

Zusammenfassung Es wird über die pathologischen Befunde bei fünf Erwachsenen mit cervicaler Myelopathie nach Röntgenbestrahlung von Hypopharynx-Carcinomen berichtet. Die Befunde zeigten weitgehende Übereinstimmung mit jenen früherer Beobachtungen, doch wurden in allen Fällen Teleangiektasien angetroffen. Die Pathogenese der Röntgenspätschädigung des Rückenmarks wird unter Berücksichtigung experimenteller Befunde diskutiert. Eine Gefäßschädigung — vorwiegend durch Schädigung der Gefäßendothelzellen — wird als wichtigster pathogenetischer Faktor angenommen.

     

Solitary osteochondroma of spine causing spinal cord compression

Three cases of spinal cord compression due to solitary osteochondroma of the spine are reported. The rarity and benign nature of the tumour is stressed. Other reported cases are reviewed.     

脊髓髓内病变的显微外科治疗

目的分析脊髓髓内占位性病变的手术特点,探讨手术时机、手术方式及预后。方法回顾性分析2002年7月-2008年4月经手术和病理证实的25例脊髓髓内占位性病变,随访患者术后神经功能状态。结果病变全切20例,次全切除3例,大部切除2例。术后病理证实室管膜瘤15例,星形细胞瘤2例,海绵状血管瘤2例,脂肪瘤2例,神经鞘瘤1例,血管畸形1例,结核瘤1例,炎性肉芽肿1例。术后神经功能好转20例,无变化3例,加重2例。结论对脊髓髓内病变应早期诊断,应在发生明显神经功能障碍之前实施手术。沿着确切的瘤一髓界面分离、切除病变,是肿瘤一级切除的基本保证,重建蛛网膜下腔能有效防止脊髓粘连;采用椎板成型解剖学复位技术可提高术后脊柱稳定性。     

Gunshot wounds of the spine and spinal cord. Neurosurgical tactics

In the Department of Neurosurgery, Medical Academy in Lód? in the years 1971-1986 out of 356 injuries to the spine and spinal cord 6 cases (1.7%) were shot wounds. The indications to surgical treatment were: high-grade posttraumatic spinal instability, intense liquorrhoea with threatening meningitis, and violent pains in lower extremities. The clinical material and the tactics of neurosurgical management are described.     

MR investigation of spinal cord herniation in the thoracic spine

Transdural herniation of the spinal cord is thought to be previously extremely rare and very often misdiagnosed. Possible reasons may be iatrogenic and traumatic or in about one third of cases it may be unknown, where the probable origin might be a congenital dural defect. The pathology may show characteristic and misleading MR patterns of the thoracic spine, emphasising the importance of these patterns. This anomaly can lead to progressive Brown-Sequard syndrome. Surgical intervention, consisting the repair of the dural defect may result in improvement or even complete regression of the neurologic deficits.     

Epidemiology of spinal cord lesions in Denmark

Denmark has a population of about 5.2 million. The rehabilitation of spinal cord injured (SCI) takes place in two specialised rehabilitation hospitals. The incidence of new traumatic SCI admitted to these hospitals in the period 1975-1984 was 9.2 per million per year. During this period 92 Danes with non-traumatic and 268 with newly sustained traumatic spinal cord lesions were admitted to the rehabilitation hospital in Hornboek, which uptake area corresponded to South and East Denmark and Greenland and the Faroe Islands. Among the traumatic SCI 47% were due to traffic accidents, 23% to falls to a level below, 8% to attempted suicides, 6% to shallow water diving, and 6% to sporting accidents. The number of SCI caused by traffic accidents was found to decrease coincidently with the introduction of general speed limits and compulsory seat belt wearing. The male/female ratio was for the traumatic SCI 3.3, which was significantly lower than in the preceding 10-year period. 40% of all traumatic SCI were sustained at 15-24 years of age, and 51% had tetraplegia. Traffic accidents gave rise to more cervical, and falls to more caudal lesions. 41% of the traumatic SCI had an improvement in their neurological status after their admission to the neurosurgical department until the discharge from the rehabilitation hospital. Those with incomplete lesions showed greater improvement than those with complete lesions regardless of the level. Complete cervical lesions had significant better remissions than complete thoracic/lumbar lesions.     

Athetosis-dystonia in intramedullary lesions of spinal cord

Athetosis and dystonia are well known clinical signs, described in disorders of basal ganglia. As opposed to pseudoathetosis, true athetosis was hitherto not reported in cord lesions. We here report three patients with athetosis and dystonia of hands due to intramedullary lesions of cervical cord: two patients with syringomyelia and one with glioma. Even though pseudoathetosis can be produced by lesions of posterior columns and likely to be confused with the involuntary movements of our patients, they had clinical and EMG findings consistent with true athetosis. A possible explanation for the athetosis and dystonia due to cord lesion is being postulated.