Asunto(s)
Neurilemoma , Humanos , Neurilemoma/diagnóstico por imagen , Neurilemoma/patología , Imagen por Resonancia Magnética , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/patología , Femenino , Masculino , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/patología , Persona de Mediana EdadRESUMEN
Spinal cord tumors are uncommon, and its multiple representatives not always have pathognomonic characteristics, which poses a challenge for both patients and caring physicians. The radiologist performs an important role in recognizing these tumors, as well as in differentiating between neoplastic and non-neoplastic processes, supporting clinical and surgical decision-making in patients with spinal cord injury. Magnetic Resonance Imaging (MRI) assessment, paired with a deep understanding of the various patterns of cord involvement allied to detailed clinical data can provide a diagnosis or significantly limit the differential diagnosis in most cases. In this article, we aim to review the most common and noteworthy intramedullary and extramedullary spinal tumors, as well as some other tumoral mimics, with an emphasis on their MRI morphologic characteristics.
Asunto(s)
Traumatismos de la Médula Espinal , Neoplasias de la Médula Espinal , Humanos , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/patología , Imagen por Resonancia Magnética/métodos , Diagnóstico Diferencial , Médula EspinalRESUMEN
Spinal Paragangliomas are rare tumors, most frequently involving the cauda equina and the filum terminale. We report the case of a 62-year old woman presenting with a one month's lower back pain, left sciatica and leg weakness. Spinal magnetic resonance imaging showed a extramedullary lesion at L3-L4 level, measuring 37 x 52 x 21 mm with contrast enhancement. It presented an unenhancing intradural cystic lesion in the upper pole. The patient underwent lumbar laminectomy, and with neurofisiologic monitorization the tumor was completely resected. Microscopic examination of the tumor revealed a paraganglioma. In a review of the literature, we found only five previous reported cases in which the tumor is accompanied by a cyst.
Los paragangliomas son tumores poco frecuentes que se localizan en la región de la cauda equina y filum terminal. Presentamos el caso de una mujer de 62 años con una historia de 1 mes de evolución de lumbalgia, ciática y debilidad en el miembro inferior izquierdo. Una resonancia magnética lumbar mostró una tumoración extramedular en el nivel L3-L4 que medía 37 x 52 x 21 mm que se realzaba con contraste. Presentaba así mismo una lesión quística en el polo superior del tumor. Se realizó una laminectomía lumbar y bajo control neurofisiológico se realizó una extirpación completa el tumor. El estudio microscópico revelo que se trataba de un paraganglioma. Realizamos una revisión de la literatura encontrando únicamente otros cinco casos de paraganglioma espinal con lesión quística acompañante
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Paraganglioma/cirugía , Paraganglioma/diagnóstico por imagen , Neoplasias de la Médula Espinal/cirugía , Neoplasias de la Médula Espinal/diagnóstico por imagen , Quistes/cirugía , Quistes/diagnóstico por imagen , Imagen por Resonancia Magnética , LaminectomíaRESUMEN
Intramedullary schwanommas are rare, and most cases are reported in cervical region. Less than 20 dorsal intramedullary schwanommas have been reported till date in literature. This is due to their cell of origin, the Schwann cell, which is not normally found within the parenchyma of the brain and spinal cord; therefore it is not surprising that these lesions are rare. We report a rare solitary dorsal intramedullary schwanomma in a young adult patient who presented with paraplegia.
Asunto(s)
Humanos , Femenino , Adulto , Neoplasias de la Médula Espinal/cirugía , Neurilemoma/cirugía , Neurilemoma/patología , Médula Espinal/cirugía , Médula Espinal/patología , Neoplasias de la Médula Espinal/diagnóstico por imagen , Diagnóstico Diferencial , Laminectomía/métodos , Neurilemoma/diagnóstico por imagenRESUMEN
Here, we report a case of a 3-year-old female who presented to clinic with an enlarging mass in the posterior cervical midline. The mass was present since birth and demonstrated no cutaneous stigmata. Plain film, CT, and MRI of the cervical spine (C3-C5) revealed enlargement of the spinal canal, soft tissue calcification, spinal dysraphism, and an intramedullary, predominantly fatty, mass. The mass had associated calcifications and a highly proteinaceous cyst. Surgical resection of the spinal lesion was subsequently performed. Histopathological evaluation revealed a mature teratoma. Cervical spinal teratomas in the pediatric population are rare entities with few cases currently reported in the literature. We conducted a systematic review to outline the current evidence detailing cases of intramedullary spinal cord teratomas. Six articles were included for final review. All patients in the included articles underwent maximal surgical resection with one patient also receiving chemotherapy and radiation. With our report, we aim to add to the literature on cervical intramedullary spinal cord teratomas in the pediatric population.
Asunto(s)
Neoplasias de la Médula Espinal , Disrafia Espinal , Teratoma , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/patología , Vértebras Cervicales/cirugía , Niño , Preescolar , Femenino , Humanos , Cuello/patología , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/patología , Neoplasias de la Médula Espinal/cirugía , Teratoma/diagnóstico por imagen , Teratoma/patología , Teratoma/cirugíaRESUMEN
Sacral spinal cord ependymoma is an uncommon pathology. Most of the reported cases are consistent with a myxopapillary ependymoma histopathologic subtype. Non-myxopapillary ependymomas rarely occur in the sacral region. Most lesions are intradural; however, rare extradural cases can occur. We present the case of a 46-year-old female patient diagnosed with a grade II sacral extradural ependymoma, emphasising the importance of an interdepartmental case approach for diagnosis and management. Even though grade II ependymomas are considered low grade, the potential for recurrence and metastatic disease has been reported. There are no treatment guidelines for these rare tumours besides gross total resection.
Asunto(s)
Ependimoma , Neoplasias de la Médula Espinal , Ependimoma/diagnóstico por imagen , Ependimoma/cirugía , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Región Sacrococcígea , Sacro/diagnóstico por imagen , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/cirugíaRESUMEN
The present case reports a 13-year-old patient with an intradural arachnoid cyst, which manifested itself with a sudden loss of strength and sensitivity in the lower and upper limbs and a severe pain in the cervical and thoracic region. On examination, a lesion displayed as an intradural hematoma; however, a laminotomy was performed and it was realized that the lesion was an arachnoid spinal cyst of the cervical-dorsal spine.
Asunto(s)
Humanos , Masculino , Adolescente , Neoplasias de la Médula Espinal/cirugía , Quistes Aracnoideos/cirugía , Quistes Aracnoideos/patología , Neoplasias de la Médula Espinal/complicaciones , Neoplasias de la Médula Espinal/diagnóstico por imagen , Quistes Aracnoideos/diagnóstico por imagen , Laminectomía/métodosRESUMEN
This report presents the longest spanning intradural myxopapillary ependymoma consisting of 23 vertebral segments in the literature. An 11-year-old boy presented with right arm pain, mid back pain and progressive paraparesis associated with urinary retention. On MRI, the patient was found to have an intradural lesion extending from C5 to S3. The patient underwent T7 and T8 laminectomies with an almost total resection except for a minimal residual adhering to the spinal cord. The patient with the largest spanning spinal cord ependymoma was managed satisfactorily without significant morbidity. A small laminectomy may be used in some occasions despite the tumour's extensive size because it may have a single point of attachment to the cord.
Asunto(s)
Ependimoma/diagnóstico por imagen , Neoplasias de la Médula Espinal/diagnóstico por imagen , Vértebras Cervicales , Niño , Ependimoma/patología , Ependimoma/cirugía , Humanos , Laminectomía , Vértebras Lumbares , Imagen por Resonancia Magnética , Masculino , Radioterapia Adyuvante , Sacro , Neoplasias de la Médula Espinal/patología , Neoplasias de la Médula Espinal/cirugía , Vértebras Torácicas/cirugía , Carga TumoralRESUMEN
Melanoma is a malignant neoplasm of melanin-producing cells. Melanoma usually occurs in the skin, but can also arise in any anatomical site that contains melanocytes, such as mucous membranes, the eyes, and the central nervous system (CNS). Primary CNS malignant melanoma most often develops in the leptomeninges. We report a case of a rare intramedullary melanoma of the thoracic spinal cord. A 78-year-old man was treated with surgery, radiotherapy, and immunotherapy for leptomeningeal spread. We also discuss the role of imaging methods in diagnosis and follow-up. Medullary melanoma occurs more frequently in adults. The most common presenting symptoms are the insidious onset of lower extremity weakness and paresthesia. Magnetic resonance imaging is the method of choice for evaluation. Although there are no imaging features to accurately distinguish primary malignant melanoma from other melanocytic or hemorrhagic tumors, hyperintensity on T1-weighted magnetic resonance imaging should lead to inclusion of this neoplasm in differential diagnosis of spinal cord tumors. Positron emission tomography-computed tomography is a useful auxiliary examination to evaluate the extent of local and metastatic disease. Surgical resection is the primary treatment for intramedullary melanoma. However, the efficacy of adjunctive radiotherapy and chemotherapy for primary spinal cord malignant melanoma is still controversial.
Asunto(s)
Neoplasias Encefálicas , Melanoma , Neoplasias Cutáneas , Neoplasias de la Médula Espinal , Adulto , Anciano , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Masculino , Melanoma/diagnóstico por imagen , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/cirugíaRESUMEN
BACKGROUND: Intraspinal tumors are 10 to 15 times less common than brain tumors. The midline approach with extensive laminectomies represents the current gold-standard for resection, causing instability, muscle damage, and kyphosis among other well-known complications. Minimally invasive series reported their results using retractor-based systems. We analyzed a patient series treated with a non-expansile tubular approach, describing the technique, grade of resection, and clinical outcomes. METHODS: A series of consecutive cases operated between 2016 and October 2018 were analyzed retrospectively. The database included age, sex, clinical presentation, intraspinal location (intra/extradural), number of laminotomies, grade of resection, surgical time, bleeding, and follow-up. The initial and follow-up clinical condition was analyzed using the Frankel scale. RESULTS: A total of 13 patients underwent surgery: 3 intraspinal/extradural (23%), 8 intradural/extramedullary (61.5%), and 2 intramedullary tumors (15.3%); these were classified as 5 meningiomas (38.4%), 4 neurofibromas (30.7%), 2 schwannomas (15.3%), 1 hemangioblastoma (7.6%), and 1 astrocytoma (7.6%). Eleven (84.61%) patients had complete motor improvement, 1 patient had partial improvement, and 1 patient had no improvement (7.6% each). An 18-mm working channel tube was used for extramedullary lesions and 20-mm tubes for intramedullary injuries. Total tumor resection was achieved in 11 patients (84.6%) and subtotal in 2 patients (15.38%) corresponding to intramedullary tumors. CONCLUSIONS: Although this study consisted of a small series, we have shown the possibility of resecting intraspinal tumors (some intradural-intramedullary) with non-expansile tubes in a safe and effective way with no complications. Most of the patients had complete neurological improvement at the end of follow-up.
Asunto(s)
Descompresión Quirúrgica/métodos , Fijadores Internos , Microcirugia/métodos , Neoplasias de la Médula Espinal/cirugía , Neoplasias de la Columna Vertebral/cirugía , Adulto , Anciano , Descompresión Quirúrgica/instrumentación , Diseño de Equipo , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Meningioma/diagnóstico por imagen , Meningioma/cirugía , Microcirugia/instrumentación , Persona de Mediana Edad , Neurilemoma/diagnóstico por imagen , Neurilemoma/cirugía , Neurofibroma/diagnóstico por imagen , Neurofibroma/cirugía , Estudios Retrospectivos , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Adulto JovenRESUMEN
Objective To report a case of intradural extramedullary metastasis originated from a kidney neoplasm. Metastases in this topography occur in a low frequency, especially considering that the primary tumor was located along the urinary system. Case Report Amale adult begins to present with pain in the lower limbs and develops flaccid paraparesis of the pelvic limbs, also attacking the control of the sphincter. The patient had a previous history of right nephrectomy due to a kidney neoplasm. After investigation with imaging exams, ametastatic lesion was found to be the source of the symptoms. The patient was surgically treated by the neurosurgery team of the hospital. Conclusion Cases like this are not common, and considering the low incidence of these cases and the nonspecific symptoms, such as pain, we do not always come up with the hypothesis of a metastasis in this topography. The surgical treatment, although it is a palliative feature, has an important part inmaintaining the performance and the quality of life of the patient.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Médula Espinal/terapia , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias Renales/complicaciones , Metástasis de la Neoplasia/terapia , Compresión de la Médula Espinal , Análisis de SupervivenciaAsunto(s)
Carcinoma de Células Renales/diagnóstico por imagen , Carcinoma de Células Renales/patología , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/patología , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/secundario , Anciano , Carcinoma de Células Renales/terapia , Diagnóstico Diferencial , Humanos , Neoplasias Renales/terapia , Imagen por Resonancia Magnética , Masculino , Neoplasias de la Médula Espinal/terapia , Vértebras Torácicas , Tomografía Computarizada por Rayos XRESUMEN
Subacute necrotizing myelopathy (SNM) or Foix-Alajouanine syndrome is a rare disease characterized by progressive neurological dysfunction caused by a spinal dural arteriovenous fistula (AVF). Radiological diagnosis is usually suspected when there is intramedullary nonspecific enhancement and perimedullary flow voids. Ring-enhancement is rarely reported in the scope of AVF, which poses a diagnostic challenge and raises the suspicion of a spinal cord tumor. In such situations, biopsy can be required and delay proper diagnosis. We report the case of a patient with SNM, who underwent biopsy on the assumption of it being a spinal cord tumor.
Asunto(s)
Fístula Arteriovenosa/diagnóstico por imagen , Enfermedades de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/diagnóstico por imagen , Anciano , Angiografía , Fístula Arteriovenosa/patología , Biopsia , Diagnóstico Diferencial , Femenino , Humanos , Médula Espinal/diagnóstico por imagen , Médula Espinal/patología , Enfermedades de la Médula Espinal/patología , Enfermedades de la Médula Espinal/cirugía , Neoplasias de la Médula Espinal/patología , SíndromeRESUMEN
Summary Subacute necrotizing myelopathy (SNM) or Foix-Alajouanine syndrome is a rare disease characterized by progressive neurological dysfunction caused by a spinal dural arteriovenous fistula (AVF). Radiological diagnosis is usually suspected when there is intramedullary nonspecific enhancement and perimedullary flow voids. Ring-enhancement is rarely reported in the scope of AVF, which poses a diagnostic challenge and raises the suspicion of a spinal cord tumor. In such situations, biopsy can be required and delay proper diagnosis. We report the case of a patient with SNM, who underwent biopsy on the assumption of it being a spinal cord tumor.
Resumo Mielopatia necrotizante subaguda (MNS) ou síndrome de Foix-Alajouanine é uma doença rara que se caracteriza por disfunção neurológica progressiva causada por uma fístula arteriovenosa espinal dural. O diagnóstico radiológico é comumente suspeitado quando aparece captação não específica de contraste e de artefatos de fluxo (flow voids) perimedulares. Raramente, a captação de contraste exibe o aspecto em anel, constituindo um grande desafio diagnóstico. Nesses casos, o principal diagnóstico diferencial é um tumor intramedular, e os pacientes são encaminhados para biópsia da lesão, atrasando o diagnóstico definitivo. Relatamos o caso de uma paciente com MNS, a qual foi submetida à biópsia da lesão em virtude de suspeita de tumor intramedular.
Asunto(s)
Humanos , Femenino , Anciano , Enfermedades de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/diagnóstico por imagen , Fístula Arteriovenosa/diagnóstico por imagen , Médula Espinal/patología , Médula Espinal/diagnóstico por imagen , Enfermedades de la Médula Espinal/cirugía , Enfermedades de la Médula Espinal/patología , Neoplasias de la Médula Espinal/patología , Síndrome , Biopsia , Angiografía , Fístula Arteriovenosa/patología , Diagnóstico DiferencialAsunto(s)
Descompresión Quirúrgica/métodos , Neuroblastoma/secundario , Neoplasias del Sistema Nervioso Periférico/patología , Canal Medular/patología , Neoplasias de la Médula Espinal/secundario , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Desarrollo Infantil/fisiología , Femenino , Humanos , Biopsia Guiada por Imagen/métodos , Lactante , Imagen por Resonancia Magnética/métodos , Masculino , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Neuroblastoma/diagnóstico por imagen , Neuroblastoma/terapia , Neoplasias del Sistema Nervioso Periférico/diagnóstico por imagen , Neoplasias del Sistema Nervioso Periférico/terapia , Pronóstico , Medición de Riesgo , Canal Medular/diagnóstico por imagen , Compresión de la Médula Espinal/prevención & control , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/terapia , Resultado del TratamientoAsunto(s)
Lipoma , Polirradiculopatía , Neoplasias de la Médula Espinal , Adulto , Femenino , Humanos , Lipoma/complicaciones , Lipoma/diagnóstico por imagen , Lipoma/cirugía , Imagen por Resonancia Magnética , Polirradiculopatía/diagnóstico por imagen , Polirradiculopatía/etiología , Polirradiculopatía/cirugía , Neoplasias de la Médula Espinal/complicaciones , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/cirugíaRESUMEN
BACKGROUND: Intramedullary hemangioblastomas are rare benign vascular tumors, infrequent in pediatric patients. Clinical symptoms vary according to the age of presentation, tumor size, location, and concomitant syringomyelia. This is the second reported case of hemangioblastoma presenting with acute hydrocephalus. CASE PRESENTATION: A 3-month-old infant with acute hydrocephalus was asymptomatic after a ventriculoperitoneal shunt was placed. She returned 3 months later with irritability, acute paraplegia, and respiratory distress. Magnetic resonance imaging (MRI) showed an intramedullary T8-T9 tumor with syringomyelia. She underwent surgical resection with good results during the 6-month follow-up. CONCLUSION: Intramedullary tumors may present as hydrocephalus and other nonspecific symptoms, with invariably delayed diagnosis in children, but must be considered in suspicious cases.
Asunto(s)
Hemangioblastoma/complicaciones , Hidrocefalia/etiología , Hidrocefalia/cirugía , Neoplasias de la Médula Espinal/complicaciones , Antígenos CD34/metabolismo , Femenino , Hemangioblastoma/diagnóstico por imagen , Humanos , Hidrocefalia/diagnóstico por imagen , Lactante , Molécula-1 de Adhesión Celular Endotelial de Plaqueta/metabolismo , Neoplasias de la Médula Espinal/diagnóstico por imagen , Tomógrafos Computarizados por Rayos XAsunto(s)
Humanos , Femenino , Adulto , Polirradiculopatía/cirugía , Polirradiculopatía/etiología , Polirradiculopatía/diagnóstico por imagen , Neoplasias de la Médula Espinal/cirugía , Neoplasias de la Médula Espinal/complicaciones , Neoplasias de la Médula Espinal/diagnóstico por imagen , Lipoma/cirugía , Lipoma/complicaciones , Lipoma/diagnóstico por imagen , Imagen por Resonancia MagnéticaRESUMEN
Spinal cord metastases are an uncommon secondary location of a malignant neoplasm. They are rarely diagnosed during life and when that is the case, it is in the clinical setting of a disseminated cancer and very seldom as the first clinical manifestation. We report two patients, with no previous disease, who developed a progressive myelopathy. An intramedullary spinal cord tumor was diagnosed, based on the clinical picture and imaging studies. They were operated and biopsies showed spinal cord metastases whose primary tumor was a lung neoplasm. We discuss the clinical features in these patients, the diagnosis of progressive myelopathy in cancer patients, treatment and prognosis of this unusual secondary cancer location.
Asunto(s)
Adenocarcinoma de Células Claras/secundario , Neoplasias Pulmonares/patología , Neoplasias de la Médula Espinal/secundario , Adenocarcinoma de Células Claras/diagnóstico por imagen , Adulto , Resultado Fatal , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía , Neoplasias de la Médula Espinal/diagnóstico por imagenRESUMEN
An infant with congenital torticollis underwent chiropractic manipulation, and within a few hours had respiratory insufficiency, seizures, and quadriplegia. A holocord astrocytoma, with extensive acute necrosis believed to be a result of the neck manipulation, was found and resected. We believe that every child with torticollis, regardless of age, should undergo neurologic and radiologic evaluation before any form of physical treatment is instituted.