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The authors present a group of 23 patients with extradural spinal metastases who had undergone surgical treatment with different approaches, with reference to the anatomical site of the tumours. They report the results and discuss the criteria of the different surgical technical choices.
Basal cell carcinoma (BCC) is the most common cutaneous malignancy affecting populations with light skin, though these tumors rarely cause severe morbidity or mortality. We report an adult male with back pain and leg weakness associated with a neglected, ulcerated lower back tumor of fifteen years duration. The clinical impression of BCC causing spinal cord compression was confirmed by microscopy and magnetic resonance imaging (MRI).
Ossification of the ligamentum flavum is common in Japan but rare in Western countries. Myelopathy of variable severity is a possible complication. Extension of the lesions over several levels at the thoracic spine is exceedingly rare. We report a new case in a 50-year-old man who had slowly progressive spinal cord compression with a sensory level at the navel. Computed tomography (CT) and magnetic resonance imaging (MRI) of the thoracic spine showed calcium-density masses that were in contact with the neural arches and bulged into the spinal canal at T5/T6, T7/T8, T9/T10, and T10/T11. Laboratory test findings were unremarkable. Surgical decompression by laminectomy and foraminotomy was followed by a favorable outcome. Histology showed extensive areas of bone metaplasia associated with calcific deposits. The diagnosis, treatment, and possible etiologies of this rare condition are discussed based on a literature review.
A six-year-old, male Doberman pinscher was presented for acute onset of upper motor neuron tetraparesis. An extradural compressive lesion compatible with intervertebral disk rupture at the sixth to seventh cervical (C6-C7) disk space was evident on myelography. A large, gelatinous mass of pure cryptococcal organisms causing spinal cord compression was identified upon exploratory surgery. Removal of the mass caused relief of clinical signs. No evidence of involvement of other organ systems was found; however, serum and cerebrospinal fluid titers were positive for cryptococcal infection. The dog was treated with fluconazole (5.5 mg/kg body weight, per os sid) until serum titers for cryptococcal infection were negative at seven months postsurgery. To the authors' knowledge, this is the only report of a dog with cryptococcosis treated successfully using fluconazole as a sole agent.
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In many cases of advanced prostate cancer, bone metastasis frequently occurs. Androgen deprivation therapy is very effective for these cases, but this therapy would result in failure, and symptomatic metastasis would develop. Approximately eighty percent of cases with bone metastasis showed epidural metastasis. When these lesions enlarge, spinal cord compression (SCC) occurs in five to ten percent of cases. Many urologist would choose an adequate modality for this problem, based on the prognosis and/or general status of each patient. In this article we overview laminectomy for SCC and present our experience.
BACKGROUND CONTEXT: The reported incidence of vertebral hemangioma within the spinal column is common. Most often these benign vascular tumors are incidental radiographic findings and do not cause neurological sequelae. Rarely, vertebral hemangiomas will cause compressive neurological symptoms, such as radiculopathy, myelopathy and paralysis. In these cases the clinical presentation is usually the subacute or delayed onset of progressive neurological symptoms. This report demonstrates a symptomatic vertebral hemangioma presenting with rapid onset neurologic sequelae. PURPOSE: To discuss diagnostic and management issues presented by symptomatic vertebral hemangioma. STUDY DESIGN: Case report and review of literature. PATIENT SAMPLE: Sixty-one-year-old white woman with low back pain and rapidly progressive myelopathic symptoms. METHODS: A case of vertebral hemangioma with neurological sequelae is presented followed by a discussion of the literature concerning diagnostic and therapeutic options in the management of this pathologic entity. RESULTS: The results of our review reveal that the incidence of vertebral hemangioma causing compressive neurological symptoms is rare despite the overall prevalence of vertebral hemangioma. Vertebral hemangioma may present with rapid onset myelopathic symptoms and may mimic those symptoms caused by a malignancy. Radiographic imaging modalities are extremely useful and display characteristic findings in the diagnostic evaluation of these tumors. Angiographic embolization of feeding vessels has been effective in minimizing operative blood loss, and surgical decompression and stabilization is frequently indicated. Postsurgical radiotherapy has also been demonstrated to serve as a limited adjunct to surgery by reducing tumor recurrence in the event of less than complete tumor resection. CONCLUSIONS: Because of the rapid presentation of myelopathic symptoms in this case, preoperative angiographic embolization was not performed, and the patient underwent emergent decompressive surgery. In this case emergent operative decompression and stabilization was effective in reversing the patient's myelopathic symptoms, while maintaining long-term stability of the spinal column. Postoperative radiation was not administered because of the extent of tumor resection. Surgical intervention has produced long-term cure of this patient's myelopathy and T10 vertebral hemangioma.
Extramedullary hematopoiesis is a common accompaniment of a variety of hematologic diseases such as hereditary spherocytosis, thalassemia and myelofibrosis. The association of extramedullary hematopoiesis with polycythemia vera in the proliferative phase is much less usual. We report a patient who presented with paraplegia due to spinal cord compression; clinical investigation revealed a paravertebral hematopoietic tumor, and the diagnosis of polycythemia vera was then established.
Endodermal sinus tumor is an uncommon malignant germ-cell neoplasm. These tumors usually present in childhood or young adulthood as testicular or ovarian masses; however, mediastinal and intracranial tumors have been described. The authors report the occurrence of a primary paraspinal endodermal sinus tumor in a 21-month-old boy who presented with thoracic spinal cord compression. A review of the literature failed to reveal a similar case. The clinical presentation, radiographic characteristics, operative findings, and patient outcome are discussed.
Adenocystic carcinomas are malignant tumours that arise from the major accessory salivary glands. Cutaneous involvement can result from direct extension from a salivary gland neoplasm. Cutaneous adenocystic carcinomas remote from adjacent salivary tissue are rare. We present the case of an elderly patient with primary cutaneous adenoid cystic carcinoma causing spinal cord compression at the L1-L2 level. The patient was operated on and the tumour totally removed. No similar cases have been found in our review of the literature.
Fifteen consecutive patients with thoracic disc herniation treated by posterolateral microsurgical costotransversectomy are described. With appropriate modifications to the standard technique, costotransversectomy was found to be a suitable approach even for calcified central discs, and discs which had eroded intradurally. All patients had evidence of spinal cord compression preoperatively with varying degrees of leg weakness. The results of surgery are discussed. Ten patients who were disabled but ambulant showed marked improvement in symptoms and signs. Of the remaining five, all of whom were severely disabled and nonambulant preoperatively, four demonstrated significant improvement. Most patients mobilised rapidly, 13 being able to walk unaided within 24 hours. One patient developed an intrathoracic meningocoele postoperatively, which resolved after multiple percutaneous aspirations. Otherwise there were no serious pulmonary complications. We believe that costotransversectomy is the approach of choice for central as well as centrolateral and lateral thoracic disc herniations.