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Results for “Epidural Neoplasms”

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At least 19 recordsLinked to original sources
PubMed1985

Circulatory disturbance of the spinal cord with epidural neoplasm in rats.

An experimental model of spinal epidural neoplasm was produced in rats by injecting Walker 256 carcinoma cell suspension anterior to the T12-13 vertebral body. With this model, spinal cord blood flow (SCBF) and its response to CO2 inhalation were estimated by the carbon-14-antipyrine autoradiography and the hydrogen clearance methods. In the early stages after tumor implantation, weakness, axonal swelling, and edema of the white matter were observed, while both SCBF and its response to CO2 inhalation remained normal. In the next stage, the tumor invaded the spinal canal and compressed the spinal cord epidurally. The edema of the white matter progressed, while the gray matter was morphologically intact. The SCBF and its response to CO2 inhalation were altered at both the compression area and caudally in the spinal cord. Changes in response to CO2 inhalation appeared earlier than the SCBF decrease. In the last stage, the SCBF decreased rapidly to the critical level, producing irreversible nervous tissue damage. Microangiographic studies revealed extensive obliteration of the spinal epidural venous plexus and patency of the larger nutritional vessels. From the data obtained, the progressive vascular pathophysiology related to spinal epidural neoplasm is as follows: 1) the vertebral venous plexus is compressed and obliterated in the early stages of the disease, and vasogenic edema appears in the spinal cord; 2) as the tumor grows, mechanical compression of the spinal cord is added and the circulatory disturbance increases; and 3) in the last stage, SCBF decreases rapidly to a critical flow level, and the loss of cord function becomes irreversible.

Angiography↗
PubMed1980

Edema and circulatory disturbance in the spinal cord compressed by epidural neoplasms in rabbits.

An experimental model of spinal cord compression by epidural neoplasms was produced in rabbits by injecting a VX2 tumor-cell suspension anterior to the T-13 vertebral body. With this experimental model, edema and circulatory disturbance of the spinal cord compressed by epidural tumors were studied. The characteristic histopathological findings in the compressed spinal cord were edema and axonal swelling in the white matter. Water content and uptake of intravenously injected 99mTc pertechnetate in the compressed spinal cord were significantly greater than in the spinal cord distant from the tumor, and increased in proportion to the degree of neurological loss. Microangiography and fluorescein angiography demonstrated stenosis or obstruction of the epidural venous plexus and impairment of venous drainage in the compressed spinal cord at the early stage of neurological symptoms. It is suggested that venous stasis and subsequent vasogenic edema in the spinal cord play an important role in the symptomatology of metastatic epidural spinal cord compression.

Animals↗
PubMed1989

Identification of epidural neoplasm. Radiography and bone scintigraphy in the symptomatic and asymptomatic spine.

Early identification and treatment of epidural neoplasm, before the development of significant neurologic deficits, provides the best opportunity for a favorable outcome. Among the many patients with symptoms, signs, or scintigraphic or radiographic findings suggesting possible epidural disease, a small proportion will have the lesion. The selection of patients for definitive imaging of the epidural space should be based on a determination of the risk of this complication. In this study, the medical records, plain spinal radiographs, bone scintigraphs and myelograms of 43 patients were analyzed retrospectively to assess the risk of epidural disease associated with specific clinical, radiographic, and scintigraphic findings. Cervical, thoracic, and lumbosacral spinal segments were evaluated independently. Symptomatic segments (SS) (N = 41), defined by focal pain or neurologic dysfunction, were distinguished from asymptomatic segments (AS). At SS, epidural disease was found at 86% and 8% of abnormal and normal spinal radiographs, respectively (P less than 0.001), and at 69% and 0% of abnormal and normal scintigrams, respectively (P less than 0.001), whereas at AS epidural disease occurred in 43% and 3% of abnormal and normal spinal radiographs, respectively (P less than 0.001), and 14% and 7% of abnormal and normal scintigrams, respectively (P = NS). Vertebral collapse was highly predictive of an epidural lesion. Epidural disease occurred in 12% of SS and 0% of AS with an abnormal scintigram and normal radiograph, 86% of SS and 45% of AS with abnormalities on both scintigram and radiograph, and at two AS when both were normal. Decision analysis applied to these data yielded a specific conditional probability of epidural disease for each combination of clinical, scintigraphic, and radiographic findings. These data provide a basis for the selection of patients for additional evaluation of the epidural space before neurologic deficits develop.

Adult↗
PubMedDate not supplied

Surgical treatment of vertebro-epidural neoplasms of the cervical tract via the anterior approach.

Fifteen cases of vertebral-epidural neoplasms of the cervical tract, treated surgically by the technique of longitudinal median somatotomy with inlay arthrodesis via the anterior approach are presented. Compression of the spinal anterior artery is eliminated by the wide anterior longitudinal exposition, which also creates a support for a possible second operation, either laminectomy or foraminotomy.

Adolescent↗
PubMed1986

[Cortical somatosensory evoked potential associated with experimental chronic cord compression by epidural neoplasm in rabbits].

An experimental model of spinal cord compression was developed in rabbits by epidural neoplasms which were injected anterior to the T 13 vertebral body and grew into the spinal canal through the intervertebral foramina. With this experimental model, the neurological condition of the animals was monitored using a scale and changes of somatosensory evoked potentials (SEPs) were studied to evaluate the neurophysiological effect of experimental chronic cord compression. The animals were immobilized with pancuronium bromide and artificial respiration was maintained through a tracheostomy. SEPs were recorded by silver ball electrodes which were positioned epidurally over the somatosensory cortex through small burr holes. A subcutaneous needle placed at the nose served as a reference electrode. Right hind paw was stimulated via two percutaneous needles with 0.1 msec rectangular impulses sufficiently strong to produce motor responses, ranging from 10 to 20 volt in control rabbits. Electrical stimuli were delivered at a rate of 1 Hz. The intensity of electrical stimulation was raised up to 300 volt, when no consistent SEP was observed in the rabbit with spinal neoplasm. The SEP was summated by averaging 50 successive cortical transients with the analysis time of 200 and 500 msec. The cortical SEPs in the rabbit normally consisted of a positive-negative sequence, which we labelled P1, N1, P2, N2 and so on. Early peaks, P1 and N1, were observed constantly with average latencies of 30.1 and 53.3 msec respectively in normal rabbits. The variability of amplitudes seen even in control animals made them a less useful measure of function than latencies. Normal SEPs were preserved until the animals demonstrated moderate paraparesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Plain film clues to the diagnosis of spinal epidural neoplasm and infection.

Radiographs of 22 normal patients and 35 patients with proven epidural disease were correlated with CT scans to determine the range of normal and abnormal appearances of the osseous surfaces marginating the spinal canal. A subtle but useful plain film clue to early epidural disease was indistinctness of the posterior vertebral body margin, which in at least one case was the solitary radiographic sign of epidural metastasis. The radiographic distinctness of each of the bony margins of the spinal canal varied predictably with spinal level in normal individuals owing to systematic variations in obliquity. Indistinctness of an osseous spinal canal margin, interpreted with knowledge of the range of normal anatomy at the appropriate level, may provide the earliest plain film clue to the presence of spinal epidural disease.

Diagnosis, Differential↗
PubMed1977

Experimental spinal cord compression by epidural neoplasm.

We have developed an experimental model of spinal cord compression in rats. Tumor injected anterior to the T-12 vertebral body grows through the intervertebral foramina to compress the cord and produces paraplegia in 3 to 4 weeks. Evidence for vasogenic edema in spinal cord compressed by tumor includes increased water content, leakage of horseradish peroxidase into gray matter, and histologic evidence of edema. The vascular supply to the cord overlying the tumor appears to be compromised. Both spinal cord edema and clinical symptoms are lessened by treating symptomatic animals with dexamethasone.

Acute Disease↗
PubMed1977

Treatment of experimental spinal cord compression caused by extradural neoplasms.

Epidural spinal cord compression was produced in rats by injection of Walker 256 carcinoma cell suspension anterior to the T-12 or T-13 vertebral body. The tumor grows through the intervertebral foramina to compress the spinal cord and produce paraplegia in 3 to 4 weeks. The effect of several treatments upon clinical signs was assessed. Dexamethasone caused a significant but transient improvement in neurological function. Radiation therapy likewise improved neurological function, and was more effective when given by a high-dose protracted course than when given either in a single dose or a low-dose protracted course. Laminectomy was not helpful in relieving neurological symptoms. Dimethyl sulfoxide did not relieve neurological symptoms. Cyclophosphamide was most effective in relieving neurological symptoms, and most of the animals that were treated with that drug when they were severely weak but still able to move their hind limbs recovered fully. Some animals that were totally paraplegic when treatment began recovered function after radiation therapy or cyclophosphamide treatment, but recovery was better if treatment was started when animals could still move their hind limbs. This animal model appears to be a useful way of studying the treatment of human spinal cord compression produced by epidural neoplasms.

Animals↗
PubMedDate not supplied

[Results of treatment of extradural spinal neoplasms].

82 patients with malignant epidural neoplasms (s.e.n.) were operated on between 1980 and 1990. Some underwent radio- or chemotherapy following surgery. Exact data on neurological results of treatment were obtained from 42 cases which represented the analysed group. When patients were ambulatory and/or had useful motor function of their upper extremities following treatment the result was accepted as positive. This was found in 71% of cases. In patients with severe paresis (non-walking before surgery) positive result was obtained in 59% of cases. In patients with mild paresis or neurologically without signs, positive results were obtained in 100% of cases. Of patients who died, 45% had positive neurological result until death. Overall 21% of cases (49% of those with severe neurological deficits) did not regain the ability of walking that is the most important benefit which may result from treatment. Those patients presented in severe general condition, advanced neoplastic spread to other systems and total transverse spinal cord damage. In about 90% of cases there was a significant relief of back and radical pain.

Breast Neoplasms↗
PubMed2001

[Epidural non-Hodgkin's lymphoma presenting as a spinal cord compression].

OBJECTIVE AND METHODS: epidural localization is a rare presenting sign of non Hodgkin's lymphoma. In this study, we describe the clinical, histological and immunohistochemical data in 13 cases (9 men and 4 women) of non-Hodgkin's lymphoma with epidural involvement. RESULTS: the median age was 63 years (range 36-76 years). Clinically, most patients complained of back pain (median duration, 3.4 months) followed by acute neurological deterioration. In 10 out of 13 tumors, a thoracic localization was observed and a decompressive laminectomy was performed in all cases. Histology and immunohistochemistry showed all tumors to be B-cell lymphomas which were classified as: lymphocytic lymphoma (3 cases), prolymphocytic lymphoma (1 case), follicular lymphoma (2 cases), diffuse large cell lymphoma (6 cases) and AIDS associated Burkitt lymphoma (1 case). Post-operative staging revealed bone and/or paravertebral involvement in 11 cases and disseminated disease in 5 cases. Median survival following complementary therapy, radiotherapy and chemotherapy in most cases, was 20 months. CONCLUSION: histological features of epidural lymphomas are similar to other extranodal lymphomas and their prognosis is better than other epidural neoplasms, especially when the tumor is localized.

Adult↗
PubMed1986

Epidural cord compression in association with genitourinary neoplasms.

The epidural compression secondary to genitourinary malignancies is relatively uncommon. Of 2118 patients who were diagnosed as having a genitourinary malignancy at the Columbia-Presbyterian Medical Center from 1970-1979, 21 are known to have developed an epidural cord compression by June 30, 1985 (16 from prostate, 1 from urinary bladder, and 4 from renal origin). The following items were reviewed in these 21 patients: age of the patient at diagnosis of the primary tumor; primary site of the genitourinary primary; time in months from the date of diagnosis of the genitourinary primary to the data of diagnosis of the spinal cord compression; methods of diagnosis; presenting symptoms and signs; treatment methods; and survival following the date of diagnosis of the compression. The distribution of location of the epidural metastasis in the current series is as follows: cervical-thoracic, 7%; thoracic, 73%; and lumbosacral, 20%. Skip metastases to the epidural space was the initial sign of malignancy in six patients (31.5%). Five patients (26%) with epidural cord compression survived at least 24 months following the date of diagnosis of their compression. Only two patients in this series with paraplegia (secondary to their compression) had improvement in ambulation following treatment of their compression: of these two patients, one had a prostate primary and the other a renal primary. The indications and techniques for surgery and radiotherapy are briefly described and early diagnosis and treatment are stressed.

Aged↗
PubMed1992

An isolated nonosseous metastasis to the epidural space from an osteogenic sarcoma.

Metastatic disease from osteosarcoma most commonly occurs in the lung and bony sites. Both primary spinal osteosarcomas and spinal metastatic lesions are rare. A case is reported of a nonosseous epidural metastatic lesion from osteosarcoma. It was visualized best by metrizamide-enhanced computed tomographic scanning. The patient symptomatically improved with excision of the lesion although there was massive recurrence despite combined therapy.

Adolescent↗