1/17. Combined posterior and posterolateral one-stage removal of a giant cervical dumbbell schwannoma.OBJECTIVE: Huge dumbbell schwannomas in the cervical region are not a rare clinical entity in neurosurgical practice. Despite the benign nature, the adhesions between tumor capsule and spinal cord, vertebral artery, cervical plexus, and carotid sheath can complicate surgery, leading to a fatal outcome. We performed one-stage combined surgery through the posterior midline and an unusual posterolateral cervical route in the same position and describe its advantages. METHOD: We removed the intraspinal component totally through a posterior midline approach and freed spinal cord and vertebral artery. After removal of the posterolateral extraspinal component using the same incision, a posterolateral cervical approach along the posterior margin of sternocleidomastoid muscle was performed, and the anterolateral extraspinal tumor was excised totally through the dissection plane between anterior and middle scalene muscles. RESULTS AND CONCLUSIONS: The operative time was less than 3 h, and the patient was discharged on the 3rd postoperative day without any neurological sequel. The combination of posterior midline and posterolateral approach in large dumbbell schwannomas is easier to perform and a more safe technique than the combination with anterolateral accesses in the cervical region and also less invasive than the transuncodiscal technique in selected cases. This approach reduces the risk of neurovascular injury, since it does not require retraction and repositioning of the patient and, therefore, facilitates total excision and reduces the operative time.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
2/17. Neurologic complications of prostate cancer.Neurologic complications continue to pose problems in patients with metastatic prostate cancer. From 15 to 30 percent of metastases are the result of prostate cancer cells traveling through Batson's plexus to the lumbar spine. Metastatic disease in the lumbar area can cause spinal cord compression. Metastasis to the dura and adjacent parenchyma occurs in 1 to 2 percent of patients with metastatic prostate cancer and is more common in those with tumors that do not respond to hormone-deprivation therapy. Leptomeningeal carcinomatosis, the most frequent form of brain metastasis in prostate cancer, has a grim prognosis. Because neurologic complications of metastatic prostate cancer require prompt treatment, early recognition is important. physicians should consider metastasis in the differential diagnosis of new-onset low back pain or headache in men more than 50 years of age. spinal cord compression requires immediate treatment with intravenously administered corticosteroids and pain relievers, as well as prompt referral to an oncologist for further treatment.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
3/17. Intramedullary ancient schwannoma of the cervical spinal cord: case report and review of literature.We report a rare case of intramedullary ancient schwannoma of cervical spinal cord in a 68 year old patient. About 49 cases of intramedullary schwannomas and neurofibromas have been reported in the literature but to our knowledge there is no report of the 'ancient' variety of intramedullary schwannoma. The cell of origin of these tumours is the schwann cell, which normally does not exist in the parenchyma of the central nervous system. Many theories have been advanced to explain this paradox. According to one theory, these tumours arise from the perivascular nerve plexus of the pial vessels. This plexus was found mostly to exist along the branches of the anterior spinal artery. In our case, the tumour was supplied by two branches of the anterior spinal artery, which may add further support to the above theory.- - - - - - - - - - ranking = 2keywords = plexus (Clic here for more details about this article) |
4/17. choroid plexus carcinoma presented with spinal dysfunction caused by a drop metastasis: a case report.A 2-year-old girl demonstrating gait disturbance and dysuria was evaluated and showed two large remote tumors at the left lateral ventricle and lower spinal canal. Pathological analysis demonstrated both of the tumors to be choroid plexus carcinoma (CPC) with high MIB-1 labeling index. The enhanced mitotic propensity would have contributed to an early stage of drop metastasis from the primary site to the sacral sac and following accelerated formation of a longitudinal tumor, which had grown in the subarachnoid space conforming to the spinal canal and finally caused the presenting symptoms of spinal dysfunction. This report shows that CPC can develop exophytically in the subarachnoid space as well as in the ventricle simultaneously before appearance of clinical symptoms and confirms the importance of extensive neuroimaging in its evaluation.- - - - - - - - - - ranking = 35.821890042497keywords = choroid plexus, choroid, plexus (Clic here for more details about this article) |
5/17. Thoracic dumbbell intra- and extramedullary schwannoma.We present a rare case of a solitary dumbbell intra- and extramedullary schwannoma of the thoracic spine in a 54-year-old man without signs of von Recklinghausen's disease. The patient presented with motor weakness in the left lower extremity, bilateral sensory impairment below the T9 dermatome and rectovesical dysfunction. Preoperative magnetic resonance imaging was suspicious for an intradural extramedullary tumor. At operation, the tumor was located posteriorly, at the midline, with no relationship to the posterior nerve roots and was firm and adherent to the adjacent spinal cord, which surrounded the intramedullary portion of the tumor. The intramedullary mass was completely removed with sharp dissection after removal of the extramedullary mass. Surgery resulted in minimal postoperative neurological deficits. These tumors may arise from the schwann cells of the nerve plexus surrounding vessels in the posterior median sulcus and thus may grow in both an intra- and extramedullary fashion. The optimal treatment of these schwannomas is total removal.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
6/17. Disappearance of phantom limb pain during cauda equina compression by spinal meningioma and gradual reactivation after decompression.We describe a 65-yr-old woman, whose right lower limb had been amputated at the mid-femoral level because of complicated femur fracture sustained at the age of 5 yr. After amputation, she experienced phantom limb pain (PLP), which gradually decreased in intensity but persisted for 60 yr. At this point the pain diminished progressively, in parallel with the evolution of cauda equina compression caused by an intraspinal tumor. The PLP gradually reappeared over 3 mo after surgical removal of the tumor. IMPLICATIONS: We present a case in which phantom limb pain (PLP) in an amputated leg disappeared during cauda equina compression by meningioma and reactivated after surgical decompression. This case suggests that complete compression or blockade of nerves, a nerve plexus, the cauda equina, or the medullary cord may result in suppression of PLP, and decompression of or recovery from the block may cause reactivation.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
7/17. Dumbbell-shaped cervical spinal neurilemmoma presenting as neck mass.Cervical neurilemmoma may originate from any nerve sheath tissue in the neck including the vagus nerve, glossopharyngeal nerve, brachial plexus, sympathetic trunk and cervical spine. We report an unusual case of a dumbbell-shaped neurilemmoma arising from the cervical spinal roots in a patient who complained of having had a neck mass for several months. Computed tomographic scan and magnetic resonance imaging revealed a dumbbell-shaped tumour extending from the C4 spinal level through the intervertebral foramen into the right parapharyngeal space. decompression surgery was performed first via the cervical approach. Five months later, the patient received laminectomy and a complete tumour excision. The symptoms and signs were significantly relieved without neurological sequelae. No evidence of recurrence was noted after one-year follow up. This two-staged operation could offer an alternative surgical approach yielding ideal therapeutic results in such a rare disease.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
8/17. Delayed occurrence of multiple spinal drop metastases from a posterior fossa choroid plexus papilloma. Case report.choroid plexus papilloma is a benign central nervous system tumor that occasionally spreads along the subarachnoid space. The authors report the case of a 49-year-old man who presented with back pain 19 years after resection of a posterior fossa choroid plexus papilloma. magnetic resonance imaging revealed multiple spinal lesions without any residual or recurrent intracranial tumor. All spinal lesions were resected and histologically diagnosed as atypical choroid plexus papilloma. The authors suggest that patients in whom choroid plexus papilloma is diagnosed should undergo total neuraxis imaging at the time of initial diagnosis as well as periodic follow-up examinations after resection to rule out drop metastases.- - - - - - - - - - ranking = 741.45791369219keywords = choroid plexus papilloma, choroid plexus, plexus papilloma, choroid, plexus, papilloma (Clic here for more details about this article) |
9/17. Charged particle radiotherapy of paraspinal tumors.Between 1976 and 1987, 52 patients with tumors adjacent to and/or involving the cervical, thoracic, or lumbar spinal cord were treated with charged particles at the University of california Lawrence Berkeley Laboratory. The histologies included chordoma and chondrosarcoma (24 pts), other bone and soft tissue sarcoma (14 pts), and metastatic or unusual histology tumors (14 pts). radiation doses ranged from 29 to 80 Gray-equivalent (GyE), with a median dose of 70 GyE. Twenty-one patients received a portion of their treatment with photons. Median followup was 28 months. For 36 previously untreated patients, local control was achieved in 21/36 patients and the 3-year actuarial survival was 61%. Of 16 patients treated for recurrent disease, 7/16 were locally controlled and the 3-year actuarial survival was 51%. For patients treated for chordoma and chondrosarcoma, probability of local control was influenced by tumor volume (less than 100 cc or greater than 150 cc) and whether disease was recurrent or previously untreated. Complications occurred in 6/52 patients, including one spinal cord injury, one cauda equina and one brachial plexus injury, and three instances of skin or subcutaneous fibrosis. Charged particle radiotherapy can safely deliver high tumor doses to paraspinal tumors with good local control.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
10/17. Somatosensory evoked potentials in a patient with a cervical glioma and syrinx.Short-latency somatosensory evoked potentials (SSEPs) were obtained in a 61-year-old patient with a cervical spinal cord glioma extending from C3 to C7. SSEPs in response to tibial nerve stimulation were normal; however, all components of the median nerve responses were markedly abnormal bilaterally (except for normal brachial plexus responses). This selective abnormality of median nerve SSEPs has not been reported previously in a patient with cervical cord tumor associated with a syrinx and illustrates the use of the SSEP in the anatomical localization of the lesion.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
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