Cases reported "Spinal Cord Diseases"

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1/15. Spinal intramedullary ependymal cyst: a case report.

    BACKGROUND: Spinal intramedullary ependymal cysts are extremely rare. Only seven pathologically proven cases have been reported in the literature. METHOD: We present an 18-month-old female with thoracic spinal intramedullary ependymal cyst that was diagnosed pathologically. RESULTS: Histological diagnosis was made by light microscopy after immunostaining. After partially removing the cyst wall and establishing communication between the cyst and the subarachnoid space, the patient improved neurologically. CONCLUSIONS: For spinal intramedullary ependymal cyst we recommend diagnosis by MR imaging without myelography, then enucleation of the cyst, if possible. Otherwise, we remove the cyst wall as much as possible and create adequate communication between the cyst and the subarachnoid space.
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2/15. Degenerative intraspinal cyst of the cervical spine: case report and literature review.

    STUDY DESIGN: A case report and a literature review are presented. OBJECTIVE: To describe and review the clinical presentations, characteristic findings from imaging studies, and treatment of synovial and ganglion cysts arising within the cervical spinal canal. SUMMARY OF BACKGROUND DATA: Synovial and ganglion cysts in the cervical spine are rare. To the authors' knowledge, 24 sporadic cases in all, designated by various terms, have been reported in the literature. methods: Three cases of synovial and ganglion cysts in the cervical spine are reported as well as a review of the literature. RESULTS: Characteristic findings from imaging studies included a fluid-containing extradural lesion demonstrated on magnetic resonance images and gas content in the lesion demonstrated on ordinary or sagittally reconstructed computed tomography images. A laminectomy with removal of the cyst was the treatment of choice in most cases. CONCLUSIONS: Neither communication with an adjacent facet joint nor histopathology of the cyst wall provides a persuasive basis for differentiating ganglion, synovial cyst, and cyst arising from the ligaments. To accommodate the varied presentations, the authors propose a comprehensive term for these lesions: "degenerative intraspinal cyst."
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3/15. Effectiveness of a transforaminal surgical procedure for spinal extradural arachnoid cyst in the upper lumbar spine.

    Spinal extradural arachnoid cysts are relatively rare, and the pathogenesis is still unclear. Here, we report a 24-year-old woman with a Type I lesion by Nabors' classification (extradural arachnoid cyst without spinal nerve root fiber involvements), who complained of low back pain and right thigh pain, treated surgically using a transforaminal approach. magnetic resonance imaging (MRI) and myelography showed a large extradural cystic lesion close to the L1 nerve root sleeve, accompanied by moderate L1 nerve root compression and a communication between the extradural cyst and the subarachnoid space. Resection of the cyst wall and closure of the ostium were easily performed by this approach. This procedure resulted in the relief of both low back pain and right thigh pain. Histological examination showed clusters of meningothelial cells, which was a typical feature of arachnoid cysts. Postoperative MRI demonstrated that both the cystic lesion and nerve root compression had disappeared. This transforaminal procedure proved useful for the treatment of a lesion located around a lumbar spinal nerve root.
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4/15. Concurrent intra-medullary and intra-cranial tuberculomas.

    Although tuberculosis of the central nervous system is well known, the incidence of intra-medullary tuberculomas is low and a combination of intra-medullary with intra-cranial tuberculomas is extremely rare. This communication reports a case of disseminated (intra-medullary, intra-cerebellar and intra-cerebral) tuberculomas in a six-year-old girl initially presenting with a spinal tumour syndrome. Conservative treatment with anti-tuberculous medications and a short course of injectable steroids resulted in complete resolution of her symptoms.
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5/15. Detection of a dural defect by cinematic magnetic resonance imaging and its selective closure as a treatment for a spinal extradural arachnoid cyst.

    STUDY DESIGN: We document a giant spinal extradural arachnoid cyst treated by selective closure of the dural defect. It was diagnosed using cinematic magnetic resonance imaging (cine-MRI). OBJECTIVE: To demonstrate the effectiveness of selective closure of the dural defect as a treatment for a spinal extradural arachnoid cyst. SUMMARY OF BACKGROUND DATA: The standard treatment for a spinal extradural arachnoid cyst is total resection of the cyst wall, if possible, and the closure of the communication site, if any, between the cyst and the subarachnoid space, after an extensive laminectomy. To our knowledge, selective closure of the dural defect through minimal laminotomy with little cyst resection has not been reported. methods: A 29-year-old woman presented with right leg muscle weakness and was diagnosed with an extradural arachnoid cyst ranging from spinal regions T11 to L3 using MRI. myelography demonstrated that the cyst communicated with the subarachnoid space. Cine-MRI showed a pulsating flow voiding on the left side of level L1, suggesting the location of the communication site. Fenestration of the T12-L1 region was performed, preserving the spinous processes and the facet joints. A small dural rent was found on the left side of level L1. This was closed using small clips. RESULTS: MRI 12 days later demonstrated that the cyst had shrunk dramatically. It had disappeared completely by 4 months. The patient's muscle weakness improved gradually, and she was almost complaint-free 6 months after the operation. CONCLUSIONS: Selective closure of the dural defect based on cine-MRI will be useful for treating extradural arachnoid cysts.
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6/15. Noncommunicating spinal extradural arachnoid cyst causing spinal cord compression in a child.

    Extradural arachnoid cysts in the spine are relatively uncommon causes of spinal cord compression in the pediatric population that are thought to arise from congenital defects in the dura mater. Most reports describe such cysts communicating with the intrathecal subarachnoid space through a small defect in the dura. The authors describe the case of a child who presented with spinal cord compression caused by a large spinal extradural arachnoid cyst that did not communicate with the intradural subarachnoid space. An 11-year-old girl presented with urinary urgency, progressive lower-extremity weakness, myelopathy, and severe gait ataxia. magnetic resonance imaging of the spine demonstrated a large extradural arachnoid cyst extending from T-8 to T-12. The patient underwent a thoracic laminoplasty for en bloc resection of the spinal extradural arachnoid cyst. Intraoperatively, the dura was intact and there was no evidence of communication into the intradural subarachnoid space. Postoperatively, the patient's motor strength and ambulation improved immediately, and no subsequent cerebrospinal fluid leak occurred. Noncommunicating spinal extradural arachnoid cysts are extremely rare lesions that can cause spinal cord compression in children. Because the dura remains intact, they can be removed entirely without subsequent dural repair. The authors review the literature and discuss the proposed underlying mechanisms of formation of these arachnoid cysts.
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7/15. Congenital spinal arachnoid cysts: report of 2 cases with review of the literature.

    Two cases of congenital spinal arachnoid cysts with paraparesis are presented. Case 1, a 16-year-old male patient, had a 2-year history of progressive weakness of the lower limbs. Postmyelographic axial computed tomography (CT) and myelography revealed a dorsally located extradural mass. The configuration of the mass was further assessed with magnetic resonance imaging (MRI). He underwent laminectomy from T8 to L1 with total excision of an extradural arachnoid cyst. A communication with the subarachnoid space found at the T8 level was surgically closed. The patient made an uneventful recovery. Case 2, a 9-year-old girl, developed paraparesis and the cauda equina syndrome two days prior to admission. Postmyelographic CT and myelography revealed an anteriorly located intradural mass. She underwent laminectomy from C6 to T2 and partial removal of an intradural arachnoid cyst. One week later, her neurological functions had recovered completely. The literature dealing with this rare spinal lesion is also reviewed.
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8/15. Hydromyelic hydrocephalus. Correlation of hydromyelia with various stages of hydrocephalus in postshunt isolated compartments.

    The clinical features and pathophysiology of specific forms of hydromyelia are analyzed in this report together with the chronological changes of associated hydrocephalus. Nine patients were studied; all had hydromyelia with varying degrees of associated hydrocephalus. Clinically applicable classification systems were used to evaluate the progression of hydrocephalus (Stages I to IV) and to define the compartment isolated after shunting in the previously communicating cerebral ventricles (Types I to IV). Four patients had Stage IV disease (holoneural canal dilatation); one had Stage II and four had Stage I disease (both Stages I and II with supratentorial hydrocephalus). All patients were initially treated by ventriculoperitoneal shunting at an average age of 9.9 years. Five patients had progressive spinal symptoms before or after treatment of their hydrocephalus. Two patients had Type III isolation (an isolated rhombencephalic ventricle) with a functioning ventricular shunt; ventriculography confirmed a communication between the fourth ventricle and the hydromyelia, and both patients improved after placement of a shunt in the fourth ventricle. The remaining patients had Type IV isolation (isolated central canal dilatation) with a functioning ventricular shunt. This study indicates that in some cases the pathophysiology of hydromyelia is closely related to associated hydrocephalus. A new concept of the development of an isolated compartment after shunting is proposed to explain the progression of hydromyelia in these cases.
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9/15. Symptomatic meningeal diverticula of the sacral nerve roots in a girl. A case report.

    The rare case of a 12-year-old girl with sciatic pain and bilateral meningeal diverticula of S1 and S2 nerve roots on both sides, is reported. Meningeal diverticula are a rare cause of sciatic pain and are exceptional in infants and children. water-soluble myelography shows a rapid and complete opacification of the diverticulum, because of its large communication with the subarachnoid space; computerized tomography and magnetic resonance show an aspecific CSF collection, similar to all nerve root cysts. The complete removal of the cyst wall, with closure of its pedicle, results in the clinical remission in symptomatic cases.
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10/15. Direct spinal arteriovenous fistula: a new type of spinal AVM. Case report.

    A patient presenting with progressive paraparesis was found to have a spinal arteriovenous fistula at the T3-4 vertebral level. The lesion consisted of a direct communication of the anterior spinal artery with a very distended venous varix that drained mostly superiorly to the posterior fossa and simulated a posterior fossa arteriovenous malformation (AVM) on vertebral angiography. The patient was treated by surgical ligation of the fistula through an anterior transthoracic approach. He deteriorated abruptly on the 4th postoperative day, probably because of retrograde thrombosis of the enlarged anterior spinal artery. Over the next few months, he improved to the point of being able to walk with crutches. He has also regained sphincter control. The different types of spinal AVM's are reviewed. Our case does not fit into any of these groups. A new category, Type IV, is proposed to designate direct arteriovenous fistulas involving the intrinsic arterial supply of the spinal cord.
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