Cases reported "Spinal Neoplasms"

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1/22. Revisited: spinal angiolipoma--three additional cases.

    Angiolipomas are benign tumours which usually arise from subcutaneous tissue, particularly in the forearm, but they do occur rarely in the spinal canal. To the best of our knowledge 60 cases of histologically confirmed spinal angiolipoma have been reported in the medical literature. They show a female predominance (1.6:1), and the mean age at presentation is 43 years. They usually arise in the thoracic spine, most cases presenting with slowly progressive signs and symptoms of cord compression. Rarely, massive acute haemorrhage into the tumour may herald its presence. Surgical resection or decompression are the most satisfactory methods of treatment in most patients. We describe three further cases of spinal angiolipoma, and discuss their aetiology, pathogenesis, clinico-pathological features and surgical management.
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2/22. Lumbar ependymoma presenting with paraplegia following attempted spinal anaesthesia.

    Neurological deterioration from intraspinal haematoma following insertion of a spinal needle is extremely rare. We present the case of a 28-yr-old female, who presented with complete paraplegia following attempted spinal anaesthesia for delivery of her third child. Space-occupying iatrogenic spinal haemorrhage from a previously undiagnosed lumbar ependymoma was found to be the precipitating cause. Following laminotomy with blood clot and tumour removal her neurological function improved.
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3/22. Preoperative embolization and intraoperative cryocoagulation as adjuncts in resection of hypervascular lesions of the thoracolumbar spine.

    OBJECT: The purpose of this study was twofold. First the authors evaluated preoperative embolization alone to reduce estimated blood loss (EBL) when resecting hypervascular lesions of the thoracolumbar spine. Second, they compared this experience with intraoperative cryotherapy alone or in conjunction with embolization to minimize further EBL. methods: Twelve patients underwent 13 surgeries for hypervascular spinal tumors. In 10 cases the surgeries were augmented by preoperative embolization alone. In one patient, two different surgeries involved intraoperative cryocoagulation, and in one patient surgery involved a combination of preoperative embolization and intraoperative cryocoagulation for tumor resection. When cryocoagulation was used, its extent was controlled using intraoperative ultrasonography or by establishing physical separation of the spinal cord from the tumor. In the 10 cases in which embolization alone was conducted, intraoperative EBL in excess of 3 L occurred in five. Mean EBL was of 2.8 L per patient. In one patient, who underwent only embolization, excessive bleeding (> 8 L) required that the surgery be terminated and resulted in suboptimum tumor resection. In another three cases, intraoperative cryocoagulation was used alone (in two patients) or in combination with preoperative embolization (in one patient). In all procedures involving cryocoagulation of the lesion, adequate hemostasis was achieved with a mean EBL of only 500 ml per patient. No new neurological deficits were attributable to the use of cryocoagulation. CONCLUSIONS: Preoperative embolization alone may not always be satisfactory in reducing EBL in resection of hypervascular tumors of the thoracolumbar spine. Although experience with cryocoagulation is limited, its use, in conjunction with embolization or alone, suggests it may be helpful in limiting EBL beyond what can be achieved with embolization alone. Cryocoagulation may also assist resection by preventing spillage of tumor contents, facilitating more radical excision, and enabling spinal reconstruction. The extent of cryocoagulation could be adequately controlled using ultrasonography or by establishing physical separation between the tumor and spinal cord. Additionally, somatosensory evoked potential monitoring may provide early warning of spinal cord cooling.
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keywords = blood loss
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4/22. Posterior cervical haemangiopericytoma with intracranial and skull base extension. Diagnostic and therapeutic challenge of a rare hypervascular neoplasm.

    Haemangiopericytomas are rare hypervascular tumors arising from pericytes. They may occur anywhere in the body, but posterior cervical location is rather uncommon. A case of posterior cervical haemangiopericytoma with posterior fossa and temporal bone extension is reported. Although the patient had undergone preoperative endovascular embolization and surgical resection on three separate occasions, control of the skull base extension was not successful. Following endovascular embolization combined with radiotherapy, the patient has been asymptomatic for 48 months. Angiographic features may help in differentiating haemangiopericytomas from other hypervascular lesions. Preoperative endovascular embolization is recommended due to the pronounced tendency for haemorrhage throughout biopsy and surgical procedures.
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5/22. cryosurgery re-visited for the removal and destruction of brain, spinal and orbital tumours.

    Advances in neuroimaging and cryosurgical techniques have prompted us to re-evaluate the potential of cryosurgical techniques for the removal and the destruction of various neoplasms. We have used cryosurgical instrumentation to remove tumours in the brain, spine and orbit in 71 patients without complications. cryosurgery was used to facilitate removal and extraction in 64 and to destroy residual neoplasms when removal was incomplete in 7. Intraoperative real time ultrasonic imaging permitted precise delimitation of tumours from surrounding tissues and allowed monitoring during the production of cryosurgical lesions thus permitting heretofore unavailable visualization of the production of cryogenic lesions in the central nervous system. New cryosurgical instrumentation was used to produce lesions up to three times larger than similar sized probes previously available. Our results reconfirm that cryosurgery facilitates the removal of tumours in the brain, spinal cord and orbit, reduces blood loss in vascular tumours, and is effective in ablating residual neoplasms involving the superior sagittal sinus, torcula and parasagittal areas. A Doppler flowmeter proved useful for monitoring sagittal sinus blood flow during the production of cryosurgical ablation of residual tumour attached to the walls of the sagittal sinus. Recent advances in ultrasonic and neuroimaging coupled with stereotactic techniques and improvements in cryosurgical instrumentation may prove useful in the future percutaneous destruction of selective intracranial neoplasms.
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keywords = blood loss
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6/22. Acute spinal cord compression caused by vertebral hemangioma.

    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.
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keywords = blood loss
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7/22. Infiltrating spinal angiolipoma: a case report and review of the literature.

    Angiolipomas are rarely encountered in the spine. We report the case of a 47-year-old man with a thoracic angiolipoma involving the T9 vertebral body. A preoperative spinal angiogram confirmed a highly vascular neoplasm. The lesion was treated with endovascular embolization prior to a T9 corpectomy and resection of the epidural component of the tumor. At time of surgery, minimal blood loss occurred during resection of the vertebral body and the epidural mass. Pathologic examination demonstrated features consistent with spinal angiolipoma. This report emphasizes the clinical, radiographic, and pathologic features of infiltrating spinal angiolipoma and discusses therapeutic management options.
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keywords = blood loss
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8/22. Novel use of a threadwire saw for high sacral amputation. Technical note and description of operative technique.

    The authors describe and demonstrate an innovative modification of the osteotomy procedure required to achieve a supraforaminal high sacral amputation in a patient harboring a large sacral chordoma. Via a combined anterior-posterior approach, three carefully placed threadwire saws were used to create releasing osteotomies through specific portions of the dorsal iliac crests and through the axial midportion of the S-1 vertebral body. The threadwire saws are pulled away from neurovascular and visceral structures, ensuring greater protection. Other advantages include markedly reduced blood loss while performing the osteotomies, a high degree of cutting accuracy, negligible bone loss, and ease and speed of bone cutting.
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ranking = 70.728757889405
keywords = blood loss
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9/22. Surgical excision of sacral tumors assisted by occluding the abdominal aorta with a balloon dilation catheter: a report of 3 cases.

    STUDY DESIGN: A report of 3 cases of upper sacral tumors excised by occluding the abdominal aorta with a balloon dilation catheter (BDC). OBJECTIVE: To investigate the feasibilities of reducing intraoperative hemorrhage and improving the safety of surgical excision of sacral tumors assisted by occluding the abdominal aorta with a BDC. SUMMARY OF BACKGROUND DATA: Surgical excision of upper sacral tumors has been considered a high-risk and difficult operation, with multiple complications because of its massive and uncontrollable intraoperative hemorrhage. However, until now and to our knowledge, no report on resection of sacral tumors assisted by occluding the abdominal aorta with a BDC is available. methods: A BDC was used to occlude the abdominal aorta for 40-65 minutes in assisting with resection of upper sacral tumors in 3 cases. RESULTS: After the abdominal aorta was occluded, much less intraoperative hemorrhage was found, and the volume of blood loss was only 100-200 mL. This procedure assisted the surgeon in identifying clearly the surgical margin and sacral nerves surrounded by the tumors. In addition, intraoperative contamination was also minimized. The blood pressure remained stable during the operation. CONCLUSION: To occlude the abdominal aorta with a BDC may effectively reduce intraoperative hemorrhage, thus assisting the surgeon in the complete and safe resection of upper sacral tumors.
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ranking = 70.728757889405
keywords = blood loss
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10/22. Lumbar vertebral hemangioma causing cauda equina syndrome: a case report.

    STUDY DESIGN: Case report. OBJECTIVES: To report a case of lumbar hemangioma causing neurogenic claudication and early cauda equina, managed with hemostatic vertebroplasty and posterior decompression. SUMMARY OF BACKGROUND DATA: This is the first report to our knowledge of a lumbar hemangioma causing neurogenic claudication and early cauda equina syndrome. Most hemangiomas causing neurologic symptoms occur in thoracic spine and cause spinal cord compression. vertebroplasty as a method of hemostasis and for providing mechanical stability in this situation has not been discussed previously in the literature. methods: L4 hemangioma was diagnosed in a 64-year-old woman with severe neurogenic claudication and early cauda equina syndrome. Preoperative angiograms showed no embolizable vessels. Posterior decompression was performed followed by bilateral transpedicular vertebroplasty. The patient received postoperative radiation to prevent recurrence. RESULTS: Complete relief of neurogenic claudication and cauda equina with less than 100 mL of blood loss. CONCLUSION: A lumbar hemangioma of the vertebral body, although rare, can cause neurogenic claudication and cauda equina syndrome. Intraoperative vertebroplasty can be an effective method of hemostasis and provide stability of the vertebra following posterior decompression.
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keywords = blood loss
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