Cases reported "Spinal Neoplasms"

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11/22. Gastric carcinoma presenting with extensive bone metastases and marrow infiltration causing extradural spinal haemorrhage.

    Gastric carcinoma is the third most common gastrointestinal (GI) malignancy after colon and pancreatic carcinoma. A Japanese study showed that the incidence of bone metastases of gastric cancer was 13.4% among autopsies. It is very rare for the primary presentation of a gastric malignancy to be with bone metastases. This case report is of a 46-year-old female patient, who presented with a thoracic vertebral wedge fracture and was subsequently found to have widespread vertebral metastatic deposits with marrow infiltration. The infiltration and suppression of marrow function was complicated by an acute bleed into the extradural space causing spinal cord compression. This case demonstrates two important features. First, that gastric cancer, although far less common than breast, kidney, thyroid, prostate and bronchial cancer, is a cause of metastases to bone. Second, it highlights the complications of bone metastases, marrow suppression, leukoerythroblastic anaemia, spinal canal haematoma and cord compression. The case is illustrated by axial and sagittal MRI slices.
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12/22. Preoperative embolization of hypervascular spinal metastases using percutaneous direct injection with n-butyl cyanoacrylate: technical case report.

    OBJECTIVE: Intraoperative blood loss constitutes a major cause of perioperative morbidity in surgical decompression and reconstruction of highly vascular spinal metastatic tumors. We propose a technique for embolization of highly vascular vertebral metastases using percutaneous direct injection using n-butyl cyanoacrylate (NBCA) instead of polymethylmethacrylate to complement preoperative transarterial embolization and to minimize operative blood loss. methods: Five patients with renal cell carcinoma metastases to the spine (one cervical, one thoracic, and three lumbar) underwent embolization by percutaneous direct injection of the affected vertebrae with a mixture of NBCA and iodized oil to supplement transarterial embolization with polyvinyl alcohol particles and fibered platinum coils. This was achieved via a transpedicular approach in four cases and by direct vertebral body puncture in one case. RESULTS: The percutaneous NBCA direct injection procedure was technically successful in all cases and was not associated with neurological or medical complications. All patients underwent subsequent vertebrectomy and spinal instrumentation. Surgical resection was performed with lower than expected blood loss and with a subjective improvement in tumor tissue handling and dissection. CONCLUSION: The extent of tumor devascularization can be improved by supplementing transarterial embolization with NBCA direct injection to decrease operative blood loss and increase the safety of surgical resection and stabilization of highly vascular spinal metastases.
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keywords = blood loss
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13/22. Unusual haemostasis for an unusual tumour. Catastrophic bleeding from a tactile neurofibroma affecting the thoracic vertebrae. Case report.

    The symptomatology of a typical acute descending thoracic aorta dissection was imitated by profuse haemorrhage caused by a benign tumour composed almost exclusively of Wagner-Meissner like tactile corpuscles and fatty tissue. The tumour caused extensive destruction of the bodies of the fifth and sixth thoracic vertebrae at the level of the vertebro-costal articulation. Emergency cross clamping of the descending aorta and haemostasis of the bleeding from osteal defects by tamponade with bone polymethyl methacrylate appeared the only way to control the life threatening haemorrhage. It seems that an intrathoracic tactile neurofibroma with a similar case history has not been reported till now.
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14/22. Subarachnoid haemorrhage with acute cauda symptom due to spinal tumour.

    Massive spontaneous subarachnoid haemorrhage causing compression of the cauda equina is reported. The origin of haemorrhage is concluded to have been an intradural angioblastic meningioma of the filum terminale at the L 3/4. Our paper describes the course of this patient in respect of diagnostic problems and reviews 6 cases of spontaneous spinal subarachnoid haematoma due to SAH from a spinal tumour with acute compression of the adjoining nervous structures. The necessity of early diagnosis and proper operative treatment is stressed.
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keywords = haemorrhage
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15/22. Vertebral hemangiomas presenting with neurologic symptoms.

    Six cases of spinal hemangiomas with neurologic symptoms are reported. In three of them the diagnosis was obtained before surgery using plain x-rays and spinal computed tomography scan or biopsy. In the other cases the diagnosis was not done before surgery. In two cases preoperative embolization had minimized blood loss during surgery. laminectomy was performed in three cases. Large removal and/or vertebrectomy was carried out in the other cases. Our results and a review of the literature about the investigations and treatment of vertebral hemangiomas led us to propose a stereotypical management of spinal hemangiomas with neurologic symptoms.
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ranking = 17.682189472351
keywords = blood loss
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16/22. Facilitation of removal of a hypervascularized cervical vertebral body tumour by intraoperative temporary occlusion of the tumour-feeding vertebral artery, using intraarterial catheterization.

    The surgical treatment of a highly vascularized tumour that destroyed the fourth cervical vertebral body in a young patient, without neurological deficits, is reported. After posterior stabilization an anterior approach was used in order to replace the affected vertebral body with an acrylic prosthesis. The tumour-feeding vessels originated largely from the right vertebral artery. In order to maintain optimal visibility, intraoperative haemorrhage was kept at a minimum by temporarily occluding the tumour-feeding vertebral artery with an intraarterial catheter.
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keywords = haemorrhage
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17/22. Surgical management of haemangioendothelioma of the spine.

    Four patients with haemangioendothelioma of the spine which was treated surgically are presented. Two were male and two female, mean age 30 years (range 5-60). All tumours were sited in the thoracic spine between T5 and T10; three were primary and one metastatic from a hepatic haemangioendothelioma. Each patient had a significant neurological deficit at presentation; three were paraplegic. A diagnosis of vertebral neoplastic disease was suggested on plain radiographs, and in three cases this was supported by computed tomography or magnetic resonance imaging. Two patients underwent anterior decompression and posterior instrumented stabilisation, one anterior decompression alone and one posterior decompression followed by tumour vessel embolisation and then anterior decompression. Intra-operative blood loss was a significant feature despite the use of hypotensive anaesthetic techniques and local haemostatic agents. Three of the tumours were tested for factor viii (a tumour for vascular tumours), and all proved positive. In these, sufficient histological material was available to grade the tumours according to the classification of Campanacci et al. [1]. All were grade II. Three patients recovered completely from paraglegia; one had residual mild spasticity which required the use of a walking aid. The mean improvement in Frankel grade was 2.5 (range 1-4). In two the tumour recurred outside the spine within 18 months; one had subsequently died. The presentation, investigation and results of surgery for haemangioendothelioma of the spine are presented. Particular attention is drawn to the neurological status at presentation, the effect of pre-operative tumour embolisation and the dramatic recovery that can be achieved in these patients following surgery.
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ranking = 17.682189472351
keywords = blood loss
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18/22. Preoperative embolization in the treatment of spinal metastasis from renal cell carcinoma--a case report.

    Metastatic lesions due to renal cell carcinoma are frequently hypervascular. Surgical treatment of these lesions results in excessive operative blood loss. Bleeding may result in technical difficulties and complications during the operation. When surgical treatment of hypervascular spinal metastases is indicated, preoperative embolization, although technically demanding, has been effective in devascularizing these lesions and is an adjunct to internal fixation.
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ranking = 17.682189472351
keywords = blood loss
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19/22. Spinal subarachnoid haemorrhage from an "ancient" schwannoma of the cervical spine.

    A case of spinal subarachnoid haemorrhage secondary to degenerative changes in a cervical schwannoma is presented. The problems associated with diagnosis as well as the possible mechanisms resulting in haemorrhage from spinal tumours are reviewed.
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keywords = haemorrhage
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20/22. Spinal epidural hematoma due to hemangioma of vertebra.

    A case of acute flaccid paraplegia is reported, due to epidural bleeding in the dorso-lumbar region. A hitherto undiagnosed and asymptomatic hemangioma of a dorsal vertebra was considered to be the source of the haemorrhage. Recovery followed early laminectomy and evacuation of blood clots.
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ranking = 0.25
keywords = haemorrhage
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