Cases reported "Spinal Neoplasms"

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1/18. Symptomatic intraspinal air entrapment.

    A 59-year-old man who had undergone the removal of a lipoma of the thoracic spine presented with progressive weakness of the lower limbs when lumbar puncture followed drainage of a subcutaneous collection of cerebrospinal fluid. Computed tomography showed entrapped intraspinal air which compressed the spinal cord. This rare, but serious complication can occur in a patient with altered intrathecal pressure following spinal surgery.
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2/18. Myelographic evaluation of nontraumatic spinal canal obstruction: a new approach.

    A new technique simplifies the evaluation of the spinal canal above obstructing lesions encountered during myelography via the lumbar route. After the demonstration of a block with 2--4 ml Pantopaque, a second injection of 2--4 ml Pantopaque is made through the lumbar needle with the patient in 45 degree Trendelenberg (or any degree necessary to keep the initial contast bolus against the inferior margin of the obstruction). In all 10 cases in this series, the second injection easily displaced contrast around and above obstructions that could not be overcome by gravity thereby obviating a lateral cervical or cisternal puncture. No technical failures of complications were encountered. The method is not recommended in cases of traumatic spinal canal obstruction.
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3/18. Percutaneous technique for sclerotherapy of vertebral hemangioma compressing spinal cord.

    PURPOSE: In this study we report a percutaneous technique to achieve sclerosis of vertebral hemangioma and decompression of the spinal cord and nerve roots. methods: Under CT guidance the affected vertebral body is punctured by a biopsy needle and sclerosant is injected directly into the tumor. In the case of large paravertebral extension, additional injection is given in the paravertebral soft tissue component to induce shrinkage of the whole tumor mass and release of the compressed spinal cord. RESULTS: Using this technique we treated five patients in whom vertebral hemangioma gave rise to neurologic symptoms. In three patients, sclerotherapy was the only treatment given. In the other two patients, sclerotherapy was preceded by transcatheter embolization. Neither decompressive surgery, radiation therapy nor stabilization was required with this technique. CONCLUSION: Our experience with CT-guided intraosseous sclerotherapy has proved highly satisfactory.
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4/18. Iatrogenic intraspinal epidermoid tumor: two cases and a review of the literature.

    STUDY DESIGN: Two cases of patients whom intraspinal epidermoid tumors presented and were successfully removed 6 years after neonatal lumbar puncture are reported. OBJECTIVE: To describe the presentation of this type of spinal tumor and strategies for diagnosis and treatment. SUMMARY OF BACKGROUND DATA: cells iatrogenically implanted into the spinal canal during lumbar puncture can slowly grow until symptomatic. diagnosis can be difficult and is often delayed. MRI appears to offer some advantages in diagnosis provided that gadolinium is used. Treatment is by surgical excision. methods: The first patient, a 6-year-old boy, presented with severe episodic hip pain of unknown etiology. MRI of the lumbar spine revealed a 1-cm epidermoid at L1-L2. The second child, a 6-year-old girl, presented with low back pain and dragging of the feet. MRI revealed a mass at L3. RESULTS: In both cases, complete excision via lumbar laminectomy was performed. Both patients were asymptomatic at the 1-year follow-up with resolution of preoperative weakness. CONCLUSIONS: This study highlights an uncommon but not rare tumor that may present to the spine specialist in a variety of ways. The diagnosis is often delayed. The advent of MRI has improved the ease and accuracy of diagnosis. Complete excision is usually possible and is curative.
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5/18. Filum ependymoma mimicking spontaneous intracranial hypotension.

    A 34-year-old man with a 2-week history of orthostatic headaches and a "dry tap" at lumbar puncture was found to have a lumbar intradural mass on magnetic resonance imaging (MRI) examination. A myxopapillary ependymoma was resected and the patient's headache completely resolved. The combination of spontaneous orthostatic headaches and a "dry tap" at the time of lumbar puncture does not always indicate the presence of a spontaneous cerebrospinal fluid (CSF) leak and intracranial hypotension.
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6/18. Preoperative devascularization of a circumferential osteogenic metastasis to the upper cervical spine by direct percutaneous needle puncture: a technical note.

    Direct percutaneous needle puncture (DPNP) for presurgical devascularization of head and neck as well as skull base tumours is an established, yet not widespread method. We present a case of a large and highly vascularized metastasis with partial destruction of the first two cervical vertebrae and encasement of the spinal cord that was successfully treated by DPNP for preoperative devascularization after an attempted endovascular embolization had failed. The lesion was safely and effectively devascularized, which facilitated the surgical removal. The case presented illustrates the technique and furthermore demonstrates its value.
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7/18. Intradural extramedullary mature cystic teratoma: not only a childhood disease.

    OBJECTIVE: The authors report on the first case of a spinal intradural extramedullary cystic teratoma in an aged patient. These lesions have been reported in adolescents and young adults often with a history of spinal dysraphism. They are believed to be congenital lesions; however, they have also been reported in patients with a history of posterior spinal surgery or lumbar puncture. METHOD: An 85-year-old man was evaluated for persistent and progressive lower extremity paresis. His symptoms began after relatively minor trauma. He had no prior lumbar surgeries. neuroimaging studies revealed an L1-L2 intradural mass. A putative diagnosis of a cystic intradural extramedullary mass was made. A lumbar laminectomy and durotomy were performed. RESULTS: A cystic lesion containing hair follicles, cartilage, adipose, and neural tissue was encountered. Pathologic review corroborated the diagnosis of cystic teratoma. CONCLUSIONS: The occurrence of cystic teratomas in the absence of previous surgery or lumbar puncture is uncommon. Even rarer are reports of these lesions in aged patients. Of particular interest in this case is the fact that this patient had not undergone any previous lumbar procedures nor did he have a history of spinal dysraphism. Though rare, this entity should be included in the differential of cystic intradural spinal cord lesions.
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8/18. 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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9/18. Spinal coning after lumbar puncture in prostate cancer with asymptomatic vertebral metastasis: a case report.

    A 60-year-old man was admitted to our hospital for complete urinary retention. prostate cancer was diagnosed and anti-cancer chemotherapy was administered. Regression of prostatic enlargement was appreciated and difficult urination improved. At 6 months after the initial treatment vertebral metastasis of T10-11 was noted on a bone scintigram but there were no symptoms induced by bone metastasis. orchiectomy was performed with the patient under lumbar anesthesia. Complete paralysis of both lower extremities occurred postoperatively. Computerized tomography and myelographic findings demonstrated complete subarachnoid block with an extramedullary spinal cord tumor. It was concluded that traction on the spinal cord producing neurological deterioration (spinal coning) occurred after removal of the cerebrospinal fluid by lumbar puncture.
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10/18. Granulocytic sarcoma in childhood acute myelogenous leukemia.

    A 12-year-old boy with acute myelogenous leukemia developed acute weakness and paresthesias of the lower extremities after lumbar puncture. Computed tomography and magnetic resonance imaging revealed 2 large paraspinal masses (granulocytic sarcoma) causing spinal cord compression. Treatment with corticosteroids, radiation therapy, and chemotherapy caused complete resolution of symptoms; there was no evidence of tumor on subsequent magnetic resonance imaging or at autopsy. Granulocytic sarcomas (chloromas) rarely involve the nervous system in patients with acute myelogenous leukemia, although with increased survival it is apparent that the incidence may be greater than previously believed. central nervous system prophylaxis was not administered to our patient but may be recommended for future patients if systemic disease can be controlled. General features of central nervous system complications of acute myelogenous leukemia, characteristics of granulocytic sarcoma, and review of current radiographic techniques used in the evaluation of these tumors are discussed.
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