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PubMed1968

Spinal neoplasms.

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Adolescent↗
PubMed1997

Strategy for the treatment of patients with spinal neoplasms.

Progress in oncological therapy within the last decade has enhanced the survival time of patients suffering from tumorous osteolyses of the spine. While the necessity of surgical intervention is often settled by acute clinical symptoms, the extent of surgery is certainly co-determined by the patient's expectations and the time of survival to be expected. We therefore developed a specific tumor algorithm for operations on the spine with special emphasis on prognosis and the attainable quality of life. The results of 154 patients with tumorous osteolyses of the thoracic and lumbar spine, who were treated according to our algorithm, underline the unequivocal advantages of initially posterior procedures.

Algorithms↗
PubMedDate not supplied

[Results of treatment of extradural spinal neoplasms].

82 patients with malignant epidural neoplasms (s.e.n.) were operated on between 1980 and 1990. Some underwent radio- or chemotherapy following surgery. Exact data on neurological results of treatment were obtained from 42 cases which represented the analysed group. When patients were ambulatory and/or had useful motor function of their upper extremities following treatment the result was accepted as positive. This was found in 71% of cases. In patients with severe paresis (non-walking before surgery) positive result was obtained in 59% of cases. In patients with mild paresis or neurologically without signs, positive results were obtained in 100% of cases. Of patients who died, 45% had positive neurological result until death. Overall 21% of cases (49% of those with severe neurological deficits) did not regain the ability of walking that is the most important benefit which may result from treatment. Those patients presented in severe general condition, advanced neoplastic spread to other systems and total transverse spinal cord damage. In about 90% of cases there was a significant relief of back and radical pain.

Breast Neoplasms↗
PubMed2003

Surgical management of metastatic spinal neoplasms.

OBJECT: In this study the authors retrospectively review outcomes in patients treated for metastases to the spine. Surgery for metastatic tumors to the spine remains an important part of the treatment armamentarium. Maximum tumor resection with a minimum number of complications is one of the goals of surgery. Current surgical procedures include tumor resection and spinal stabilization for optimal results. METHODS: The records of 96 patients who underwent surgery for a metastatic spine tumor at the authors' institution were reviewed. Spinal instrumentation was used in the majority of patients. Ambulatory status was maintained in 91% and pain improved in 94% of patients. Complications included infection (5.2%), cerebrospinal fluid leak (2%), and delayed hardware failure (3.1%). The mortality rate was 4.1%; the main cause was due to tumor progression. CONCLUSIONS: Surgery is indicated in a select group of patients with metastatic tumors to the spine. A multidisciplinary approach is recommended for patient selection and complication avoidance. Surgical options, including approach, type of reconstruction and extent of resection (including en bloc spondylectomy) need to be addressed for optimal outcomes.

Adenocarcinoma↗
PubMed1992

Neoplasms and related disorders.

Spinal neoplasms may be primary or metastatic, benign or malignant. In adults, metastatic involvement of the spine will represent the most important neoplastic disease of this region. However, hemangiomas are the most common spinal neoplasms. The vast majority of intradural, extramedullary neoplasms that will be identified in the spine are meningiomas and neurofibromas. Both lesions may be sporadic or associated with phakomatoses. Intramedullary spinal cord and filum terminale tumors are relatively rare and are far less common than intramedullary brain tumors. As is the case in the brain, these are overwhelmingly glial neoplasms, with ependymomas and low-grade astrocytomas representing the majority of the lesions. Hemangioblastoma deserves mention because of its often characteristic imaging findings and its association with von Hippel-Lindau disease.

Humans↗
PubMed2000

Surgical pathology of intramedullary spinal cord neoplasms.

The surgical pathology of intramedullary spinal cord neoplasms is most accurately based on radical resection specimens rather than on small biopsies, which may be highly misleading. A review of the neuropathology files at NYU Medical Center revealed 294 surgical specimens of intramedullary cord lesions examined between January 1, 1991 and December 31, 1998. Of these 117 were from children (age less than 21 years) and 177 were from adults (21 and over). While most types of central nervous system tumors known to occur in the brain also occur in the spinal cord, the different proportions of these tumors by histologic type, and the differences in the proportions of tumor types in children compared to adults, are both significant. In adults ependymomas are the predominant tumor type (93 total) while in children astrocytomas and mixed neuronal-glial tumors are virtually equally common and outnumber ependymomas. In this period no cord Primitive Neuroectodermal Tumors were identified. Among the astrocytic neoplasms and other gliomas, high grade tumors were distinctly uncommon in children and only slightly more common in adults, in sharp contrast with the brain, where the majority of adult intra-axial tumors are high grade.

Adult↗
PubMed1990

Magnetic resonance imaging contrast agents: theory and application to the central nervous system.

The theoretical aspects of magnetic resonance (MR) imaging contrast agents are reviewed, and their current applications to the central nervous system (CNS) and their future applications are discussed. Profound differences exist between contrast agents used for MR imaging and computerized tomography (CT). In MR imaging, the contrast agents are not imaged directly but rather act on adjacent protons to shorten T1 and T2 relaxation times. This in turn results in signal intensity changes. The lanthanide metal, gadolinium, in the form of gadopentetate dimeglumine, has been found to be both safe and efficacious as the only currently approved contrast agent for MR imaging. Magnetic resonance imaging revolutionized the detection and treatment of disease affecting the brain and spine. Initially, it was thought that signal characteristics on MR imaging would allow differentiation of specific pathology. It was soon found that MR studies were able to detect more abnormalities but were less able to characterize them. The recent development of contrast agents for MR imaging has allowed this modality to surpass CT for the evaluation of most CNS lesions. At present, contrast-enhanced MR imaging is generally accepted as the study of choice for evaluating acoustic neurinomas, pituitary lesions, meningeal disease, primary and secondary brain tumors, active multiple sclerosis, intradural spinal neoplasms, intramedullary spinal disease, and postoperative states in both the spine and brain. Even when contrast-enhanced CT can detect the same abnormalities, evaluation of the lesions in multiple planes on MR imaging can sometimes yield invaluable information, especially prior to surgery. Future developments of contrast material for MR imaging include non-gadolinium compounds, intrathecal contrast media, cerebral blood flow and volume evaluation, and, possibly, antibody-labeled contrast agents.

Animals↗
PubMed2004

Cervical spinal cord neoplasm in a patient with an implanted cervical spinal cord stimulator: the controversial role of magnetic resonance imaging.

OBJECTIVE: To discuss the diagnostic relevance and safety concerns of performing magnetic resonance imaging (MRI) in the presence of an implanted spinal cord stimulator (SCS). CASE REPORT: A 39-year old man with CRPS I and major depression fell and fractured his humerus. A cervical SCS had been placed several years earlier. After the fall, he developed progressive lower extremity weakness. Eventually, he became wheelchair dependent and required assistance with transfers. These symptoms were attributed to CRPS and deconditioning. He was admitted to an inpatient rehabilitation unit for functional restoration. At presentation, he reported developing neck and upper thoracic pain, which started several months before the fall - a pain that was distinct from his total body pain. A contrast-enhanced CT scan of the neck was normal, except for the spinal cord stimulator induced artifact. Our pain service was consulted. After performing a neurological exam, cervical myelopathy was suspected. An MRI of the spine demonstrated a mass compressing the cervical spinal cord. The patient tolerated the MRI, despite the presence of a neurostimulator. The mass was identified as an extramedullary, intradural schwannoma and was completely excised during surgery. The patient made a profound neurological recovery. CONCLUSION: The diagnostic value of MRI may outweigh the potential dangers of using this imaging modality when a patient with a neurostimulation device presents with a new-onset neurological deficit. Thorough informed consent and close physician monitoring of these patients during the MRI is imperative.

Journal Article↗
PubMed1995

Vascular malformations presenting as spinal cord neoplasms: case report.

Three cases of adult patients with subacute courses of progressive caudal spinal cord disease are presented. Computed tomography, magnetic resonance imaging, and myelographic studies were interpreted preoperatively as representing a spinal cord neoplasm in each case. No evidence of enlarged or abnormal surface vessels was observed by neuroimaging or intraoperatively. Biopsy specimens from each spinal cord lesion showed the typical histopathological features of a spinal vascular malformation. We conclude that vascular malformations of the caudal spinal cord can appear as isolated intramedullary lesions with apparently normal surface vessels and that these lesions may be difficult to distinguish from spinal cord neoplasms.

Aged↗
PubMed1983

Primary extradural neoplasms causing spinal cord compression.

Thirteen patients presented primary extradural neoplasms compressing the spinal cord and/or roots in a four year period. Laminectomy and tumour excision or biopsy were carried out in twelve patients and transthoracic resection in the one remaining. Six tumours were benign; two were neurofibromata associated with von Recklinghausen's disease; two were osteochondromata; and there were single cases of cavernous haemangioma and aneurysmal bone cyst. All patients are alive and well; follow-up ranges between 1.3 an 8.5 years post-operation. Among the malignant neoplasms there were three malignant lymphomata, two Ewing's sarcoma and single instances of mesenchymal chondrosarcoma and chondrosarcoma of the classical type. Four patients are alive, having been followed up between 3.5 to 5 years.

Adolescent↗