المؤلفون: Adelhoefer, Siegfried J.^1,2 (AUTHOR) sadelho1@jh.edu, Feghali, James¹ (AUTHOR), Rajan, Sharika³ (AUTHOR), Eberhart, Charles G.³ (AUTHOR), Staedtke, Verena⁴ (AUTHOR), Cohen, Alan R.¹ (AUTHOR)

المصدر: Child's Nervous System. Jul2024, Vol. 40 Issue 7, p2209-2214. 6p.

مصطلحات موضوعية: *MENINGIOMA, *SPINAL cord compression, *VESTIBULAR apparatus diseases, *SCHWANNOMAS, *SENSORINEURAL hearing loss, *GENETIC disorders, *MAGNETIC resonance imaging

مستخلص: NF2-related schwannomatosis (NF2) is a rare autosomal-dominant genetic disorder characterized by bilateral vestibular schwannomas and multiple meningiomas. This case report presents the extremely rare occurrence of an anaplastic meningioma in a 12-year-old male with previously undiagnosed NF2. The patient presented with a history of abdominal pain and episodic emesis, gait unsteadiness, right upper and lower extremity weakness, and facial weakness. He had sensorineural hearing loss and wore bilateral hearing aids. MR imaging revealed a sizable left frontoparietal, dural-based meningioma with heterogeneous enhancement with mass effect on the brain and midline shift. Multiple additional CNS lesions were noted including a homogenous lesion at the level of T5 indicative of compression of the spinal cord. The patient underwent a frontotemporoparietal craniotomy for the removal of his large dural-based meningioma, utilizing neuronavigation and transdural ultrasonography for precise en bloc resection of the mass. Histopathology revealed an anaplastic meningioma, WHO grade 3, characterized by brisk mitotic activity, small-cell changes, high Ki-67 proliferation rate, and significant loss of P16. We report an anaplastic meningioma associated with an underlying diagnosis of NF2 for which we describe clinical and histopathological features. [ABSTRACT FROM AUTHOR]

المؤلفون: Stanners, Megan¹ (AUTHOR), O'Riordan, Marguerite¹ (AUTHOR), Theodosiou, Eirini² (AUTHOR), Souppez, Jean-Baptiste R.G.³ (AUTHOR), Gardner, Adrian^1,4,5 (AUTHOR) adrian.gardner@nhs.net

المصدر: Spine Journal. Jul2024, Vol. 24 Issue 7, p1302-1312. 11p.

مصطلحات موضوعية: *SPINAL cord, *SPINAL cord compression, *LITERATURE reviews, *ANIMAL experimentation, *ANIMAL welfare

مستخلص: Spinal cord compression is a source of pathology routinely seen in clinical practice. However, there remain unanswered questions surrounding both the understanding of pathogenesis and the best method of treatment. This arises from limited real-life testing of the mechanical properties of the spinal cord, either through cadaveric human specimens or animal testing, both of which suffer from methodological, as well as ethical, issues. To conduct a review of the literature on the mechanical properties of the spinal cord. A systematic review of the literature on the mechanical properties of the spinal cord is undertaken. All literature reporting the testing of the mechanical properties of the spinal cord. Reported physiological mechanical properties of the spinal cord. The methodological quality of the studies has been assessed within the ARRIVE guidelines using the CAMARADES framework and SYRCLE's risk of bias tool. This paper details the methodologies and results of the reported testing. We show that (1) the research quality of previous work does not follow published guidelines on animal treatment or risk of bias, (2) no standard protocol has been employed for sample preparation or mechanical testing, (3) this leads to a wide distribution of results for the tested mechanical properties, not applicable to the living human or animal, and (4) animal testing is not a good proxy for human application. The findings summarize the sum of current knowledge inherent to the mechanical properties of the spinal cord and may contribute to the development of a physical model which is applicable to the living human for analysis and testing in a controlled and repeatable fashion. Such a model would be the basis for further clinical research to improve outcomes from spinal cord compression. [ABSTRACT FROM AUTHOR]

المؤلفون: Vavourakis, Michail¹ (AUTHOR) michail.vavourakis@outlook.com, Sakellariou, Evangelos¹ (AUTHOR) athanasiosgalanis@yahoo.com, Galanis, Athanasios¹ (AUTHOR) karapana@yahoo.com, Karampinas, Panagiotis¹ (AUTHOR) dimitriszaxariou@yahoo.com, Zachariou, Dimitrios¹ (AUTHOR) georgetsalimas@yahoo.com, Tsalimas, Georgios¹ (AUTHOR) billmarou@gmail.com, Marougklianis, Vasileios¹ (AUTHOR) mrozhs@gmail.com, Argyropoulou, Evangelia² (AUTHOR) eva.argirop@gmail.com, Rozis, Meletis¹ (AUTHOR) angkaspiris@hotmail.com, Kaspiris, Angelos¹ (AUTHOR) spirosgp@med.uoa.gr, Pneumatikos, Spiros G.¹ (AUTHOR)

المصدر: Journal of Clinical Medicine. Jun2024, Vol. 13 Issue 12, p3590. 14p.

مصطلحات موضوعية: *SPINAL cord compression, *MEDICAL personnel, *PROGNOSIS, *DIAGNOSIS, *PATHOLOGICAL physiology, *SPINAL cord cancer

مستخلص: Background: Spinal cord compression is a formidable complication of advanced cancer, and clinicians of copious specialities often have to encounter significant complex challenges in terms of diagnosis, management, and prognosis. Metastatic lesions from cancer are a common cause of spinal cord compression, affecting a substantial portion of oncology patients, and only in the US has the percentage risen to 10%. Acute metastasis-correlated spinal cord compression poses a considerable clinical challenge, necessitating timely diagnosis and intervention to prevent neurological deficits. Clinical presentation is often non-specific, emphasizing the importance of thorough evaluation and appropriate differential diagnosis. Diagnostic workup involves various imaging modalities and laboratory studies to confirm the diagnosis and assess the extent of compression. Treatment strategies focus on pain management and preserving spinal cord function without significantly increasing patient life expectancy, while multidisciplinary approaches are often required for optimal outcomes. Prognosis depends on several factors, highlighting the importance of early intervention. We provide an up-to-date overview of acute spinal cord compression in metastases, accentuating the importance of comprehensive management strategies. Objectives: This paper extensively explores the pathophysiology, clinical presentation, diagnostic strategies, treatment modalities, and prognosis associated with spinal cord metastases. Materials and Methods: A systematic literature review was conducted in accordance with the PRISMA guidelines. Conclusions: We aim to help healthcare professionals make informed clinical decisions when treating patients with spinal cord metastases by synthesizing current evidence and clinical insights. [ABSTRACT FROM AUTHOR]

المؤلفون: McKean, D.¹ (AUTHOR), Avula, L. V.¹ (AUTHOR), Walters, H. R.² (AUTHOR), Papanikitas, J.¹ (AUTHOR), Joshi, A.² (AUTHOR), Yanny, S.¹ (AUTHOR), Berkowitz, Y.² (AUTHOR), Morgan, S.³ (AUTHOR), Hughes, R.¹ (AUTHOR)

المصدر: Seminars in Musculoskeletal Radiology. 2024 Supplement 1, Vol. 28, pS1-S24. 24p.

مصطلحات موضوعية: *METASTASIS, *SPINAL cord compression, *PROSTATE cancer, *MAGNETIC resonance imaging, *SPINAL tuberculosis

مستخلص: This article discusses the use of percutaneous electrochemotherapy (ECT) as a treatment for radiotherapy-resistant metastatic epidural spinal cord compression (MESCC) caused by metastatic prostate cancer. ECT combines systemic bleomycin with electric pulses delivered locally at the tumor site to increase cell membrane permeability and enhance the effectiveness of bleomycin. The article presents a case study of a 66-year-old patient who underwent ECT and experienced significant improvement in pain and spinal cord compression. While previous studies have shown the effectiveness of ECT in other types of tumors, there is limited data available for its use in prostate cancer. [Extracted from the article]

المؤلفون: Manganas, Konstantinos¹ (AUTHOR) kmagganas92@gmail.com, Xydaki, Aikaterini¹ (AUTHOR) katerina.xydaki@gmail.com, Kotsiafti, Angeliki¹ (AUTHOR) kotsiauti.aggeliki@gmail.com, Papakonstantinou, Olympia² (AUTHOR) sogofianol@gmail.com, Delicou, Sophia¹ (AUTHOR) sophiadelicou@hippocratio.gr

المصدر: Thalassemia Reports. Jun2024, Vol. 14 Issue 2, p26-32. 7p.

مصطلحات موضوعية: *EXTRAMEDULLARY hematopoiesis, *SPINAL cord compression, *SYMPTOMS, *LUMBAR pain, *CHELATION therapy

مستخلص: Extramedullary hematopoiesis (EMH) serves as a compensatory mechanism in chronic hemolytic anemias, such as thalassemia, and can result in spinal cord compression. This case report highlights a 36-year-old woman with transfusion-dependent β-thalassemia (TDT) who presented with lower extremity motor deficiency, pelvic paresthesia, and bladder dysfunction. The patient had a history of lower back pain, bilateral lower limb weakness, and demonstrated poor compliance with iron chelation therapy. MRI findings indicated spinal cord compression attributable to extramedullary hematopoiesis. Due to the infeasibility of surgical intervention, the patient underwent hypertransfusion and iron chelation therapy. While neurological symptoms improved, urinary retention persisted. The patient continues to receive iron chelation treatment and undergo transfusions. Managing extramedullary hematopoiesis in thalassemia necessitates an individualized treatment approach. [ABSTRACT FROM AUTHOR]

المؤلفون: Liu, Hongju¹ (AUTHOR), zhang, Zhe¹ (AUTHOR), Li, Sining² (AUTHOR), Hou, Yuli² (AUTHOR), Tong, Xuezhi¹ (AUTHOR), Yu, Yanbing¹ (AUTHOR), Wu, Hao^1,3 (AUTHOR) wuhaoneurosurgery@163.com

المصدر: World Neurosurgery. Jun2024, Vol. 186, pe75-e80. 6p.

مصطلحات موضوعية: *SPINAL surgery, *SPINAL cord compression, *TREATMENT effectiveness, *MAGNETIC resonance imaging, *CERVICAL vertebrae, *SPINAL fusion, *DISCECTOMY, *NECK pain

مستخلص: To investigate the clinical outcomes of anterior cervical decompression and fusion (ACDF) surgery for the treatment of Hirayama disease (HD). In this study, 15 patients with HD who underwent ACDF operation between March 2022 and March 2023 with complete data were retrospectively analyzed. Following the diagnosis, conservative treatment was ineffective, and thus, disease progression severely affected the quality of life (QOL) of patients. ACDF was performed in the China-Japan Friendship Hospital, and patients were regularly followed up postoperatively. The cervical range of motion (ROM), the anteroposterior and transverse diameter of the spinal cord, and their ratio was measured before and after the operation. The neurologic function of patients before and after the last follow-up was evaluated using the selected brief-Michigan Hand Questionnaire (sb-MHQ), whilst the overall therapeutic effect after the operation was evaluated using Odom's criteria. All patients were followed up for an average of 12 ± 4.5 (6–18) months. Dynamic X-ray displayed that the ROM of cervical vertebrae decreased from 72.73 ± 12.72° (53–97°) to 33.53° ± 10.34° (15–54°) (P < 0.001). Moreover, flexion cervical magnetic resonance imaging (MRI) performed after the operation revealed that spinal cord compression was markedly relieved, and the ratio of the anteroposterior diameter of the spinal cord to the transverse diameter increased from 0.27 ± 0.09 to 0.43 ± 0.03 (P < 0.001). At the last follow-up visit, finger extension tremor symptoms were alleviated, although they did not completely disappear. Contrastingly, muscle atrophy showed no significant improvement. Finally, the sb-MHQ score significantly increased from 17.33 ± 1.76 preoperatively to 24.80 ± 1.78 at the last follow-up (P < 0.001). Our results collectively highlighted the efficacy of ACDF for the treatment of HD. This procedure can limit excessive cervical flexion and repeated compression of the spinal cord during cervical movement and considerably improve upper limb functions. [ABSTRACT FROM AUTHOR]

المؤلفون: Zhang, Yangming¹ (AUTHOR), Fang, Xiang¹ (AUTHOR), Luo, Lin² (AUTHOR), Xiong, Yan¹ (AUTHOR), Zhang, Wenli¹ (AUTHOR), Gou, Yawei² (AUTHOR), Gong, Chunfu² (AUTHOR), Xiang, Zhou¹ (AUTHOR), Kuang, Fuguo² (AUTHOR) 2248063616@qq.com, Duan, Hong¹ (AUTHOR) duanhong1970@126.com

المصدر: Orthopaedic Surgery. Jun2024, Vol. 16 Issue 6, p1292-1299. 8p.

مصطلحات موضوعية: *SURGICAL decompression, *SPINAL cord compression, *SPONTANEOUS fractures, *MICROWAVES, *MANN Whitney U Test, *SPINAL cord injuries, *SPINAL cord tumors

مستخلص: Objectives: There is still controversy over the choice of treatment for end‐stage spinal metastases. With the continuous development of microwave technology in spinal tumors, related studies have reported that microwave combined with techniques such as pedicle screw fixation and percutaneous vertebroplasty can achieve the purpose of tumor ablation, relieving spinal cord compression, enhancing spinal stability, effectively relieving pain, and reducing recurrence rates. This study aimed to analyze the effectiveness of microwave ablation combined with decompression and pedicle screw fixation in the palliative management of spinal metastases with pathological fractures. Methods: This retrospective study enrolled 82 patients with spinal metastases and pathological fractures treated between January 2016 and July 2020, with 44 patients undergoing pedicle screw fixation along with laminectomy (fixation group) and the remaining 38 receiving microwave ablation in addition to the treatment provided to group fixation (MWA group). Before surgery, all patients underwent pain assessment using the visual analogue scale (VAS) and evaluation of spinal cord injury using the Frankel classification. After surgery, the patients' prognoses were assessed using the Tomita score, modified Tokuhashi score system, and progression‐free survival. Additionally, we compared operative time and blood loss between the two groups. Survival analysis utilized the Kaplan–Meier method with a log‐rank test for group comparisons. Paired t‐tests and the Mann–Whitney U test were applied to metric and non‐normally distributed data, respectively. Neurological function improvement across groups was evaluated using the χ2 test. Results: All patients were followed up for a median duration of 18 and 20 months in the fixation and MWA groups, respectively, with follow‐up periods ranging from 6 to 36 months. Statistically significant reductions in postoperative VAS scores were observed in all patients compared with their preoperative scores. The MWA group exhibited reduced blood loss (t = 2.74, p = 0.01), lower VAS scores at the 1‐ and 3‐month follow‐ups (t = 2.34, P = 0.02; t = 2.83, p = 0.006), and longer progression‐free survival than the fixation group (p = 0.03). Although the operation times in the MWA group were longer than those in the fixation group, this difference was not statistically significant (t = 6.06, p = 0.12). No statistically significant differences were found regarding improvements in spinal cord function between the two groups (p = 0.77). Conclusion: Compared with decompression and pedicle screw fixation for treating spinal metastases with pathological fractures, microwave ablation combined with decompression and pedicle screw fixation showed better outcomes in terms of pain control, longer progression‐free survival, and lower blood loss without increasing operative time, which has favorable implications for clinical practice. [ABSTRACT FROM AUTHOR]

المؤلفون: Yavorkovsky, Leonid L.¹ (AUTHOR)

المصدر: Oncology Research & Treatment. 2024, Vol. 47 Issue 6, p287-295. 8p.

مصطلحات موضوعية: *SPINAL cord compression, *DIFFUSE large B-cell lymphomas, *MAGNETIC resonance imaging, *SPINAL canal, *NON-Hodgkin's lymphoma, *THORACIC vertebrae

مستخلص: Introduction: The management of metastatic spinal cord compression (mSCC) is a demanding task. The main challenges of mSCC include various manifestations and unpredictable outcomes with indiscriminate treatment recommendations. Because of attendant urgency with potentially devastating health consequences, the SCC is an emotionally disturbing experience whose management could take an impulsive rather than rational approach. The treatment strategy is particularly problematic when mSCC is caused by a malignant lymphoma with its protean attributes. Case Report: A 68-year-old female presented with generalized body pain and weight loss. Imaging studies revealed a vast bulk of the disease involving lymph nodes, spleen, visceral organs, musculature, marrow, and bones including vertebrae with extension into the spinal canal. A biopsy of the chest wall mass showed high-grade diffuse large B-cell lymphoma. A magnetic resonance imaging (MRI) of the spine demonstrated diffuse marrow replacement by the tumor of the thoracic and lumbar spine with compression of the cord. The prompt treatment with corticosteroids and immunochemotherapy (ICT) was recommended, but the patient elected to seek a second opinion. After two doses of radiation therapy, the patient's general condition rapidly deteriorated and she was hospitalized for systemic ICT. Despite the treatment, her condition continued to deteriorate, and she died 3 weeks after the presentation. Conclusion: The presented case demonstrates some hitherto unaddressed challenges in evaluation and treatment of mSCC caused by aggressive non-Hodgkin lymphoma (LSSC). The case scrutinizes the role of MRI in uncommon clinical situations. The case has also exposed some ethical issues associated with the proper management of LSCC. Established Facts: Metastatic spinal cord compression (mSCC) can complicate any type of malignancy, most commonly the breast, prostate and lung cancers. Non-Hodgkin lymphoma (NHL), however, demonstrates the highest cancer-specific SCC incidence with the majority being diffuse large B cell lymphomas. Lymphomatous SCC (LSCC) must be distinguished from the primary or secondary CNS lymphomas. The management of LSCC most commonly follows the same strategy as other malignancies and involves decompression surgery, local radiation treatment or both. Chemotherapy as a treatment of LSCC has been introduced as early as the 1970s, but its role and necessity in LSCC management have long remained controversial. The indications for, and the role of, diagnostic MRI in evaluation of LSCC, although well established, could be intricate and difficult to ascertain. [ABSTRACT FROM AUTHOR]

المؤلفون: Dokponou, Yao Christian Hugues¹ (AUTHOR) dokponou2407@gmail.com, Saad, Moussa Elmi¹ (AUTHOR), Obame, Fresnel Lutece Ontsi¹ (AUTHOR), Imbunhe, Napoleão¹ (AUTHOR), Mohcine, Salami¹ (AUTHOR), El Asri, Abad Cherif¹ (AUTHOR), Gazzaz, Miloud¹ (AUTHOR)

المصدر: Egyptian Journal of Neurosurgery. 5/27/2024, Vol. 39 Issue 1, p1-8. 8p.

مصطلحات موضوعية: *ANGIOMAS, *SPINAL cord compression, *CERVICAL cord, *NERVOUS system, *SYMPTOMS, *SURGICAL excision

مستخلص: Background: Cavernous malformations can occur throughout the cerebral nervous system, most commonly located in the supratentorial compartment. The intramedullary location is rare and accounts for approximately 2.4% to 5% of all spinal vascular tumors. The cervical cord location and its clinical manifestations are underreported. Methods: The authors report a case of spinal cord compression at the C5–C6 level by a cervical intramedullary cavernoma with a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and meta-analysis guidelines. Relevant studies (1980 to 2023) that reported patients with cervical intramedullary cavernoma were identified from PubMed databases. Results: A total of 29 studies reporting 423 patients were included in this study with a mean age of 40.5 ± 6.3 years old. The overall male-to-female ratio was 1:2.5 with a median duration of follow-up of 46 months [18.5–63.9]. The type of resection as well as the patient's outcome was also reported. Conclusion: Intramedullary cavernous angiomas are rare. Early surgical total resection of the symptomatic lesions in adequate conditions is crucial for good outcomes. [ABSTRACT FROM AUTHOR]

المؤلفون: González-Kusjanovic, Nicolás¹ (AUTHOR), Delgado Ochoa, Byron¹ (AUTHOR), Vidal, Catalina¹ (AUTHOR), Campos, Mauricio¹ (AUTHOR) mcampos@uc.cl

المصدر: International Orthopaedics. May2024, Vol. 48 Issue 5, p1341-1350. 10p.

مصطلحات موضوعية: *SPINAL cord compression, *SURGICAL complications, *PATIENT selection, *SURVIVAL rate, *SURVIVAL analysis (Biometry)

مستخلص: Purpose: The prevalence of metastatic epidural spinal cord compression (MESCC) is increasing globally due to advancements in cancer diagnosis and treatment. Whilst surgery can benefit specific patients, the complication rate can reach up to 34%, with limited reporting on their impact in the literature. This study aims to analyse the influence of major complications on the survival of surgically treated MESCC patients. Methods: Consecutive MESCC patients undergoing surgery and meeting inclusion criteria were selected. Survival duration from decompressive surgery to death was recorded. Perioperative factors influencing survival were documented and analysed. Kaplan–Meier survival analysis at one year compared these factors. Univariate and multivariate Cox proportional hazard regression analyses were performed. Additionally, univariate analysis compared complicated and uncomplicated groups. Results: Seventy-five patients were analysed. Median survival for this cohort was 229 days (95% CI 174–365). Surgical complications, low patient performance, and rapid primary tumour growth were significant perioperative variables for survival in multivariate analyses (p < 0.001, p = 0.003, and p = 0.02, respectively) with a hazard ratio of 3.2, 3.6, and 2.1, respectively. Univariate analysis showed no variables associated with complication occurrence. Conclusion: In this cohort, major surgical complications, patient performance, and primary tumour growth rate were found to be independent factors affecting one year survival. Thus, prioritizing complication prevention and appropriate patient selection is crucial for optimizing survival in this population. [ABSTRACT FROM AUTHOR]