• Journal of Korean Neurosurgical Society
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• v.43 no.5
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• pp.232-236
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• 2008

Total laminectomy for the removal of intradural-extramedullary spinal cord tumors has been used widely, but postoperative complications often develop, such as kyphosis, spinal instability, and persistent back pain. In this study, we evaluated seven patients with intradural-extramedullary spinal cord tumors with respect to the value of unilateral limited laminectomy. Our cases included six schwannomas, and one meningioma. The cervical region was involved in four cases, the thoracolumbar region in two cases, and the lumbar region in one case. The rationale for choosing a unilateral approach is to preserve musculoligamentous attachments and posterior bony elements as much as possible. The patients were mobilized on the third postoperative day and preoperative neurological symptoms were recovered within a few weeks. We did not observe any complication relating to unilateral limited laminectomy and at follow-up evaluation (at 3 and 12 months postoperatively), none of the patients showed spinal deformity or spinal instability. We think that the unilateral limited laminectomy is a safe and efficient technique for the treatment of intradural-extramedullary spinal cord tumors. We suggest that this technique is one of the best treatments for these tumors.

• Journal of Korean Neurosurgical Society
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• v.54 no.5
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• pp.415-419
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• 2013

Hemangioblastomas are sporadic tumors found in the cerebellum or spinal cord. Supratentorial hemangioblastomas are rare, and those with meningeal involvement are extremely rare and have been reported in only approximately 130 patients. Here, we report the case of a 51-year-old female patient with supratentorial meningeal hemangioblastoma detected 5 years after surgical resection of an infratentorial hemangioblastoma associated with von Hippel-Lindau disease. Patients with von Hippel-Lindau syndrome are at risk for developing multiple hemangioblastomas, with new tumor formation and growth and possible meningeal infiltration. Regular lifelong follow-up in at-risk patients is recommended and should include the differential diagnosis of dural-based tumors such as angioblastic meningioma and metastatic renal cell carcinoma.

• Journal of Veterinary Clinics
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• v.31 no.2
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• pp.152-155
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• 2014

An 11-year-old castrated Schnauzer presented with paraplegia for the last two weeks, initially developed pelvic limb ataxia 6 months ago and left pelvic limb paresis 3 months ago. On neurological examination, paraplegia and postural reaction deficits were noted in the pelvic limbs with no deep pain sensation, and the dog showed exaggerated spinal reflexes and involuntary urination. Magnetic resonance (MR) images of thoracolumbar spinal cord were obtained with a 0.3 Tesla magnet. A mass with a broad base to the dorsal and left dural margins was identified at the level of L2, causing marked spinal cord compression. The mass showed isointensity to the spinal cord on T1-weighted (T1W) precontrast images, hyperintensity on T2-weighted images, marked homogeneous contrast enhancement with well-defined margins and the "dural tail" sign on T1W postcontrast images. An intradural-extramedullay tumor was considered, most likely, meningioma was highly suggestive. Left-sided hemilaminectomy and dorsal laminectomy were performed. An intradural mass partially adherent to dura mater was compressing the spinal cord, and the mass was completely removed with the attached dura mater. A histopathologic diagnosis of angiomatous subtype meningioma was made.

• Investigative Magnetic Resonance Imaging
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• v.17 no.2
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• pp.149-153
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• 2013

Detection of cerebrospinal fluid leakage or exact localization of leakage site after spinal surgery is difficult on conventional imaging studies. We report two patients with surgery-related spinal CSF leakage detected on magnetic resonance (MR) myelography. They presented with severe headache after spinal surgeries, lumbar discectomy and excision of spinal meningioma, respectively. The sites of spinal CSF leakage in the patients were detected accurately on MR myelography, and the patients recovered from the postoperative CSF leakage after being treated with an epidural blood patch or reoperation. MR myelography may be effective in demonstrating the exact site of surgery-related spinal CSF leakage.

• Journal of Veterinary Clinics
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• v.31 no.5
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• pp.439-444
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• 2014

A 5-year-old, 2.7 kg female maltese dog was presented a local veterinary clinic with one week history of hindlimb lameness associated with patellar luxation. Reduction of bilateral medial patellar luxation was operated using trochlear resection and lateral reinforcement technique. Three weeks after the surgery, the dog showed bending spine with pain in thoracic and lumbar region, continuous ataxia and intermittent convulsion. Magnetic resonance imaging scanning revealed a hyperintense mass in right frontal lobe of brain and abnormal cavitation from cervical cord to third lumbar cord. Histopathologically, neoplasm in brain composed of meningothelial cells showed loosely reticular or lace-like morphology with numerous extracellular cystic spaces of variable size and shape. Neoplastic cells were positive for vimentin and negative for neuron specific enolase and glial fibrillary acidic protein. Irregular shaped enlarge central canal-like cavity was existed in cervical and lumbar cords. In our best knowledge, this report described the clinical findings, imaging and histopathologic characteristics of unusual intracranial microcystic meningioma with secondary syringomyelia in a dog.

• Journal of Korean Neurosurgical Society
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• v.30 no.1
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• pp.47-53
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• 2001

Objective : This study was undertaken to evaluate operative results and prognosis according to preoperative clinical status and histopathological finding of spinal cord tumor. Methods : We analyzed of clinical feature, tumor location, histopathologic finding, operative results and prognosis in 55 patients with spinal cord tumor during last 10 years. Results : 1) The incidence of spinal cord tumors varies with the age of affected patients who are 2 to 75 years of age. Peak incidences were in the 5th & 7th decade of life, and the ratio of male to female was 1.2:1. 2) The most common histopathologic type was neurinoma(41.9%). 3) The tumors were located most frequently in the thoracic area(22 cases, 40.0%) and in the intradural extramedullary space(30 cases, 54.5%). 4) The most common initial clinical feature was pain in 20 cases(36.4%). For neurologic status on admission, 30 cases(54.5%) showed motor disturbance. 5) In radiologic studies, there were abnormal finding in 21 cases from plain X-rays among 37 cases. The entire 20 cases in when myelography was done showed subarachnoid blockade, either complete or incomplete. The magnetic resonance imaging, regard as the most accurate diagnostic method, revealed the exact location of the tumor and the relationship of the tumor with the adjacent anatomical structure. 6) The total removal was possible in 36 cases(65.5%), subtotal removal in 17 cases(30.9%) and biopsy in 2 cases (3.6%). Nineteen cases(90.5%) among 21 cases with preoperative radiculopathy group showed recovery or improvement, where as only 11 cases(36.7%) among 30 cases with preoperative motor weakness group showed recovery or improvement, with statistically significant difference(p<0.01). Pathologically, 26 cases(83.9%) among 31 cases of neurinoma and meningioma showed postoperative recovery or improved, but only 1 case(6.3%) among 16 cases of metastatic tumor, astrocytoma and ependymoma recovered. Postoperative complication noted in 5 cases(9.1%), and were noted postoperative hematoma, pneumonia, pulmonary edema and spinal cord infarction. Conclusion : Preoperative neurologic status and histopathologic finding are considered important factors of Postoperative outcome in patients with spinal cord tumor.

• Journal of Korean Neurosurgical Society
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• v.30 no.9
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• pp.1103-1107
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• 2001

Objective : Atypical and malignant meningiomas(AM, MM) are known to be rare and show aggressive behavior. Limited data are available concerning the clinical features, effectiveness of surgical removal and role of radiation therapy with AM, MM. The authors report our experience of AM, MM, with respect to clinical features. Methods : Twenty-four cases of AM and 28 cases of MM, who were operated between 1988 and 1999 were retro-spectively studied review of medical records and radiological findings. These were compared with control group of 24 cases of menigiomas manifestating usual clinical course, which are selected arbitrarily among operative cases between Apr. 1999 and Dec. 1999. Mean follow-up periods were 26(1-91) months for AM and 23(1-62) for MM. Authors analyzed the prognostic factors for survival, and statistical analysis were accomplished by Kaplan-Meier method and log-rank test. Results : Differences of clinical features between control groups and these atypical and malignant meningioma group were not significant. However, the location of MM was frequent in non-basal area(p<0.01). In AM, there were 4 patients of recurrence, and 3 patients of mortality. Among mortality cases, only one patient died of tumor progression, the other patients died of other causes. The survival at 2 year and 5 year in this group were 88% and 74% respectively, and in MM, 11 patients died due to tumor progression and 2 had spinal metastasis. The survival at 2 year and 5 year were 72% and 20%, respectively. For extent of resection, total removal(Simpson grade 1 or 2) was less often achieved in MM compared with AM(50% vs. 83%). Extent of resection of tumor and postoperative radiation therapy did not affect survival in both AM, MM. Conclusions : Clinical behavior of AM showed more benign than that of MM. Prognostic factor for survival is not related extent of resection of tumor and postoperative radiation therapy. However, further investigation with long-term follow-up and additional cases is mandatory.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.6
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• pp.3979-3985
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• 2013

Background: Although primary malignant CNS tumors are registered in the national cancer registry (NCR) of Iran, there are no available data on the incidence of the primary malignant or benign CNS tumors and their common histopathologies in the country. This study analyzed the 10-year data of the Iranian NCR from March 21, 2000 to March 20, 2010, including a systematic review. Materials and Methods: The international and national scientific databases were searched using the search keywords CNS, tumor, malignancy, brain, spine, neoplasm and Iran. Results: Of the 1,086 primary results, 9 papers were selected and reviewed, along with analysis of 10-year NCR data. The results showed that primary malignant brain tumors have an overall incidence of 2.74 per 100,000 person-years. The analysis of the papers revealed a benign to malignant ratio of 1.07. The most common histopathologies are meningioma, astrocytoma, glioblastoma and ependymoma. These tumors are more common in men (M/F=1.48). Primary malignant spinal cord tumors constitute 7.1% of the primary malignant CNS tumors with incidence of 0.21/100,000. Conclusions: This study shows that CNS tumors in Iran are in compliance with the pattern of CNS tumors in developing countries. The NCR must include benign lesions to understand the definitive epidemiology of primary CNS tumors in Iran.

• Journal of Korean Neurosurgical Society
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• v.55 no.5
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• pp.284-288
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• 2014

A rare case of atlantoaxial rotatory subluxation occurred after pediatric cervical spine surgery performed to remove a dumbbell-shaped meningioma at the level of the C1/C2 vertebrae. This case is classified as a post-surgical atlantoaxial rotatory subluxation, but has a very rare morphology that has not previously been reported. Although there are several reports about post-surgical atlantoaxial rotatory subluxation, an important point of this case is that it might be directly related to the spinal cord surgery in C1/C2 level. On day 6 after surgery, the patient presented with the Cock Robin position, and a computed tomography scan revealed a normal type of atlantoaxial rotatory subluxation. Manual reduction was performed followed by external fixation with a neck collar. About 7 months after the first surgery, the subluxation became severe, irreducible, and assumed an atypical form where the anterior tubercle of C1 migrated to a cranial position, and the posterior tubercle of C1 and the occipital bone leaned in a caudal direction. The pathogenic process suggested deformity of the occipital condyle and bilateral C2 superior facets with atlantooccipital subluxation. A second operation for reduction and fixation was performed, and the subluxation was stabilized by posterior fixation. We encountered an unusual case of a refractory subluxation that was associated with an atypical deformity of the upper spine. The case was successfully managed by posterior fixation.