Rare giant intradural epidural hemolymphangioma:A case report

BACKGROUND Hemolymphangioma is a rare,noninvasive benign tumor that originates from vascular and lymphatic malformations.It is usually congenital and can present with varying symptoms depending on its location and size.There are very few reports of hemolymphangiomas within the spinal canal,and giant lesions are exceptionally rare.CASE SUMMARY In July 2023,a 64-year-old male with a giant intravertebral epidural hemolymphangioma from thoracic 11 to lumbar 2(T11-L2)was admitted to the Department of Spine Surgery at the People's Hospital of Binzhou City,China.The patient experienced progressive lumbar and left lower limb pain,numbness,weakness in both lower limbs,and difficulty with urination and defecation.Imaging studies revealed a large cystic mass in the spinal canal at T11-L2.Surgical decompression was performed,and the pathology confirmed hemolymphangioma.CONCLUSION Complete resection of hemolymphangiomas has the best prognosis,and final diagnosis relies on pathologic diagnosis.In this case,the mass was removed intact with a pedicle nail rod system,leading to adequate spinal decompression and restoration of spinal stability.

Thoracic spinal cord injury and paraplegia caused by intradural cement leakage after percutaneous kyphoplasty: A case report

BACKGROUND Percutaneous kyphoplasty(PKP)is a pivotal intervention for osteoporotic fractures,pathological vertebral compression fractures,and vertebral bone tumors.Despite its efficacy,the procedure presents challenges,notably complications arising from intradural cement leakage.Timely and accurate diagnosis,coupled with emergent intervention is imperative to improve patient prognosis.This case report illuminates the intricacies and potential complications associated with PKP,emphasizing the critical need for vigilant monitoring,prompt diagnosis,and immediate intervention to mitigate adverse outcomes.CASE SUMMARY A 58-year-old male patient,experiencing a T7 osteoporosis-related pathological compression fracture,underwent PKP at a local hospital.Two weeks postprocedure,the patient developed paraplegic and dysuric symptoms,necessitating emergency decompression surgery.Gradual improvement was achieved,marked by the restoration of muscle strength,sensation,and mobility.CONCLUSION PKP Intradural cement leakage following PKP is unusual and potentially fatal.Prompt imaging examinations,urgent evaluation,and the decompression surgery are essential,which help alleviate symptoms associated with spinal damage,markedly improving the overall prognosis.

First description of cervical intradural thymoma metastasis

Thymoma and thymic carcinoma are rare epithelial tumors, which originate from the thymus gland. According to the World Health Organization there are "organotypic"(types A, AB, B1, B2, and B3) and "non-organotypic"(thymic carcinomas) thymomas. Type B3 thymomas are aggressive tumors, which can metastasize. Due to the rarity of these lesions, only 7 cases of extradural metastasis are described in the literature. We report the first and unique case of a man with cervical intradural B3 thymoma metastasis. A 46-year-old man underwent thymoma surgical removal. The year after the procedure he was treated for a parietal pleura metastasis. In 2006 he underwent cervical-dorsal extradural metastasis removal and C5-Th1 stabilization. Seven years after he came to our observation complaining left cervicobrachialgia and a reduction of strength of the left arm. He underwent a cervical spine magnetic resonance imaging, which showed a new lesion at the C5-C7 level. The patient underwent a surgery for the intradural B3 thymoma metastasis. Neurological symptoms improved although the removal was subtotal. He went through postoperative radiation therapy with further mass reduction. Spinal metastases are extremely rare. To date, only 7 cases of spinal extradural metastasis have been described in the literature. This is the first case of spinal intradural metastasis. Early individuation of these tumors and surgical treatment improve neurological outcome in patients with spinal cord compression. A multimodal treatment including neoadjuvant chemotherapy, surgery and postoperative radiation therapy seems to improve survival in patients with metastatic thymoma.

Intradural osteomas:Report of two cases

BACKGROUND Intradural osteoma is very rarely located in the subdural or subarachnoid space.Unfortunately,intradural osteoma lacks specificity in clinical manifestations and imaging features and there is currently no consensus on its diagnosis method or treatment strategy.Moreover,the pathogenesis of osteoma without skull structure involvement remains unclear.CASE SUMMARY We describe two cases of intradural osteomas located in the subdural and subarachnoid spaces,respectively.The first case involved a 47-year-old woman who presented with a 3-year history of intermittent headache and dizziness.Intraoperatively,a bony hard mass was found in the left frontal area,attached to the inner surface of the dura mater and compressing the underlying arachnoid membrane and brain.The second case involved a 56-year-old woman who had an intracranial high-density lesion isolated under the right greater wing of the sphenoid.Intraoperatively,an arachnoid-covered bony tumor was found in the sylvian fissure.The pathological diagnosis for both patients was osteoma.CONCLUSION Surgery and pathological examination are required for diagnosis of intradural osteomas,and craniotomy is a safe and effective treatment.

Intradural Disc Herniation Can Be Intra-Arachnoid or Extra-Arachnoid: 2 Case Reports with MRI Diagnosis and Non-Surgical Management

Intradural disc herniation is rare and often diagnosed during surgery. We present two patients with the disease, one with an intra-arachnoid type, the other with an extra-arachnoid location. The teaching point of those cases is that this very frequent pathology can take a variety of forms, depending on the structures that are infiltrated. The key point in correctly diagnosing the intradural disc herniation is to look at the angle between the fragment and the dura. Is it pushing it (as in the usual disc herniation), embedded in it (those with the extra-arachnoid type) or does it go through to fall into the CSF (In the intra-arachnoid type)? It could be diagnosed on MRI preoperatively. Contrary to many published cases of intradural disc herniation, the two patients could be managed non-surgically.

Intradural Extra Medullary Cervical Anaplastic Ependymoma. Case Report and Review of the Literature

Introduction: Intra-dural and extramedullary ependymomas are rare lesions. We report a clinical case confirmed by the histology supported by the neurosurgery department of Martinique University Hospital. Clinical, paraclinical and therapeutic data will be compared to a literature review. Observation: A 38-year-old patient was admitted for tetraparesthesia evolving since 3 months, associated with a left hemiparesis. The clinical examination revealed deterioration of the general condition and a tetrapyramidal syndrome. MRI of the cervical spine revealed extensive cervical extra-medullary intradural lesion of C3 to C5. The treatment had been an excisional surgery that had been subtotal in two stages, supplemented by craniospinal radiotherapy because the pathological examination had found a grade III anaplasic ependymoma. Conclusion: Because of their rarity, the treatment of these forms of ependymoma is not yet well codified.

Intradural spinal seeding and fatal progression of a sacrococcygeal chordoma： a case report

Chordoma as a rare malignant tumor arising from remnants of the fetal notochord accounts for 1%-4%of primary bone tumors. It is usually predominant in males. Local recurrences are common （44%-78%） and distant metastases may occur years after the initial presentation. The reported rates of metastases range from 10% to 48%, which are usually accompanied by a sacrococcygeal chordoma. Cases of surgical seeding and intradural spinal seeding also have been reported climcally. To our knowledge, the present case is the first one concerning cerebrospinal fluid metastases and fatal progression of a sacrococcygeal chordoma.

Endoscopically controlled surgery with open hemilaminectomy for the treatment of intradural extramedullary tumors:an operative technique and short-term outcomes of 20 consecutive cases

Background:To present a surgical technique for the treatment of intradural extramedullary(IDEM)tumors by using endoscopically controlled surgery with open hemilaminectomy technique.Methods:In this study,20 patients with 22 IDEM tumors were enrolled.An endoscopically controlled surgery with open hemilaminectomy was employed to remove the tumors.Data related to clinical symptoms and medical images before and after surgery were collected for perioperative evaluation and follow-up analysis.Results:All the tumors in 20 patients were well removed.The clinical symptoms were significantly reduced in all the patients as well.The short-term follow-up data showed that there was no tumor recurrence or spinal deformity.Conclusion:The endoscopically controlled surgery with open hemilaminectomy technique provided favorable exposure and satisfactory resection to the IDEM tumors.It may be an effective surgical method for treating IDEM tumors.Larger samples and longer follow-up data are needed to verify its long-term effectiveness.

Case Report:Congenital spinal intradural arachnoid cyst associated with intrathoracic meningocele in a child

Congenital spinal intradural arachnoid cyst associated with intrathoracic meningocele is very rare.We report a case in a 9-year-old Chinese boy who presented with a two-week history of progressive paraparesis and gait ataxia.Magnetic resonance imaging revealed that a dorsal intradural extramedullary cystic lesion extended from T1 to T5 and compressed the spinal cord.A left lateral intrathoracic meningocele pouch was found incidentally at the level of T1.The arachnoid cyst as well as meningocele was removed and the spinal cord compression was relieved.Arachnoid cyst was confirmed by histological examination.The patient recovered well postoperatively.This is the second report of such a case in the world according to the available literature.The take-home message for our case is that the surgical approach should be individualized,depending on the size and location.

Isolated cervical extraosseous intradural chordoma attached to the C5 nerve root: a case report

Background:As chordomas are slow growing and locally invasive with high recurrence rates,initial recommendations include complete surgical resection with or without radiation therapy.A large proportion of recurrences occur years after initial resection necessitating lengthy follow-up.The novel biomarker brachyury and the repurposing of pharmaceutical products have the potential to substantially impact long-term recurrence rates.Case presentation:A 43-year-old woman presented with an isolated,cervical extraosseous intradural extramedullary chordoma attached to a nerve root underwent a C3-5 laminectomy,C3-5 lateral mass screw instrumentation,and mass resection.All symptoms resolved by the 12-month postoperative follow-up visit.Conclusions:This is the first report of an isolated,cervical extraosseous intradural extramedullary chordoma attached to a nerve root,and this case adds to the previous six TypeⅣchordomas in the literature.Unfortunately,the very rare form of extraosseous intradural chordoma is poorly understood:the lack of detailed knowledge in how they are differentiated from other forms of chordoma confounds the development of optimal treatment strategies and follow-up guidelines.

Total spinal anesthesia caused by lidocaine during unilateral percutaneous vertebroplasty performed under local anesthesia:A case report

BACKGROUND Intradural anesthesia caused by anesthetic drug leakage during percutaneous vertebroplasty(PVP)has rarely been reported.We here report a 71-year-old woman who suffered this rare and life-threatening complication during PVP.CASE SUMMARY A 71-year-old woman,who suffered from 2 wk of severe back pain with a visual analog score of 8,came to our outpatient clinic.She was later diagnosed with a newly compressed L1 fracture and was then admitted in our department.PVP was initially attempted again under local anesthesia.However,serendipitous intradural anesthesia leading to total spinal anesthesia happened.Fortunately,after successful resuscitation of the patient,PVP was safely and smoothly performed.Great pain relief was achieved postoperatively,and she was safely discharged on postoperative day 4.The patient recovered normally at 3-mo follow-up.CONCLUSION Total spinal anesthesia secondary to PVP by anesthetic drug leakage rarely occurs.In cases of inadvertent wrong puncture leading to drug leakage when performing it under local anesthesia,surgeons should be highly vigilant during the whole procedure.Electrocardiogram monitoring,oxygen inhalation,intravenous cannula set prior to surgery,regular checking of motor activity and a meticulous imaging monitoring with slower pushing of anesthetic drugs,etc.should be highly recommended.

A Rare Case of a Thoracic Spinal Hemangiopericytoma

Spinal hemangiopericytomas are rare tumors. To date, only 80 cases of spinal hemangiopericytomas have been reported in the literature. The postoperative evolution of this condition in rare cases can be complicated by a symptomatic compressive epidural hematoma that can be the source of serious neurological complications requiring emergency surgery. We report a rare case of intradural and extramedullary spinal hemangiopericytomas with favorable evolution after treatment in an 82 years old woman.

Spinal capillary hemangioma: Report of five surgical cases and literature review

Objective: Capillary hemangioma is a benign vascular malformation that is usually encountered in soft-tissue. Rarely,it may occur in the neuraxis,and spinal capillary hemangioma(SCH) is a rare variant of it. Existing literature on SCH is limited because of its rarity. As a result,epidemiological and clinical characteristics as well as management strategy for SCH are still lacking. Here,we present a report on five patients with pathologically proven SCH,treated in Beijing Tiantan Hospital between 2013 and 2015.Methods: Patients' age,gender,clinical manifestations,radiological features,operative methods,and surgical outcomes were retrospectively reviewed,and an updated review of the literature was also provided. Results: Four patients were men and one was a woman,with a median age at presentation of 43 years(range: 15–66 years). Two lesions were intramedullary,two epidural,and one intradural extramedullary. The thoracic segment was most commonly affected(n = 3,60%),followed by the cervical(n = 1,20%) and lumbar(n = 1,20%) segments. Common symptoms,in descending order,were numbness and paresthesia,limb weakness,and pain. The surgical procedure was successfully performed with total resection of the tumor achieved in 4 patients and subtotal in 1 patient. During an average follow-up period of 32 months(range: 27–43 months),recovery of the clinical symptoms was observed in all five patients. Conclusions: SCH is a rare benign vascular disease,for which surgical resection of the lesion,by the en bloc method,is recommended. Clinically,it usually manifests with progressive myelopathy,but early surgical intervention usually produces good results and may prevent permanent neurological deficits.