Intramedullary spinal cord metastasis from pancreatic neuroendocrine tumor

Intramedullary spinal cord metastasis(ISCM) is very rare and its optimal treatment remains controversial. Pancreatic neuroendocrine tumor(pNET) is a rare tumor that usually presents with hepatic metastasis. Hepatic failure due to tumor progression is the major cause of death in cases of pNET. To date,no report has described a case of ISCM from pNET. Although spinal cord metastasis of a solid tumor is uncommon,it is a critical condition that can cause a potentially irreversible loss of neurologic function. Here,we report the case of a 45-year-old man who presented with leg weakness and voiding difficulty,and was found to have ISCM from pNET. Surgical treatment prevented further neurological deterioration. This is the first case report of ISCM from pNET.

Diagnosis and treatment of intramedullary hemangioblastoma of cervical spinal cord

OBJECTIVE: To investigate the diagnosis and surgical techniques of intramedullary hemangioblastoma of the cervical spinal cord. METHODS: MR imaging and the methods and results of surgery were analyzed in 21 patients. RESULTS: The tumors were divided into three types on MR imaging. Syringeal type, where the tumor varied in size and was accompanied by syringobulbia and syringomyelia; Cystic type, where the tumor presented as a cyst with a small mural node; and Solid type, where the tumor was revealed as a huge solid mass. All tumors were totally removed and diagnosis was confirmed by histological study. Post-operative neurological status was improved in 20 patients and aggravated in 1. CONCLUSIONS: The localization and the nature diagnosis of the tumor can be made by cervical MR imaging. Operative methods vary with tumor types. It is the most important that the tumor is dissected along the right interface and removed after devascularization.

Radical microsurgical treatment of intramedullary spinal cord tumors

Background The surgical treatment of intramedullary spinal cord tumor aims at complete removal and minimal postoperative deficit. This study was undertaken to evaluate the microsurgical features of intramedullary spinal cord tumors and the time for surgery and prognosis. Methods Twenty-one patients with intramedullary spinal cord tumor who had been treated at Nanfang Hospital, Guangzhou, China since 2000 were studied retrospectively. Fifteen patients were men and 6 women, aged 2-60 years （mean 29.28 years）. Thirteen patients had the tumor in the cervical segments, 4 in medulla-cervical segments, 1 in cervicothoracic segment, and 3 in thoracic spine. All the patients underwent microsurgery for the tumor through posterior approaches by laminectomy. The tumor was exposed through dorsal myelotomy, then tumor plane was removed carefully from the entire rostrocaudal area. The dura was sutured routinely. In case of tumors occupying too many spinal segments, titanium strip was applied to reconstruct the vertebral plate and keep the spinal column stable. All the patients were subjected to MR imaging early after operation. Results Complete removal of the tumor was made in 15 patients, subtotal removal in 5, and partial resection in 1. Neurological recovery was related primarily to preoperative neurological conditions of the patients. Patients with minor neurological deficit showed stable sensory and motor function or minor loss in the early postoperative period, and neurological function tended to improve with time. But those with significant or long-standing deficit could hardly demonstrate any recovery. The dissection interface between the tumor and normal cord tissue was the most important factor influencing the extent of surgical removal. Conclusions Intramedullary spinal cord tumor mostly take place in cervical segments, with glioma as the commonest type. Microsurgery is the major treatment of choice, by which tumor plane could be totally resected. Excellent microsurgical expertise and careful recognition of tumor plane are essential to removal of the tumor while retaining neurological functions. Titanium strip fixation is helpful to reconstruct vertebral stability. Preoperative neurological conditions of patients are directly related to their postoperative recovery. We underscore the importance of early diagnosis and radical microsurgical treatment of intramedullary spinal cord tumor.

Preoperative transarterial embolization of hypervascular vertebral tumor with permanent particles

OBJECTIVE: To evaluate the safety and value of preoperative transarterial embolization of hypervascular vertebral tumors. METHODS: Sixteen patients with hypervascular vertebral tumors underwent transarterial embolization before surgery. The lesions were located between the middle cervical and lower lumbar spine. Forty-one arteries were embolized with permanent particles injected through a microcatheter, including polyvinyl alcohol (PVA) particles (150 - 500 micro m) in 25 arteries and Dextran particles (150 - 350 micro m) in 16. Of these, 31 had pieces of gelatin sponge added for proximal pedicled embolization. The criteria for judging the effectiveness of embolization were completeness of tumor removal and estimated blood loss during surgery. RESULTS: The particles were injected into the tumor feeders through superselection in 17 arteries or flow control in 24. Tumor embolization was defined as 'total' in five patients, 'nearly total' in eight, 'subtotal' in two, and 'partial' in another. There were no symptomatic complications associated with embolization. Tumors were entirely removed in all patients. The average estimated blood loss during surgery was 1510 ml (range of 200 - 6000 ml) for all 16 patients. CONCLUSION: Preoperative embolization of hypervascular vertebral tumors is safe and effective. It can make complete resection of a tumor possible and can make a previously unresectable tumor resectable. Superselection or flow control is necessary to achieve effective devascularization and to avoid complications.