Given the inadequacy of standard malignancy treatment, the clinical application of stem cell technology should be accelerated. As with the five previously published volumes, this volume contains information on the diagnosis, therapy, and prognosis of spinal tumors.
Introduction
Diagnosis
Imaging
Therapy
Capectiabine and Lapatinib Therapy for Metastatic Breast Cancer 12 Functional Role of the Novel Nrp/B Tumor Suppressor Gene 13 Brain Tumors: Diagnostic Impact of PET Using Radiolabeled. 37 Patients with brain cancer: Health-related quality of life 38 Emerging role of brain metastases in the prognosis of breast.
Diagnosis and Treatment
Symptoms of spinal cord tumors can be quite general or they can be more specific depending on the location of the tumor. Most cancers of the spinal cord are metastatic or secondary cancers, that is, they arise as a result of cancers that have spread to the spinal cord from other parts (lung, breast, prostate, head and neck, thyroid, kidney, melanoma and gastro -intestinal) body.
Surgery
One or more of the symptoms mentioned here does not necessarily mean that a person definitely has a spinal cord tumor. Glioneuron tumors in the spinal cord behave in most cases as low-grade neoplasms, with rare exceptions where the prognosis can be unpredictable and can lead to metastases, further morbidity and serious outcomes.
Pediatric Mixed Glioneuronal Tumors in the Spinal Cord
Subsequently, a few more reports on glioneuronal tumors of the adult spinal cord were published (Anan et al. It is worth noting that one of the two unclassifiable cases also had a severe outcome (Perilongo et al. 2002).
Intradural Spinal Tumors
This chapter will focus on the clinical features, characteristics, and imaging features of the most common intradural extramedullary and intramedullary spinal tumors. The typical clinical presentation and symptoms of various intradural spinal tumors will be presented and their imaging pattern as seen on computed tomography and magnetic resonance imaging will be described.
Classifi cation, Symptoms, and Radiological Features
Most ependymomas arise in the cervical spinal cord (44% only in the cervical spinal cord and 23% involving the upper thoracic spinal cord). The tumor is usually eccentric in location and often involves long segments of the spinal cord.
Non-Dysraphic Intradural Spinal Cord Lipoma: Management
Magnetic resonance (MR) imaging is the most sensitive method for diagnosing intradural lipomas preoperatively (Bhatoe et al. 2005. Improvement in postoperative neurological status can be achieved despite the presence of significant residual tumor (Kabir et al. 2010.
Malignant Astrocytomas
Given the limited number of cases and often extremely small biopsies, there is no consensus on the prognostic significance of AA compared to GBM. Despite largely anecdotal indications that local control may be beneficial, controversy exists regarding the prognostic value of the extent of resection.
Most intramedullary spinal cord astrocytomas are low-grade, either diffuse WHO (World Health Organization) grade II or, less commonly, pilocytic astrocytomas (PA, grade I). In contrast, malignant astrocytomas (grades III and IV) are extremely rare intramedullary spinal cord astrocytomas in children (Cohen et al. Gelabert-Gonzalez M, Garcia-Allut A (2009) Spinal extradural angiolipoma: report of two cases and review of the literature.
Spinal Cord Tumor
The first case of spinal cord oligodendroglioma was reported by Kernohan et al. Although very rare, cerebral symptoms may precede spinal cord symptoms (Guppy et al. 2009. Elevated intracranial pressure appears to be a feature of spinal cord oligodendroglioma (Fortuna et al.
Primary Spinal Oligodendroglioma
It has been estimated that PSOs represent 2% of spinal cord tumors and only 1.5% of all CNS oligodendrogliomas (Pagni et al. 1991. In the vast majority of reported PSO cases, the tumor was localized and extended on average 3.5 ± 1.8 vertebral bodies (Ushida et al. 1998. Calcifications can be seen in approximately 28-40% of cases and are usually located at the periphery of the tumor (McLendon et al. 1998).
Pilomyxoid Astrocytoma
The following day, MRI of the brain and spine showed an extensive mass in the cervical cord extending from C2-C3 to C6-C7. MRI of the tumors shows well-circumscribed lesions, with the majority located in the hypothalamic/chiasmic region (Komotar et al. 2004. The catheter tip of the VP shunt ended just above a large metastatic mass in the small pelvis.
Intraspinal Oncocytic Adrenocortical Adenoma: Diagnosis
Ghatak N, Quezado M (2004) Spinal adrenal cortical adenoma with oncocytic features: report of the first intramedullary case and review of the literature. Park HS, Jang KY, Kang MJ, Song KJ, Lee KB (2007) Spinal cord oncocytoma causing paraplegia - a case report. Fifty percent of chordomas occur in the sacrum, 35% in the base of the skull, and 15% in other parts of the spine.
Chordomas of the Clivus and Upper Cervical Spine
Crockard HA (1985) Transoral approach to the base of the brain and superior cervical umbilicus. Crockard HA, Johnston F (1993) Development of transoral approaches to lesions of the skull base and craniocervical junction. James D, Crockard HA (1991) Surgical access to the skull base and upper cervical spine by extended maxillotomy.
Use of Diffusion – Weighted Imaging for Diagnosis
ADC values for spinal AT/RT have only been reported in two cases (Kodama et al. Reported ADC values for brain PNET are relatively low (Yamasaki et al. 2005), similar to cases of spinal AT/RT. Since MRI findings differs from spinal AT/RT, spinal AT/RT can mimic benign tumors in some cases.
Gangliogliomas of the Spinal Cord
Neuroimaging Correlations with Pathology, Controversies
Intramedullary spinal cord tumors usually extend the spinal cord through all or most of the involved segments. Hamburger C, Buttner A, Weis S (1997) Ganglioglioma of the spinal cord: report of two rare cases and review of the literature. Slooff JL, Kernohan JW, MacCarty CS (1964) Primary intramedullary tumors of the spinal cord and fi lum terminale.
Resection of Spinal Meningioma
One of the important perioperative complications of this tumor is transient postoperative focal hyperemia (Ijiri et al. 2009. In the posterior part of the spinal cord at the level of C1, there was an area linearly enlarged by Gd-DTPA. –F ) Postoperative MRI showing a transient region of hyperemia at the C7 level. T2-weighted sagittal image, f: Gd-enhanced T1-weighted sagittal image.
Postoperative Hyperemia in the Spinal Cord
These symmetrical abnormal findings in the spinal cord are believed to most likely represent microcystic degeneration of the gray matter. MRI enhancement of the spinal cord after administration of Gd-DEPA has been reported in CSM. The venous hypertension eventually leads to venous ischemia and hyperpermeability of the intramedullary vessels and spinal cord edema.
Postoperative Hyperemia in the Brain
Spinal cord edema in CSM after decompression is not uncommon; however, a limited number of cases were reported (Suri et al. The presence of intramedullary increase of Gd-DEPA is explained by local hyperpermeability or a breakthrough in the barrier between the brain and the spinal cord in the vessels of the white matter. , mostly venous channels.. In short, postoperative transient hyperemia of the spinal cord is important perioperative complication of spinal meningioma resection.
Spinal Cord Hemangioblastomas
Subsequently, defined resection techniques are useful to minimize the morbidity associated with surgery for spinal cord hemangioblastomas. Results after resection of sporadic spinal cord hemangioblastomas have been reported in association with VHL-associated tumors (Guidetti and Fortuna 1967; Yasargil et al. Lonser RR, Weil RJ, Wanebo JE, Devroom HL, Oldfield EH (2003b) Surgical treatment of spinal umbilical hemangioblastomas in patients with von Hippel-Lindau disease.
Spinal Radiosurgery: Delayed Radiation-Induced Myelopathy
In contrast, tolerance of the human spinal cord to the high dose-per-fraction dosimetry encounter in stereotactic radiosurgery (SRS) is relatively poorly understood. Lieberson RE, Soltys SG (2011) Tolerance of the spinal cord to stereotactic radiosurgery: insights from hemangioblastomas. Marcus RB, Million RR (1990) The incidence of myelitis after irradiation of the cervical spinal cord.
Metastatic Spine Disease
Indications, Timing, and Outcomes for Surgery and Radiation Therapy
Metastatic spinal cord compression (MSCC) is one of the most feared complications of metastatic spinal disease. One of the main indications for CRT in the setting of a metastatic spinal tumor is control of tumor growth. Almost all patients in these case series had contraindications to surgical decompression of the spinal cord.
Sequence of Surgery, Radiotherapy, and Stereotactic Radiosurgery
A change in the interval between radiation-based treatment and surgery or between surgery and subsequent EBRT or SRS has the potential to significantly affect wound healing. We reviewed the literature to present the available evidence on wound complications and on the timing of surgery and radiation in these patients. Based on animal studies and the few patient series providing specific evidence in humans, an interval of at least 1 week between EBRT or SRS and surgery, and between surgery and radiation-based therapy, appears to be indicated.
The true incidence of wound complications in MESCC and the impact of the timing of surgery and radiation-based treatment on the complication rate have not been carefully assessed. An interval of 3-4 weeks provides a significant increase in wound integrity and tensile strength and a better chance of achieving bony fusion. McPhee IB, Williams RP, Swanson CE (1998) Factors influencing wound healing after surgery for metastatic disease of the spine.
Treatment of Spinal Tumors with Cyberknife Stereotactic
Stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) have emerged over the past decade as effective and safe approaches for the treatment of tumors of the spine and spinal cord. However, the actual tolerance of the spinal cord to the dosimetry observed with SBRT is unknown. The CyberKnife is a technically very attractive option for the treatment of spinal metastases (Gagnon et al.
Recurrent Spinal Cord Cystic Astrocytomas: Treatment
This treatment can also be used to treat low-grade astrocytoma of the spinal cord in the very specific case of recurrent symptomatic cysts, despite the recurrence of classical methods such as surgery or CT scan. The isotope is injected using a CT scan, which checks the position of the needle tip during the capture of the cyst and after its fading with iodine contrast. We will describe the application of this treatment to patients presenting with cystic tumors of the spinal cord.
This tap should not completely drain the cyst in order to allow injection of the isotope with maximum visibility and control. Stabilization and reduction of cyst volume was observed in 15 patients, and disappearance in 6 patients. In our experience, doses administered at the level of the cyst wall are higher (Colnat-Coulbois et al.
