Infarct of the conus medullaris simulating a spinal cord tumor: Case report
14
Citation
16
Reference
10
Related Paper
Citation Trend
Keywords:
Conus medullaris
Cauda equina
Spinal cord tumor
Neurological examination
✓ The technique of the dorsal selective rhizotomy as originally developed by Professor Fasano and by the author is described. The rhizotomy is performed through a one-level laminectomy at L-1. Exposure of the conus medullaris and the cauda equina at this level is adequate to thoroughly assess the reflex electrical response to stimulation of the lumbosacral roots and to section the selected roots/rootlets. This approach, based on over 100 surgical procedures, obviates the need for an extensive laminectomy in a growing child without compromising the clinical results.
Rhizotomy
Cauda equina
Conus medullaris
Lumbosacral joint
Cauda Equina Syndrome
Cite
Citations (15)
Conus medullaris
Cauda equina
Spinal cord tumor
Neurological examination
Cite
Citations (14)
Conus medullaris
Cauda equina
Cauda Equina Syndrome
Thoracic vertebrae
Vertebral column
Cite
Citations (1)
An interesting case of spontaneous bleeding from an ependymoma of the filum terminale is presented.To document a rare case of rapid neurologic deterioration as a consequence of spinal tumoral hemorrhage and to highlight important issues regarding tumor histologic subtype and the impact of anticoagulation that have emerged from an illuminating review of the literature.To our knowledge, there have been only 8 reported cases of hemorrhage from an ependymoma of the filum terminale or conus medullaris causing acute cauda equina syndrome. Bleeding is described in the pathology texts as being a consequence of the vascular architecture of the myxopapillary subtype and so postulated to be more common in this group. Anticoagulation is recognized to increase the frequency of tumoral bleeding, but no studies report its effect of severity of clinical presentation.We report the case of a 57-year-old woman who developed nontraumatic acute cauda equina syndrome, including sphincter compromise. She underwent a lumbosacral laminectomy for evacuation of a hematoma, at which stage a filum terminale ependymoma was excised. Histopathologic analysis demonstrated it to be of a nonmyxopapillary subtype.The patient demonstrated gradual improvement of the neurologic deficit. At 12-month follow-up, her saddle area sensory deficit has resolved, her right lower limb is much stronger allowing her to walk long distances, and she is successfully performing intermittent self-catheterization of her bladder.The possibility of an underlying tumor should always be borne in mind so that adequate preoperative planning can be undertaken. The presence of the myxopapillary subtype should not prevent a clinician from excluding other reasons for hemorrhage, and counseling when reinstituting anticoagulation must include warning against a worse prognosis from any future hemorrhage.
Filum terminale
Conus medullaris
Cauda Equina Syndrome
Cauda equina
Ependymoma
Presentation (obstetrics)
Spinal cord tumor
Cite
Citations (37)
Conus medullaris syndrome (CMS) is a rare pathology. The conus medullaris is located at the end of the spinal cord and continues to the cauda equina. Conus medullaris lesions can cause variable symptoms and neurological deficits, usually involving the lower extremities; CMS that does not affect the lower limbs is extremely rare. No reports have described isolated CMS caused by intradural disc herniation (IDH). This report describes a case of CMS without lower extremity involvement associated with IDH at L1/2.A 52-year-old man with a 10-year history of lower back pain complained of dysuria and lumbago with no leg symptoms at his first visit to the urology department. Neurological examination revealed mild perineal hypoalgesia; however, motor function and lower extremity sensation were normal with except for left ankle dorsiflexion weakness (manual muscle test, 4/5). Magnetic resonance imaging revealed conus medullaris compression by a mass, continuous with the L1/2 disc, and severe spinal canal stenosis at vertebral levels L3/4 and L4/5. Postmyelographic computed tomography indicated direct conus medullaris compression by an intradural and extramedullary mass continuous with the L1/2 disc. Without recovery of his dysuria, the patient underwent surgery, including partial laminectomy of the L1/2, incision of the dura mater, and removal of the herniated disc. Immediately after surgery, his dysuria completely resolved. More than one year postoperatively, the patient remained active with no change in his neurological condition.Although CMS without lower limb symptoms is extremely rare, we experienced an isolated case of CMS associated with IDH causing direct conus medullaris compression. Without lower extremity involvement, the CMS diagnosis was relatively easy. Surgical treatment for CMS without lower extremity involvement caused by IDH was effective.
Conus medullaris
Cauda equina
Hypoesthesia
Dysuria
Cauda Equina Syndrome
Spinal canal stenosis
Spinal cord compression
Neurological examination
Cite
Citations (10)
The length of the spinal cord corresponds to that of the vertebral column up to the 11th gestational week. Then, the "ascensus" begins, the filum terminale is formed, and the lower spinal nerves show a progressive obliquity, which is caused by the shift between the spinal cord and the vertebral column. It ascends to lumbar levels due to the disproportional growth of the spinal cord and the vertebral column, forming the cauda equina. In newborns, the spinal cord terminates at the level of L3 vertebra, and in adults it usually ends at the level of L1 or L3 vertebra. The neurological structures associated with traumatic cauda equina and conus medullaris injuries which are resulted from the thoracolumbar spine injuries, differ significantly from those structures that are injured in cervical and thoracic spinal cord injuries. As the thoracolumbar spine is also where the distal spinal cord or epiconus, conus medullaris, and cauda equina are in close proximity, management decisions and prognosis should consider the unique variation in the injured neuroanatomical structures. It is unlikely that the cervical and the majority of the thoracic spine, where the spinal column level and the neurological segment are in close proximity, in the thoracolumbar region, there is a profound disparity between the spinal column level and the spinal cord segment. Injuries of the cauda equina and conus medullaris are generally clinically not clearly distinguishable and are often described together, since they often occur as combined injuries.
Conus medullaris
Cauda equina
Filum terminale
Vertebral column
Spinal column
Cauda Equina Syndrome
Vertebra
Thoracic vertebrae
Cite
Citations (0)
OBJECTIVE Huge intradural ossifications in the spine are quite rare. We report for the first time a patient with a huge intradural ossification caused by a mature teratoma at the conus medullaris. CLINICAL PRESENTATION A 68-year-old woman presented with low back pain and gait disturbance. Computed tomographic and magnetic resonance imaging revealed a huge ossification at the tip of the conus medullaris. INTERVENTION We performed L1 and L2 laminectomy and removed the mass completely. The pathological diagnosis was mature teratoma with remarkable ossification. CONCLUSION This unusual case of intradural ossification demonstrated regressive changes in a mature teratoma. Despite its tight adhesion to the conus medullaris and cauda equina, the ossified tumor was atraumatically removed with an ultrasonic aspirator.
Conus medullaris
Cauda equina
Spinal cord tumor
Cite
Citations (18)
Conus medullaris
Cauda equina
Filum terminale
Conus
Cauda Equina Syndrome
Cite
Citations (0)
Ependymomas are the most common glial tumors of the spinal cord, including the conus medullaris, filum terminale, and cauda equina. This study involved eight ependymomas of the spinal cord encountered during a 29-year period (1968–1996). The male:female ratio was 1:1.7, and the mean age at diagnosis was 33.7 years (range, 13–55 years). The outcome was studied in relation to initial presentation, initial therapy, location of tumor, histology of tumor, and gender after a follow-up period ranging from 2–16 years (mean, 113 months). Complete removal was achieved in six patients. Two patients received postoperative irradiation after partial removal. Histological examination revealed a benign ependymoma in all patients. Patients undergoing gross total excision at initial operation had excellent or good outcomes. We conclude that ependymomas of the spinal cord should be removed completely, if possible. Spine surgeons should be aware of the disease, and magnetic resonance imaging should be used in its detection.
Conus medullaris
Cauda equina
Filum terminale
Ependymoma
Presentation (obstetrics)
Cauda Equina Syndrome
Cite
Citations (34)
Conus medullaris
Cauda equina
Cauda Equina Syndrome
Cite
Citations (0)