Search

Spinal extradural arachnoid cysts are an uncommon condition and their exact causative triggers are still unclear. They appear to be extradural arachnoid outpouchings that connect to the intraspinal subarachnoid region via a little dura defect. These cysts are most commonly seen in the thoracic spine, followed by the lumbosacral junction. Compression of the spinal cord or nerve roots leads to the development of the symptoms. The most morbid symptom associated with these compressing extradural cysts is paresthesia. Numerous theories have been proposed about their origins, and the related conditions include spinal trauma, spina bifida, and the lymphedema-distichiasis syndrome. Their position in the spine influences the symptoms manifested. The diagnosis is made via MRI. Surgery is only performed on individuals with neurological impairment, and treatment is based on the clinical presentation. The preferred course of therapy is total surgical excision. We present a case that involves the successful surgical removal of an extradural spinal arachnoid cyst in a 10-year-old girl. Given the rarity of this pathology, its wide array of presenting symptoms, and the successful therapeutic protocol that was followed in this particular case, we believe this article shall prove beneficial to the medical fraternity., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Anand et al.)

Meningiomas are the most common central nervous system tumor. They are typically benign neoplasms but may produce neurological symptoms due to mass effect. Meningiomas may also extend to extradural locations; however, these account for only a small percentage of all meningiomas. Most extradural meningiomas arise in intraosseous locations, usually within the cranial bones or vertebrae. However, this is a rare case of extradural extension of an asymptomatic intracranial meningioma to the proximal humerus in the absence of any musculoskeletal symptoms. To the best of our knowledge, this presentation of an extradural intraosseous meningioma has not previously been reported in the literature. We present a case of an incidental intraosseous meningioma in a 66-year-old man. This patient was initially being screened for metastasis of stage IA1 adenocarcinoma of the lung, and a positron emission tomography (PET) scan revealed a focus of activity in the proximal diaphysis of the right humerus suspicious for malignancy. The upper extremity magnetic resonance imaging (MRI) demonstrated an indeterminate lesion. Curettage of the humeral lesion revealed an intraosseous psammomatous meningioma without evidence of metastatic lung carcinoma. Our case report aims to illustrate the importance of considering alternative metastatic sources, such as intracranial meningioma, during the investigation of an indeterminate bony lesion. This is the first case to illustrate asymptomatic intraosseous meningioma in an appendicular skeletal location, highlighting the need for thorough source investigation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Patel et al.)

We report a case of a man who presented with features of spinal cord compression, and imaging showed an L3-S2 space-occupying lesion that mimicked a spinal tumor. The patient underwent L3 to S2 laminectomy and a fibrous, thick sheet-like, poorly vascular lesion was observed macroscopically. The histopathological examination of the lesion showed caseous necrosis and epithelioid giant cells. This raised suspicion of tuberculosis and which was later confirmed on a polymerase chain reaction. The present case illustrates that tuberculosis is a disease that should not be ignored, particularly considering its ability to resemble other types of mass lesions., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Trivedi et al.)

Primary spinal melanoma (PSM) is a rare primary central nervous system melanoma with limited literature. A 30-year-old male presented with one year of progressive bilateral leg weakness and back pain. Physical examination revealed slightly decreased power and deep tendon reflexes of the lower extremities, decreased sensation at the level of T10, and normal anal sphincter and plantar reflexes. Magnetic resonance imaging (MRI) scan of the thoracolumbar spine revealed a hypointense lesion on T2-weighted and a hyperintense lesion on T1-weighted imaging at the level of T10 with mild extensions. The lesion was causing a mass effect on the spinal cord. The patient underwent laminectomy and near-total excision which showed a black, firm-to-hard, scarcely vascular extradural tumor extending from T10 to T11 that adhered to nerve roots. Histopathological examination and immunostaining with S-100 and Melan-A stains confirmed the diagnosis of malignant melanoma. Other imaging studies like brain computed tomography (CT) and positron emission tomography/computed tomography (PET/CT) scans, and chest X-ray were normal. On follow-up, the patient reported improvement in the power of his lower limbs with intact sensory function and sphincters. The first radiotherapy session was scheduled for six weeks postoperatively. There was no recurrence at a two-year follow-up. The possibility of a melanocytic tumor should be considered for a spinal lesion with paramagnetic properties as early surgical intervention is important for diagnosis and improved survival., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Saleem et al.)

Angiolipomas are rare primary benign tumors that can arise in the epidural canal and cause stenosis. Of the few cases of spinal angiolipomas described, most lesions have been located in the thoracic spine, and presentation of angiolipoma in the lumbar spine is very rare. The surgical management of a 39-year-old morbidly obese woman with angiolipoma that caused stenosis with neurogenic claudication and urinary changes is described. The lesion spanned L1-L2 and surgical management consisted of T12-L2 laminectomy and en-bloc resection of the lesion. During the latest follow-up, four years after the surgery, the patient's neurological symptoms showed improvement and there was no recurrence., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Ikpeze et al.)

A young adult, 18 years of age, presented to the emergency department with severe traumatic brain injury (TBI) resulting from a bicycle versus vehicle head-on collision. The patient initially presented in a promising condition but quickly deteriorated into a state of unconsciousness with no meaningful responses to stimuli or coordinated voluntary movement. Stat computed tomography (CT) revealed a large, right-sided, acute epidural hematoma (EDH) with mass-effect and a severe midline shift indicative of immediate surgery. This case highlights the importance of closely monitoring traumatic brain injury patients regardless of initial presentation and neurological exam results, as the patient's condition may drastically and rapidly change without much warning. Additionally, it is key to utilize regular radiological studies on these patients, to detect any neurological changes as close to onset as possible. Lastly, it is imperative that neurosurgeons closely monitor the patients/ state of consciousness as a rapid decline serves as a key diagnostic indicator of the need for immediate surgery., Competing Interests: The authors have declared that no competing interests exist.