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Background: No prior reports have focused on the natural history and long-term outcomes of intramedullary spinal cord cavernous malformations (ISCCMs) in children., Objective: To investigate the clinical characteristics and long-term outcomes of pediatric ISCCMs and identify the risk of hemorrhage., Methods: We retrospectively reviewed a series of 20 pediatric patients (<18 yr old) from a consecutive series of 254 patients with ISCCMs evaluated at a single institution., Results: Of the 20 pediatric patients, 9 (45.0%) presented with a severe neurological and disability status. The annual hemorrhagic rate in pediatric patients was 8.2%/patient/year. After initial overt hemorrhage events, the annual overt rehemorrhage rate increased to 30.7%/patient/year. In 234 adult patients, the respective rates were 2.8% and 7.4%. Thoracic or lumbar level lesions (P = .002, OR = 3.425, 95% CI = 1.588-7.387) and rehemorrhagic events (P = .005, OR = 3.209, 95% CI = 1.415-7.279) were more likely to follow an aggressive course. There were no significant differences in the sex distribution, location and size of lesions, types of symptoms, likelihood of a severe neurological and disability status, or immediate and long-term postoperative outcomes between pediatric and adult patients with ISCCMs., Conclusion: The annual overt hemorrhage rate and rehemorrhage rate of ISCCMs were higher in affected children than in affected adults. Surgical resection of pediatric ISCCMs remains the preferred therapeutic option and provides favorable outcomes., (Copyright © 2019 by the Congress of Neurological Surgeons.)

Background: To date, the traditional approach to intraspinal tumors has been open laminectomy or laminoplasty followed by microsurgical tumor resection. Recently, however, minimally invasive approaches have been attempted by some., Objective: To investigate the feasibility and safety of minimally invasive surgery (MIS) for primary intradural spinal tumors., Methods: Medical charts of 83 consecutive patients treated with MIS for intradural spinal tumors were reviewed. Patients were followed up during the study year, 2015, by either routine history/physical examination or by telephone consultation, with a focus on tumor status and surgery-related complications., Results: Mean age at surgery was 53.7 yr and 52% were female. There were 49 schwannomas, 18 meningeomas, 10 ependymomas, 2 hemangioblastomas, 1 neurofibroma, 1 paraganglioma, 1 epidermoid cyst, and 1 hemangiopericytoma. The surgical mortality was 0%. In 87% of cases, gross total resection was achieved. The complication rate was 11%, including 2 cerebrospinal fluid leakages, 1 asymptomatic pseudomeningocele, 2 superficial surgical site infections, 1 sinus vein thrombosis, and 4 cases of neurological deterioration. There were no postoperative hematomas, and no cases of deep vein thrombosis or pulmonary embolism. Ninety-three percent of patients were ambulatory and able to work at the time of follow-up., Conclusion: This study both demonstrates that it is feasible and safe to remove select, primary intradural spinal tumors using MIS, and augments the previous literature in favor of MIS for these tumors.

Background: Osteoplastic laminoplasty is a well-described technique that may decrease the incidence of progressive kyphosis when used in the setting of intradural spinal cord tumor resection., Objective: The BoneScalpel by Aesculap (Central Valley, Pennsylvania) is an ultrasonic osteotome that precisely cuts bone while preserving the underlying soft tissues, potentially reducing the risk of dural laceration during laminoplasty. By producing osteotomies as narrow as 0.5 mm, the device may also facilitate postoperative osteointegration., Methods: A retrospective analysis was conducted of 40 patients (mean age, 38.0 years; range, 4.0-79.7 years) who underwent osteoplastic laminoplasty using the BoneScalpel for the treatment of intradural spinal pathology at the Johns Hopkins Hospital between January 2009 and December 2011. After lesion resection, titanium plates were used to reconstruct the lamina in all cases. The technical results and procedure-related complications were subsequently noted., Results: Successful laminoplasty was carried out in all 40 patients. Intraoperatively, 1 case of incidental durotomy was noted after use of the device, which was repaired primarily without neurological or clinical sequelae. During the follow-up period (mean, 195 days; median, 144 days), there were 2 complications (1 cerebrospinal fluid leak, 1 seroma) and no cases of immediate postoperative instability., Conclusion: The BoneScalpel is a safe and technically feasible device for performing osteoplastic laminoplasty.

Objective: Although an anterolateral approach is an ideal approach to the anterior part of the cervical spinal canal, it is not often used because of various technical difficulties. This article presents the case of a patient with an intradural schwannoma ventrolateral to the spinal cord and describes the technique, anterolateral surgery without fixation, that was used to remove it., Case Presentation: A 71-year-old man presented with neck pain and easy fatigability of the legs. Magnetic resonance imaging showed an intradural tumor ventrolateral to the spinal cord at the C3 level. The diagnosis was a schwannoma., Technique: A right anterolateral approach was selected for the resection. In the dissection between the sternocleidomastoid muscle and the internal jugular vein, the accessory nerve was retracted with the fat tissue. At C3, the prevertebral aponeurosis was laterally retracted to protect the sympathetic chain. The C3 transverse process was rongeured, and the vertebral artery was shifted laterally with the venous plexus. The C2-C3 uncovertebral joint and the right third of the C3 body were removed (partial corpectomy). The tumor was easily found in the dural sac and was totally removed. The surgical wound was closed in a watertight fashion. No fixation was necessary. The symptoms improved after the operation., Discussion: The anterolateral approach is one of the best approaches for resecting ventrally located intradural lesions because it allows minimally invasive surgery. Control and protection of the accessory nerve, sympathetic chain, and vertebral artery are the keys to success.

Objective: A significant variety in morphology of conus lipomas may underlie differences in clinical presentation of the patients and controversy in surgical management. We retrospectively studied 58 patients with conus lipomas at our institutions. The purpose of this study was to infer the clinical course from the radiological findings and to provide information for decision-making in planning for surgical treatment., Methods: The patients underwent untethering surgery between 1984 and 2005. There were 35 transitional and 23 dorsal lipomas. The age at surgery ranged from 1 month to 50 years (median, 4 yr). Preoperative clinical history, radiological findings, and postoperative results were analyzed., Results: Fifteen patients were asymptomatic, and 43 patients were symptomatic preoperatively. Twenty-one patients presented with motor deficits of the lower extremities. In seven patients, motor deficits appeared early, before 1 year of age. Massive lipomas compressing the cord or herniation of the spinal cord into the subcutaneous tissue were characteristic findings of such early deterioration. Motor deficits were present in 73% of patients with lipomas extending to the lumbar level, whereas 88% of patients with lipomas confined to the sacral level had only urinary deficits. During a mean postoperative follow-up period of 7.9 years, 4 (27%) of the 15 asymptomatic patients developed urinary and/or motor deficits, and 12 (28%) of the 43 symptomatic patients showed further neurological deterioration., Conclusion: This study demonstrates that the location and morphology of conus lipomas influence the neurological presentation of the patients. Early prophylactic surgery is a reasonable treatment option if early deterioration is predicted by imaging studies.

Objective: Surgery should be considered for patients with intramedullary spinal ependymomas (ISE), particularly those presenting with a neurological deficit preoperatively. In contrast, it is still a debatable matter whether to recommend the same approach for patients with no neurological impairment. To investigate this matter, we analyzed the data of 82 consecutive patients with ISEs treated at our institution., Methods: We reviewed the medical charts of all ISE patients undergoing operation at our institution between 1985 and 2000. Particular attention was given to patients without neurological deficit before surgery., Results: Eighty-two consecutive ISE patients were included in this study. Preoperatively, a neurological deficit of variable severity was present in 72 patients (Group A, 88%) and absent in 10 patients (Group B, 12%). In the latter group, seven patients had progressive and nonspecific pain as the only presenting symptom; two had arm dysesthesias; and in one patient, ISE was diagnosed incidentally. The mean duration of their symptoms was 21 months. We achieved a total tumor excision in nine patients and subtotal removal in one. At the last follow-up assessment (mean, 45 mo), all Group B patients remained at Grade I of the McCormick classification, except one, who deteriorated to Grade Ib. Furthermore, nonspecific pain diminished in three patients, stabilized in four, and worsened in one. Arm dysesthesias diminished in one patient and stabilized in the other. No surgery-related complication or recurrence was recorded in these patients., Conclusion: Surgery should be carefully considered for ISE patients with no objective neurological deficit preoperatively because, in our experience, it resolves their preoperative complaints in 30% of cases, stabilizes them in 60%, and worsens them in 10%.

Objective: Microsurgical resection of benign intradural extramedullary spinal tumors is generally safe and successful, but patients with neurofibromatosis, recurrent tumors, multiple lesions, or medical problems that place them at higher surgical risk may benefit from alternatives to surgery. In this prospective study, we analyzed our preliminary experience with image-guided radiosurgical ablation of selected benign spinal neoplasms., Methods: Since 1999, CyberKnife (Accuray, Inc., Sunnyvale, CA) radiosurgery was used to manage 51 patients (median age, 46 yr; range, 12-86 yr) with 55 benign spinal tumors (30 schwannomas, nine neurofibromas, 16 meningiomas) at Stanford University Medical Center. Total treatment doses ranged from 1600 to 3000 cGy delivered in consecutive daily sessions (1-5) to tumor volumes that varied from 0.136 to 24.6 cm., Results: Less than 1 year postradiosurgery, three of the 51 patients in this series (one meningioma, one schwannoma, and one neurofibroma) required surgical resection of their tumor because of persistent or worsening symptoms; only one of these lesions was larger radiographically. However, 28 of the 51 patients now have greater than 24 months clinical and radiographic follow-up. After a mean follow-up of 36 months, all of these later lesions were either stable (61%) or smaller (39%). Two patients died from unrelated causes. Radiation-induced myelopathy appeared 8 months postradiosurgery in one patient., Conclusion: Although more patients studied over an even longer follow-up period are needed to determine the long-term efficacy of spinal radiosurgery for benign extra-axial neoplasms, short-term clinical benefits were observed in this prospective analysis. The present study demonstrates that CyberKnife radiosurgical ablation of such tumors is technically feasible and associated with low morbidity.

Objective and Importance: The use of intrathecal morphine has been effective with few complications for chronic intractable pain of both benign and malignant origins. A rare but serious problem that exists is the formation of an inflammatory mass at the catheter tip of the pain pump., Clinical Presentation: We report the case of a 67-year-old female patient with failed back syndrome who presented with sensory complaints and back pain., Intervention: Magnetic resonance imaging revealed impingement on the thoracic cord by a mass. The mass was originally thought to be a spinal cord tumor; however, operation and chemical analysis of the mass showed that it was a bupivacaine precipitate at the tip of the catheter of the pain pump., Conclusion: This is the first such case, to our knowledge, of a bupivacaine precipitate mimicking a spinal cord tumor.

Objective and Importance: Extradural hemangioblastomas account for 8 to 12% of all spinal hemangioblastomas. Among them, intra-extradural forms with a dumbbell extension are extremely rare. We report a case of intra-extradural hemangioblastoma involving the C6 cervical nerve root., Clinical Presentation: The patient was a 31-year-old woman presenting with signs of myelopathy and C6 radiculopathy on the right side. A computed tomographic scan and magnetic resonance imaging demonstrated a dumbbell tumor that had developed through the C5-C6 intervertebral foramen. Angiography revealed a well-circumscribed mass with feeders from the vertebral artery and the deep cervical artery., Intervention: The tumor was totally removed through the lateral approach, with control of the vertebral artery and sacrifice of the C6 cervical nerve root. Limited bone drilling to enlarge the foramen permitted us to reach and resect the intradural component. Histopathological examination confirmed the diagnosis of hemangioblastoma. Follow-up was uneventful., Conclusion: This is the sixth reported case of a cervical dumbbell hemangioblastoma investigated by computed tomographic scanning and MRI but the first one resected via the lateral approach. The lateral approach seems appropriate for surgical resection because it provides primary control of the vascular feeders and access to the extradural and intradural components.

Objective and Importance: Spinal cord schwannomas are intradural nerve sheath tumors that almost universally occupy a dorsolateral, lateral, or ventrolateral position. Therefore, resection of these lesions typically proceeds via a posterior or posterolateral approach., Clinical Presentation: We present a case of a midline ventral intradural schwannoma of the cervical spinal cord causing myelopathy. To the best of our knowledge, no previous reports specifically discuss purely midline ventral intradural schwannomas., Intervention: Resection of the tumor was performed via an anterior cervical corpectomy with spinal arthrodesis and fixation. We review possible causes for such an anomalous location for schwannoma as well as the advantages and disadvantages of various surgical strategies for removing the tumor., Conclusion: This case exemplifies the usefulness of anterior approaches to the cervical spine in treating unusual intradural spinal cord tumors.

Twelve patients with benign dumbbell tumors of the cervical spine were treated surgically between March 1991 and July 1994. Gross total resection was achieved in 11 patients, using a single-stage modified posterior midline exposure with laminectomy and complete unilateral facetectomy. This exposure provides contiguous intraspinal, foraminal, and extraforaminal access that extends up to 4 cm from the lateral dural margin. The surgical considerations of these tumors, including the surgical technique, potential spinal instability, vertebral artery, and risk of nerve root injury, are presented.

Five intramedullary cavernous angiomas were surgically removed after being localized by intraoperative ultrasound imaging. Two patients were men, and three were women; in three patients, the symptoms had an acute onset, whereas in the other two, it was gradual. The vascular malformation was localized in the dorsal tract in three patients and in the cervical tract in two. Intraoperative ultrasound imaging visualized the lesion, which appeared hyperechogenous in all cases, and showed its relationship with the surrounding anatomical structures. Surgical removal was always total and was confirmed by both intraoperative echography and postoperative magnetic resonance imaging. In our experience, intraoperative ultrasound imaging was useful for localizing intramedullary cavernous angiomas, especially in cases where the lesion did not appear on the posterior surface of the spinal cord. In this way, it was possible to limit posterior myelotomy and confirm radical tumor removal intraoperatively.

A 13-year retrospective review of 17 patients with gangliogliomas treated at the University of Iowa was conducted to investigate the association between tumor location, extent of resection, pathological findings, and patient prognosis. Thirteen were in the cerebral hemispheres and 4 in the midline. The mean ages at diagnosis and symptom onset were 16 and 8.8 years, respectively. The most common presenting symptom was seizures (11 patients); focal neurological deficit was seen in 5 patients and headache in 1. Patients with hemispheric tumors had an older age at time of diagnosis and a longer duration of symptoms. Pathologically, they had more microcalcifications, lymphocytic infiltration, microcystic degeneration, and eosinophilic bodies. Cerebral hemispheric tumors were more amenable to total resection than midline neoplasms, 77% versus 25%, respectively. In the patients with hemispheric tumors, 10 patients were tumor-free after total resection. Two of the 3 patients with partial resection had stable residual tumors. The third died of tumor progression. In the 4 patients with midline neoplasms, one was tumor-free after total resection. The other 3 had subtotal resection and radiation therapy. Two died within 2 years; the third is still alive with progressive tumor. Five of 9 patients who had seizure disorders and who underwent total tumor removal were seizure-free postoperatively. The other 4 patients and the 2 with partial surgical resection continued to have seizures.

The main difficulty in dealing with intradural lesions located ventrally in the region of the craniovertebral junction (CVJ) is related to their relative inaccessibility. Posterolateral approaches involve some manipulation of the brain stem and provide limited access because of the necessity of working between the cranial nerves. Even then, the view of the ventral midline and across is limited. The transoral approach, which has been widely used for the management of extradural lesions in this area, is also useful for the treatment of intradural lesions. It provides an unimpeded although somewhat restricted, view of the ventral aspect of the CVJ without the need for brain retraction. The cranial nerves and vertebral arteries are not interposed between the surgeon and the lesion. The risks of cerebrospinal fluid leakage and infection are greatly diminished by the use of fibrin adhesive and prolonged diversion of the cerebrospinal fluid. The use of this approach, together with its technical difficulties and results, in the management of seven purely intradural lesions located ventrally at the CVJ, is discussed.

A case of subarachnoid hemorrhage caused by a cervical hemangioblastoma is presented. The clinical picture was indistinguishable from that of a subarachnoid hemorrhage from an intracranial lesion. The diagnosis was established by angiography and water-soluble contrast myelography followed by cervical computed tomographic scan. At surgery, the tumor was completely removed, and no neurological deficit was observed after the operation.

We present a case of an infiltrating spinal angiolipoma demonstrating extension into the vertebral body and the spinal epidural space. The infiltration into the epidural space caused myelopathy. About 40 cases of spinal angiolipoma and angiomyolipoma have been reported; however, only a few cases have been the infiltrating type. The radiological findings were similar to those of vertebral hemangioma, but poor enhancement of the angiolipoma on contrast-enhanced computed tomographic scans differentiated between them. The infiltrating epidural tumor was removed, and the clinical symptoms improved remarkably. Total removal of the tumor and stabilization of the involved vertebral body using the anterolateral approach may be desirable when a diagnosis of angiolipoma or angiomyolipoma is confirmed preoperatively.

A 16-year-old boy was noted to have an apparent intradural sacral mass 6 weeks after the excision of a 4th ventricle ependymoma. Although spinal axis radiation was considered, it was decided to make a definitive tissue diagnosis. At sacral laminectomy, only segmental arachnoiditis was found. The implications of this finding are the subject of this case report.

We are reporting a case of a ventrally placed intradural meningioma at the C-7, T-1 level that was shown clearly on a computed tomographic scan without the use of metrizamide. This greatly facilitated the planning of our posterolateral approach, which permitted a complete removal of the tumor with minimal manipulation of the spinal cord.

Computer-assisted myelography (CAM) is a technique in which computed tomography (CT) is combined with the intrathecal administration of metrizamide to demonstrate the spinal cord and surrounding structures. This retrospective study of 139 CAMs performed at Emory University Hospital included 125 CAMs that were preceded by routine metrizamide myelography (secondary CAM). The remaining 14 CAMs were primary studies without concomitant myelography. These CAMs and conventional myelograms were reviewed to provide indications for the use of CAM as a replacement for other radiodiagnostic studies or as an adjunct to radiological diagnosis. Eighty-one CAMs (58%) were positive for some pathological process. Of the 69 secondary CAMs demonstrating a pathological condition, 46 (67%) revealed some aspect of the lesion not apparent on routine metrizamide myelography. In no case with positive myelography was CAM negative. However, conventional myelography often added valuable diagnostic information. Although high resolution CT has allowed limited visualization of the spinal cord, CAM is often indicated for cases in which diagnosis requires more definition of cervicomedullary, extradural, intradural, extramedullary, and intramedullary lesions. Our clinical review found CAM to be extremely useful in the diagnostic evaluation of pathological conditions involving the spine and spinal cord and suggests clinical indications for the use of CAM based upon selected illustrative cases. Furthermore, CAM seemed to be superior to other radiological procedures in certain instances, such as in cases of spinal dysraphism and in the evaluation of lesions at the foramen magnum. Until more experience is obtained using spinal CT and CAM, CAM should not replace myelography altogether. The present study indicates that, rather than replacing conventional CT and myelography, CAM should be used as a primary study in situations where it has been shown to be superior and as a complementary study when other neurodiagnostic examinations are equivocal or nondiagnostic.

A case of cervical intramedullary neurofibroma diagnosed and surgically treated is reported. This patient, a 27-year-old man, had no evidence of von Recklinghausen's disease. The case is discussed, and a review of literature is presented.

We analyzed the clinical features, radiological findings, and results of surgical treatment in a series of 25 patients with lung cancer and invasion of the spine. In 12 of the 25 (40%) patients, involvement of the spine was present at the time of initial presentation of malignancy. Computed tomography revealed the presence of a large paravertebral soft tissue mass with destruction of adjacent ribs in the majority. The surgical approach consisted of an anterolateral exposure through a formal thoracotomy in 22 patients and a thoracoabdominal flank approach in the 3 patients with lumbar lesions. All gross tumor was resected from the involved paravertebral tissues, vertebral body, and epidural space. Immediate stabilization of the spine was then achieved with methyl methacrylate. Local brachytherapy (iridium-192 implants) was used in 19 patients. After treatment, 87% were ambulatory, and 67% maintained ambulation for more than 6 months. Our data suggest that compression of the spinal cord in many patients with lung cancer results from direct extension of tumor through the chest wall. Because the majority of such patients often have localized disease involving the spine, aggressive surgical treatment is indicated.

Three children with a history of malignant tumor (cerebellar medulloblastoma in two cases and adrenal neuroblastoma in one case) are discussed. All three had diffuse leptomeningeal dissemination, which was confirmed at autopsy. Computed tomography (CT) revealed diffuse enhancement of the intracranial subarachnoid spaces after the administration of contrast material. Despite the absence of spinal cord signs and symptoms, autopsy showed severe diffuse seeding of neoplastic cells in the spinal subarachnoid space giving the spinal cord the appearance of a "bamboo stick." Myelography is necessary to disclose clinically silent spinal cord lesions when CT or cerebrospinal fluid cytological examination reveals evidence of subarachnoid dissemination of tumor.

Two cases of intramedullary cavernomas are presented. Both patients showed progressive neurological deficit. Cavernoma must be considered in the differential diagnosis of spinal cord tumors.

The authors report a rare case of intramedullary teratoid cyst, in which an arteriovenous malformation of the spinal cord was first suspected. The controversial problem of the histogenesis of teratomas is reviewed. The authors stress the benign course of these lesions after operation, even when radical surgery cannot be performed.

A case of a very large intramedullary neurofibroma of the conus medullaris extending over 3 1/2 segments is reported. The tumor was successfully treated by midline myelotomy and radical excision with no exacerbation of the preoperative neurological deficit. Intramedullary neurofibroma is extremely rare, accounting for less than 1% of spinal neurofibromas. Myelotomy and radical excision under the operating microscope are recommended in such cases.

A cauda equina schwannoma presented solely with rectal pain. The tumor was found to have infarcted and hemorrhaged. A discussion of rectal pain is included, and it is speculated that some forms of rectal pain, especially those classified as proctalgia fugax or rectal neuralgia, may be due to cauda equina tumors.

Three patients with malignant gliomas who developed dissemination of tumor at the time of recurrence are presented. All three patients received combination therapy including conventional radiotherapy and interstitial radiation therapy followed by systemic BCNU chemotherapy. A review of the literature on the development of glioma metastases and an analysis of the possible mechanisms of this uncommon growth pattern are presented.

Neurological evaluation supplemented by myelography has been highly successful in diagnosing spinal cord tumors. Our experience shows that a widening of the cord on myelography is not always diagnostic of spinal cord tumors. Two patients who presented clinically with evidence of spinal cord tumor and had a widening of the cord on myelography were found to have severe cervical arachnoiditis without any evidence of intrinsic cord abnormality. Hence, cervical arachnoiditis should be considered in the differential diagnosis of spinal cord tumor on myelography.

Intradural spinal lipomas are rare, and their origin is unknown. Although the clinical presentation may not be distinctive, the neuroradiographic presentation is. Total excision is usually not possible, although subtotal resection is easily accomplished using an ultrasonic aspirator.

Computed tomographic myelography (CTM) is the procedure of choice in patients exhibiting spinal manifestations of neurofibromatosis. Due to the lack of specificity of several of the more important plain spine radiographic findings in this disease, CTM may be necessary to distinguish between surgical and nonsurgical entities. CTM will determine the size, shape, and intraspinal extension of posterior mediastinal neural tumors and separate them from the more common thoracic meningoceles. CTM will likewise elucidate the causes of posterior vertebral body scalloping, distinguishing between dural ectasia and neural tumor. CTM will also frequently demonstrate additional asymptomatic lesions at other levels.

Increasing experience-based statistical knowledge, expertise, and technical advancements in recent years have all contributed to the facility of investigations into the cause of spontaneous neuraxis hemorrhage. The sum of the neuroradiological evaluation has become increasingly more straightforward, simpler to execute, more informative, and safer to perform. Methods of investigation include the traditional forms of radiography such as skull roentgenography and conventional anteriography. However, the contribution of high resolution computed tomography, dynamic computed tomography, and venous and arterial digital subtraction angiography has been largely responsible for the progress in this complicated area of radiological diagnosis. The future advancement of radiological evaluation in patients with craniospinal hemorrhage will lie in the technical improvements of current imaging systems, as well as in the further development and refinement of new techniques such as magnetic resonance imaging.

Hydrocephalus with spinal subarachnoid obstruction is rare, and its cause is obscure. Two such patients are presented. The pathophysiology is reviewed. Spinal absorptive pathways for cerebrospinal fluid are postulated to play a critical role in such cases.

The cases of 18 patients operated on for hemangioblastoma of the spinal cord were reviewed. There were 11 men and 7 women. (M:F = 1.6:1) and in 15 patients, the onset of spinal symptoms was before the age of 40 years. There were 19 intradural and 2 extradural tumors. The tumor was accompanied by a cyst in 9 patients (50%). There were 6 cases of Lindau's disease, including 3 cases of multiple spinal tumors. Symptoms improved postoperatively in 13 patients. were unchanged in 2, and were aggravated in 3. At the present time, magnetic resonance imaging with gadolinium-diethylene-triamine-pentaacetic acid (Gd-DTPA) enhancement is the most useful tool for precise localization of the tumor and differentiation of any accompanying cyst.

A case of intramedullary neurofibroma of the cervical spine in a patient with no signs of von Recklinghausen's disease is presented. Intramedullary neurofibroma is extremely rare, accounting for less than 1% of spinal cord neurofibromas. This case is the first diagnosed with computed tomography.

A case of an intradural extramedullary meningioma of the cervical spine excised through an anterior approach is reported. This permitted a complete excision without manipulation of the cord followed by a rapid and complete recovery. The technique of excision and bone grafting is described.

We report a case of a presacral teratoma containing a malignant carcinoid component associated with an anterior sacral meningocele that presented in a 35-year-old woman. The clinical, radiographic, and pathological features of these rare tumors, of presacral meningoceles, and of the hereditary presacral teratoma syndrome are discussed.