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The vast majority of intraspinal meningiomas occur in an intradural extramedullary location. A meningioma in a purely extradural location in the cervical spine as reported here is quite exceptional. Extradural meningiomas tend to show more aggressive features than intradural meningiomas and are often confused with malignant neoplasms. We report an invasive extradural meningioma in the cervical spine with multi-segmental involvement, extension through the neural foramina and encasement of the subjacent vertebral artery, mimicking malignancies such as lymphoma and sarcoma. Although rare, meningiomas may demonstrate extradural multi-segmental growth and should be considered in the differential diagnosis of such lesions.

Introduction Spinal arachnoid cysts are rare. Most of these lesions are located in the thoracic and thoracolumbar regions. Magnetic resonance imaging is a valuable tool for understanding their location and provides important information regarding their origin and expansion. The aim of our study was to evaluate the demographics, presentations, surgical management, and outcome of a spinal arachnoid cyst. Materials and Methods All the patients from January 2003 to December 2021 who were symptomatic for spinal arachnoid cysts were taken for study. A retrospective analysis was performed. Radiological investigations were performed, and patients were graded according to the Nabors classification. Operative results were graded according to surgical technique. Results The study included 22 patients, 11 female and 11 male patients, with a male-to-female ratio of approximately 1:1. The mean age of presentation was 34.7 years (4–60 years). Of 22 patients, 15 have intradural arachnoid cysts, 7 have an intradural extramedullary arachnoid cyst, and 8 have an intramedullary arachnoid cyst. Symptoms varied from weakness in the lower limbs (50%), quadriparesis and spasticity (32%), bladder/bowel incontinence (14%), and pain (10%). Out of 22 patients, complete cyst excision was performed in 17 patients, marsupialization in 4 patients, and cystic-subarachnoid shunt in one patient. Weakness and spasticity gradually recovered over a period of time. At 1-year follow-up, all the patients had complete improvement in their weakness, spasticity, and bladder functions. No recurrence of the cyst was seen at 1-year follow-up. Conclusion Spinal arachnoid cysts are very rare in the spinal cord. Most of the lesions are located in the thoracic and thoracolumbar regions. Asymptomatic cyst requires counseling and conservative management, whereas symptomatic cyst, if operated on with surgical expertise, recurrence and complications are very low. The best surgical technique for operating these spinal arachnoid cysts is still under question, but symptom improvement is seen in all operative procedures. [ABSTRACT FROM AUTHOR]

Pediatric embryonal tumors have a rare occurrence in the peripheral nervous system. A more aberrant location is the extradural space, with only 25 cases being reported in literature. The seemingly innocuous symptoms can often be misleading as a sprain, and in our country, where tuberculosis is endemic, it can even be perceived as Pott's spine, and therefore, leads to a delayed intervention for these rapidly progressive malignancies. We report the case of a 9-year-old boy whose symptoms started with a dull neck pain that was ignored for 6 months as a neck sprain. X-ray of his cervical spine showed only subtle loss of cervical lordosis, a finding that was missed. Eventually, he developed weakness of the right upper and lower limbs and was referred to our hospital. Magnetic resonance imaging revealed a large lobulated extradural lesion extending from C1-D3 level of neoplastic etiology. Postlaminectomy, the histopathology was consistent with primitive embryonal tumor. The patient was immediately started on an intensive chemotherapy regimen and is currently in the consolidation phase. [ABSTRACT FROM AUTHOR]

A 7‐year‐old neutered male Domestic shorthair cat, with a 1.5‐year history of left eye enucleation secondary to a diffuse iris malignant melanoma, was evaluated for progressive onset of pelvic limb paresis and ataxia with severe thoracolumbar hyperaesthesia and dysorexia. Neurological examination localised a lesion to the T3–L3 spinal cord segments. Magnetic resonance imaging of the thoracolumbar spine showed a well‐defined extradural T1‐weighted hyperintense non‐contrast‐enhancing mass, initially suggesting a potential haemorrhagic component. Exploratory surgery revealed a brownish extradural lumbar mass. Histologic examination concluded to a melanoma, most probably metastatic given the animal's previous medical history. This report highlights the importance of collecting a complete medical history, which can help in obtaining a preliminary differential diagnosis in cats with clinical signs of myelopathy. Although the location of this metastasis is particularly unusual both in human and veterinary medicine, making optimal treatment challenging for neurosurgeon, our increased understanding of immune and tumour cell biology during the past decade is likely to improve the future treatments of feline melanoma and its metastases. [ABSTRACT FROM AUTHOR]

Spinal extradural arachnoid cysts are rare benign lesions occurring along the cerebrospinal axis. They may be associated with pain or varying degrees of neurological compressive symptoms. Brown-Sequard syndrome is a rare sequalae, where there is ipsilateral upper motor neuron paralysis with loss of proprioception as well as contralateral loss of pain and temperature sensation below the lesion. We present a 33-year-old female with a 6-month history of worsening right lower limb weakness and a 2-month history of right lower limb pain. Motor examination revealed right lower limb weakness as well as exaggerated knee and ankle jerk reflexes. A magnetic resonance imaging (MRI) was done, which showed an eccentrically located T4–7 cystic extradural mass causing severe cord compression. She had T4–7 laminectomies with total excision of the cyst and disconnection of the fistulous tract between the cyst and the subarachnoid space. She made full neurologic recovery with no complications. [ABSTRACT FROM AUTHOR]

Arachnoid cysts are formed by duplication of the arachnoid membrane between the arachnoid and the pia mater. Although it is very common in intracranial localization, those with spinal location are rare. Extradural arachnoid cysts of the spinal canal are extremely rare pathologies regarded as either congenital or acquired. These cysts, which can develop idiopathic, post-traumatic, and after arachnoiditis, are often detected incidentally. They present with weakness in the extremities, neuropathic pain, paresthesia, or myelopathy. Here we describe the case of a 17-year-old male patient with a history of chronic spinal trauma who attended our clinic with severe low back pain for 7 months. [ABSTRACT FROM AUTHOR]

Spinal arachnoid cysts (SACs) are an uncommon cause of spinal cord compression. A nine-year-old female child presented with pain, stiffness, and weakness in both lower limbs. The girl could walk with support. She had clinical features suggestive of Marfan's syndrome. On examination, she had spastic paraparesis. Neuroimaging revealed multiple extradural arachnoid cysts (EACs) causing cord compression, extending from the cervical to sacral level. Computerized tomography (CT) myelogram did not demonstrate a communication of the EAC with the spinal subarachnoid space at any level or within adjacent cysts. The patient underwent a dorsal laminoplasty (D6 to D8) with excision of the underlying EAC, which was causing maximum compression. Postoperatively, the patient showed significant improvement in her gait. She could walk independently at the time of discharge. The EACs are rare and the present case is the only case to have extensive spinal cord involvement from cervical to sacral levels and only the second in literature in which multiple EACs caused symptomatic cord compression. The relevant literature is reviewed. [ABSTRACT FROM AUTHOR]

In comparison to spinal intradural and intradural--extradural schwannoma, purely extradural schwannoma is rare. There is no clearcut consensus about the origin of these tumors. There are very few cases reported in the pediatric population. On literature search, we have not found a similar case in the infantile age group. We report a case of purely spinal extradural schwannoma in a 5-month-male child who presented with paraparesis. Magnetic resonance imaging scan revealed a 7.5x2.5x1.2 cm size contrast-enhancing spinal extradural mass lesion extending from D4 to D10 vertebral level. The child underwent thoracic laminotomy, and the spinal extradural mass lesion was completely excised. Histopathological examination of the specimen revealed schwannoma. The child recovered well in the post-operative period. At 1 year follow-up, he has completely regained his power in both lower limbs. [ABSTRACT FROM AUTHOR]

Background: Spinal arachnoid cysts (SAC) are typically congenital, spontaneous, traumatic (i.e., including iatrogenic/surgical), or inflammatory in origin. In descending order, they occur in the thoracic, lumbar, and cervical spine, and originate from focal entrapment of the arachnoid membrane. Arachnoid cysts represent 1-2% of all cystic spinal masses/tumors. The majority are extradural arachnoid cysts (EDAC) while 10% of all arachnoid cysts are intradural (IDAC) including subarachnoid, or extra-arachnoidal/subdural. Only rarely are they intramedullary in location. The clinical symptoms/signs of IDAC/EDAC include; intracranial hypotension (i.e., due to continued cerebrospinal fluid drainage), radiculopathy, and/or myelopathy. Methods: Magnetic Resonance Images (MR) and Myelo-Computed Tomography (Myelo-CT) studies classically document the predominant dorsal location of IDAC/EDAC. They also show their extent and severity contributing to root, cord, and/or cauda equina compression. In the cervical/thoracic spine, MR/Myelo-CT studies classically show the "double cord" or "windsock" signs, while the "fake arachnoiditis sign" may be seen in the lumbar spine. The latter sign signals the presence of a circumferential extra-arachnoidal-subdural cyst that centrally "traps" the cauda equina. Note, that this resembles and is often misinterpreted as adhesive archnoiditis. Results: Patients with significant SAC-related neurological deficits typically warrant early surgery. That surgery includes; partial/total resection/fenestration of cyst walls, and occlusion of communicating fistulas with or without accompanying shunts. Conclusion: It is critical to recognize the clinical (i.e., intracranial hypotension, radiculopathy, and/or myelopathy) and radiographic MR/Myelo-CT signs (i.e., "double cord," "windsock signs", or "fake arachnoiditis sign") of IDAC, EDAC, or intramedullary spinal arachnoid cysts to appropriately offer treatment. For those with significant neurological deficits, early surgery (i.e. optimally 0-< 24 hours after the onset of symptoms/signs consisting of laminectomies, partial/total cyst resection/fenestration, and ligation/occlusion of the subarachnoidcyst fistula with or without shunt placement), is essential to avoid significant permanent neurological sequelae. [ABSTRACT FROM AUTHOR]

We present the first case of clival cystic chordoma with extradural location, transdural transgression, and moderate bone involvement in a 10-year-old girl. Chordoma showed unconventional appearances on computed tomography (CT) and magnetic resonance imaging (MRI), due to cystic components, extradural space location with extensive intradural extension, moderate superficial bone involvement. Surgery confirmed the extradural location and histopathological examination revealed cystic chordoma. MRI and CT findings were not characteristic for a single lesion; differential diagnoses included cystic lesions such as epidermoid and dermoid cyst, ecchordosis physaliphora, and benign notochordal cell tumors. [ABSTRACT FROM AUTHOR]

Background: Ewing's sarcoma (ES) is a malignant mesenchymal tumor, most often found in the long bones, and usually affecting children and adolescents in the second decade of life. ES of the spine is a clinical rarity. Case Description: A 45-year-old male presented with a 3-month history of lower back pain which acutely worsened in conjunction with urinary retention. The magnetic resonance imaging revealed a mass extending from L5 to S2 with additional extension through the left S2-3 neural foramen. The metastatic workup was negative. At surgery, the lesion was both intradural and extradural. Following complete surgical resection, the patient was later treated with radiation and chemotherapy. Conclusion: Here, we report an adult male who acutely presented with low back pain attributable to primary intradural/extradural sacral ES. [ABSTRACT FROM AUTHOR]

Primary extradural mesenchymal chondrosarcoma (MCS) is a very rare intraspinal tumor. Proper clinical evaluation with magnetic resonance imaging (MRI) followed by biopsy of the mass can confirm the diagnosis. Since MCS has a high tendency of recurrence and metastasis, the prognosis is guarded. We report a 52 years old male with primary extradural MCS in the lumbosacral region (L5-S3). Subtotal excision and biopsy were performed which confirmed the diagnosis. The patient received post excisional radiotherapy but expired after four months. Though rare, this tumor should be kept in differentials which helps in early diagnosis and thus can be treated with radical excision of the mass along with postoperative radiotherapy. [ABSTRACT FROM AUTHOR]

Purpose: The goals of this study were to compare clinical outcomes in patients with Chiari Malformation Type I (CMI) receiving posterior fossa decompression with (PFDD) or without duraplasty (PFD). Methods: We conducted a retrospective analysis of 178 consecutive cases of 157 patients undergoing PFDD or PFD for CMI at Cohen Children's Medical Center between 2007 and 2017. Clinical improvement was defined as a clear reduction of preoperative symptoms after surgery as reported by patients and parents. An improvement of syrinx was derived from radiologic comparison of pre- and postoperative MR imaging. Chi-square analysis was performed to analyze the association between duraplasty and clinical parameters (alpha = 0.05). Results: The primary presenting complaint was headache (142/178; 80%), followed by neck, back, and upper extremity pain, and numbness or tingling (49/178; 28%). Seventy patients (78/178; 44%) underwent PFD, and 100 patients (100/178; 56%) underwent PFDD. Overall, 143 patients (143/178; 80%) experienced subjective improvement with no statistically significant difference between the two surgical techniques (p = 0.705). The number of patients receiving PFDD with syrinx improvement or stabilization (55/59; 93%) was statistically larger than those that received PFD (8/13; 62%) (p = 0.008). PFDD was associated with greater complications than PFD alone. There were 35 cases of reoperation overall (35/178; 19%), and there was no statistically significant difference in reoperation rate between PFD and PFDD (p = 0.255). Conclusions: There appears to be a role for PFDD in patients with severe syringomyelia, but overall, PFD alone may be safely offered as the initial surgical intervention for symptomatic CMI patients. [ABSTRACT FROM AUTHOR]

Background: Ganglioneuromas are rare, benign, well-differentiated tumors arising from neural crest cells that commonly occur in the posterior mediastinum, retroperitoneum, cervical spine, and adrenal gland. We report an unusual case of an extensive spinal extradural ganglioneuroma, circumferentially and longitudinally affecting the extradural space of the lumbar spine and continuously invading bilateral psoas muscles.Case Description: A 32-year-old man presented with a 1-week history of abdominal pain and diarrhea. Radiographs revealed scalloping of the posterior surfaces of the L2 and L3 vertebral bodies and widening of L2-3 and L3-4 bilateral intervertebral foramina. Computed tomography scans and magnetic resonance imaging showed a well-defined lobulated extradural mass from L1 to L4 and a continuously forming mass in the psoas muscles through L2-3 bilateral neural foramina. The mass demonstrated homogeneously isointense signal on T1-weighted images, inhomogeneously hyperintense-to-isointense signal on T2-weighted images, and inhomogeneous enhancement on fat-suppressed contrast-enhanced T1-weighted images. Radiologic diagnosis included spinal epidural lymphoma. Percutaneous biopsy with sonographic guidance was performed, and the mass was diagnosed on pathological examination as a ganglioneuroma.Conclusions: This is the first known reported case in the literature of a spinal extradural ganglioneuroma with circumferentially and longitudinally extensive involvement of the extradural space and a large psoas mass. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance imaging (MRI) patterns of canine cervical hydrated nucleus pulposus extrusion (HNPE) have been described by a few reports, but the correlation between microsurgical and MRI features has never been investigated. The aim of this study was to compare the MRI features of HNPE with microsurgical findings and cytological outcomes and also to investigate the anatomical and pathophysiological aspects of the disease. Methods: A prospective clinical study was conducted in 36 dogs suffering from HNPE. The diagnosis was based on high-field MRI findings of ventral extradural lesions, adjacent to the dorsal aspect of intervertebral discs, characterised by high signal intensity in T2-weighted sequences and hypointensity in T1-weighted sequences. MRI images were analysed with regard to the intervertebral space involved, the grading of spinal cord compression, the signal intensity and distribution of the material, and the thickness and signal intensity of the involved discs. All patients underwent microsurgical decompression and direct observations were recorded and films of the surgical procedure analysed. Results: The majority of patients had acute onset of clinical signs (78 %), the patient did not exhibit signs of pain in 75 % of dogs and neurological deficits varied from slight tetraparesis (33 %) to tetraplegia (28 %). The localization of the extruded disc material was ventral relative to the dorsal longitudinal ligament that was lifted dorsally and appeared intact at the site of compression. Direct microsurgical observations of the HNPE sites showed that extruded disc material was collected within the fibres of the dorsal longitudinal ligament. The consistency was gelatinous in 42 %, water-like in 33 %, and lumpy liquid in 25 % of cases. Cytological samples did not detect the presence of inflammation, bacteria, fungi, neoplastic cells or foreign material. Conclusions: Microsurgical features of HNPE suggest that the extruded disc is collected within the fibres of the dorsal longitudinal ligament and this may explain the typical MRI appearance of this disease. Further pathophysiological studies are needed to investigate why the cervical nucleus pulposus extrusion appears to occur without obvious trauma. [ABSTRACT FROM AUTHOR]

Primary intraosseous or ectopic meningioma of the skull is a rare tumor accounting for about 1% of meningioma. Intradiploic meningioma is an extremely rare type of extraneuraxial meningiomas. Intradiploic meningioma of the orbit is extremely rare, and <8 such cases are reported till date in western literature occurring in the pediatric age group. Here the authors present a case of 16-year-old female, who presented with progressive proptosis, with normal vision and was managed successfully surgically. Clinical features, pathophysiology, and surgical management of this rare entity are discussed in the context of pertinent literature. [ABSTRACT FROM AUTHOR]

Purely extradural spinal cavernous malformations (ESCMs) are rare, but the number of cases reported seems to be increasing. A 44-year-old woman presented with progressive cervicothoracic back pain, lower limb paraesthesia and hypertonia. MRI showed a well-circumscribed, convex lesion in the T1-4 extradural space causing cord compression and encroaching into the left T2/3 neural foramen. Selective spinal angiography demonstrated a vascular blush at the T2/T3 level corresponding with the mass. A feeding vessel arising from the base of the T1 spinous process was identified and successfully catheterised, but embolisation was precluded by unfavourable anatomy of the posterior spinal artery. At hemilaminectomy, the lesion was found to be an ESCM. The patient went on to make a full recovery. We reviewed 71 cases of ESCM reported in the last decade. Incidence of ESCM is unclear; the largest case series reported on nine patients, but most published accounts were single case studies. Patients presented with back pain (33%), myelopathy (56%) and/or radiculopathy (39%). Onset of symptoms was usually insidious over months to years, but 30% presented with sudden-onset neurological symptoms, often due to spontaneous haemorrhage. Mean age at diagnosis was 44 (range, 2-74; SD, 19.6) years with a 1:1 sex ratio. Lesions were found at all levels except C1-C2, but a strong predilection for the dorsal thoracic spine (68%) was shown. The lesion extended into an intravertebral foramen in at least 24 cases (34%). MRI is the investigation of choice, and angiography of ESCM has rarely been described. Most (87%) were hypo- to isointense on T1 MRI while hyperintensity on T2 (91%) and avid (89%), usually homogenous gadolinium update was almost universal. Perilesional haemosiderin, characteristic of intracranial and intramedullary cavernous malformation was rarely seen. In many cases, meningioma or nerve sheath tumour was misdiagnosed prior to surgery. All patients underwent total (95%) or subtotal (5%) microsurgical resection with excellent results; all improved (23%) or recovered fully (77%) after surgery. Those who presented acutely did worse; 38% had residual deficits. [ABSTRACT FROM AUTHOR]

Intraspinal extradural ganglion cysts rarely occur in the cervical spine, and their etiology is unknown. A 77-year-old female complaining of right upper extremity weakness presented with a cystic mass located in the spinal canal of the right C3-4 facet joint. A C3-4 right hemilaminectomy and excision of the cysts were performed. The cyst contained a translucent viscous material and was easily decompressed. No communication between the cyst and facet joints was found in the surgical field. The neurologic symptoms improved rapidly after surgery. The histology examination showed that the cystic wall was composed of dense fibrous tissue without a synovial cell lining concordant with a ganglion cyst. This report describes a rare case of a ganglion cyst of the cervical spine arising at the C3-4. This case highlights the need to consider a ganglion cyst as one of the causes of cervical radiculo-myelopathy. [ABSTRACT FROM AUTHOR]

Ewing's sarcoma is a rare tumor first discovered by James Ewing in 1921. It is more common in bone or skeletal component compared to soft tissue or extraosseous Ewing's sarcoma. Among soft tissue Ewing's, spinal cord involvement is rarer with only nine cases reported. We report a case of nine-year-old Malay girl who presented with low back pain for two months following a fall with progressive neurological deficits of bilateral lower limb. Magnetic resonance imaging was suggestive of a well-defined margin of intradural extramedullary tumor. With nerve sheath tumor in mind, surgical excision with laminectomy L2-S1 was performed. Intraoperative finding was an extradural mass from L3-L5 with extension to bilateral neuroforamen. Histopathology report defined a round cell tumour of Ewing's sarcoma from the mass. [ABSTRACT FROM AUTHOR]

Introduction: Destructive spondyloarthropathy may occur in long-term hemodialysis patients, but focal amyloid deposits in the spine are rare. We present a case of upper cervical extradural amyloidoma with a history of long-term hemodialysis presenting with progressive and intractable radiculopathy. Clinical presentation: We describe a 51-year-old female with a long-term history of hemodialysis treatment. She suffered progressive and intolerable right occipital headache. Neurological examination revealed right C2 radiculopathy. Magnetic resonance imaging (MRI) of the cervical spine showed a solid focal extradural mass lesion at the C2 level. She underwent subtotal resection of the extradural mass lesion and decompression of the right C2 nerve root by a posterior approach. Histological examination revealed amyloid deposits. The occipital headache immediately disappeared after surgery. Follow-up MRI 10 months after surgery demonstrated no recurrence of the extradural amyloidoma. Conclusion: Development of an upper cervical extradural amyloidoma after long-term hemodialysis is extremely rare. Prompt evaluation of long-term hemodialysis patients suffering from progressive cervical pain should be recommended, and treatment is required if there are signs or symptoms of compression of a nerve root or the spinal cord. [ABSTRACT FROM AUTHOR]

Two cases of extradural epidermoid cyst presented a symptom of headache. Computed tomography showed a high-density mass in one case without enhancement, and low-density mass in the other case with rim enhancing. Magnetic resonance imaging (MRI) revealed different signals imaging finding variation, depending on the contents of epidermoid cyst. The preoperative diagnoses of the cases are mistaken. At surgery, the lesions were found to be an epidermoid cyst. Typical MRI and computed tomography findings are neither specific for nor constant with epidemoid cysts. MRI, however, has not eliminated the need for a thoughtful, critical approach to differential diagnosis. [ABSTRACT FROM AUTHOR]

Abstract: Background context: Removal of cervical dumbbell tumors can be particularly challenging because of unique exposure requirements and proximity of the vertebral artery (VA). There are no reports describing the treatment of giant cervical spine dumbbell tumors (CSDTs). Purpose: To introduce an extensive posterolateral approach to CSDTs involving total lateral mass resection and laminectomy. Study design: Prospective study of all the patients with multilevel CSDTs treated by this new procedure between December 2002 and March 2006. Patient sample: Sixteen patients (3 men and 13 women) with CSDTs underwent the procedure we describe. The follow-up periods ranged from 9 to 51 months (average 9 months). Average age at surgery was 45 years (range 23–68 years). Outcome measures: Axial symptoms and Japanese Orthopedic Association scores were recorded. Pre- and postoperative ranges of neck motion were measured on lateral flexion and extension radiographs. Methods: After making a midline incision, we preferred exposing the extraforaminal component of the tumor before performing a semilaminectomy and lateral mass resection. Any lateral extension of a tumor can be attained by detachment of the adjacent three or more segments of the lateral mass muscle insertion. The most lateral portion can be separated beneath the tumor''s superficial muscle flap, and then when the tumor is retracted medially, the whole portion of the lateral component can be totally exposed. We then performed total lateral mass resection and laminectomy to expose the tumor at the foramina and cervical canal. Results: We were able to completely resect the tumors in every patient. The average duration of surgery was 150 minutes. Blood loss was minimal (average 400 mL). All patients were monitored for a minimum of 9 months (range 9–51 months; mean 28 months). The follow-up period was uneventful, and no patients developed spinal instability. Conclusions: Extensive posterolateral exposure enables surgeons to reach the lateralmost portion of CSDTs and also facilitates septation of the VA and resection of vertebral body encroachment of the tumor. [Copyright &y& Elsevier]

Background: Spinal extradural abscesses caused by Aspergillus species are rare and occur mostly in immunocompromised patients or in patients with Aspergillomas elsewhere in the body. In this report, the authors draw attention to a rapidly developing syndrome of extradural compressive myelopathy in an immunocompetent patient. Only four other cases have been reported previously.Case description: A 35-year-old female presented with rapidly progressive painful paraparesis progressing to paraplegia in 15 days despite adequate empiric antitubercular therapy. Magnetic resonance imaging (MRI) revealed D11 vertebral body destruction and an extradural mass compressing the cord from D10 to D12. The patient underwent a D11 corpectomy and spinal stabilization with an iliac bone strut graft, ‘Z’ Plate and screw fixation. The biopsy showed fungal hyphae with dichotomous branching diagnostic of Aspergillosis. Despite treatment with Amphotericin B and oral Itraconazole the patient developed rapidly progressive multiorgan failure and expired after 2 months.Conclusions: The authors report the fifth and extremely rare case of Aspergillus vertebral osteomyelitis with an extradural abscess in an immunocompetent patient. Therapy is controversial and predicated on the use of highly toxic drugs with inconsistent efficacies. Mortality remains grievously high. [Copyright &y& Elsevier]

Non-traumatic extradural spinal haematoma is an uncommon condition that is usually associated with a poor outcome. It may present acutely with signs and symptoms of major neurological dysfunction secondary to cord compression, or subacutely over a number of days or weeks with fluctuating symptoms. The exact aetiology of this condition is incompletely understood, but it is believed that the blood is venous in origin, as distinct from the arterial origin of intracranial extradural haematomas. Causes of non-traumatic extradural spinal haematoma include anticoagulation, vasculitis such as systemic lupus erythematosus (SLE), and spinal arteriovenous malformations. Conditions that may mimic an acute spinal haematoma include extradural abscess and extradural metastatic infiltration. It is important to make a diagnosis of extradural compression because surgery may offer the best hope in restoring neurological function in these patients. Imaging modalities used for the investigation of extradural haematomas include myelography, CT myelography (CTM) and MRI with or without gadolinium enhancement. The MR appearances of acute extradural abscess and extradural tumour can mimic an extradural haematoma. In subacute haematoma, owing to the magnetic properties of blood degradation products, MR is more specific in diagnosing and ageing of the haematoma. [ABSTRACT FROM AUTHOR]

Extradural arachnoid cysts are uncommon expanding lesions in the spinal canal which may communicate with the subarachnoid space. Usually in the lower thoracic spine, they may cause symptoms by compressing the spinal cord or nerve roots. We report cases of thoracic and lumbar arachnoid cysts studied by cystography, myelography, CT and MRI. These techniques showed extradural cystic lesions containing cerebrospinal fluid, with variable communication with the subarachnoid space, causing anterior displacement and flattening of the spinal cord. [ABSTRACT FROM AUTHOR]

A 52-year-old female presented with slowly progressive left lower limb polyradiculopathy. MRI of the lumbar region revealed an extradural dumbbell mass at L3 vertebral level, isointense on T1W and hyperintense on T2W images with homogenous contrast enhancement and extending into paraspinal region through left L3/4 foramen. L2 to L 4 left hemilaminectomy and excision of intraspinal part of tumor was performed. Histopathological examination revealed presence of cavernous hemangioma. This case is reported because of its rarity, unusual dumbbell shape of lesion and difficulty in making a preoperative diagnosis without a coexisting bone lesion. [ABSTRACT FROM AUTHOR]

Primary spinal epidural hydatid cyst without bony involvement is extremely rare. Authors report the case of a 44-yearold female brought to their attention for a rapidly progressive paraplegia. Magnetic resonance imaging (MRI) revealed extradural multiple cysts with "bunch of grapes" appearance extended to the paraspinal muscles through neural foramina without bony involvement on computed tomography (CT) scan. Histopathologic examination after a surgical approach confirmed the diagnosis of hydatid cyst. The early postoperative period showed a progressive improvement of her neurological deficit. The long-term follow-up under discontinued antihelminthic chemotherapy was uneventful [ABSTRACT FROM AUTHOR]

Arachnoid cyst are fluid-filled that are located between the arachnoid and piamater or duplicationof arachnoid membrane. Extradural arachnoid cysts in the spine are rare and primary are congenital or acquired. These are occurring idiopathic, posttraumatic and post arachnoiditis. A 32 year-old male patient is became a clinic with urinary retention and gait disorders. Thoracic Magnetic Resonance Imaging showed a spinal extradurally cystic mass isointense with that cerebro-spinal fluid at T7-8 level. Patient underwent an operation. The diagnosis of arachnoid cyst was made based on histopathology exam. The case was reported due to very rare occurrence of this entity. [ABSTRACT FROM AUTHOR]

Abstract: Hydatid disease of the spine is rare and has a poor prognosis, presenting both diagnostic and therapeutic challenges. Paraplegia is the most serious complication of the disease and is caused by compression of the spinal cord by the cysts. We report a 30-year-old woman with an isolated primary hydatid cyst that responded to treatment with albendazole. She presented with back and right leg pain. MRI of the lumbar spine showed a solitary cyst measuring 2.2×2.7cm, with an intraspinal extension at L4–L5. Physical examination did not reveal any focal deficit and the patient was treated with albendazole drug therapy (400mg daily). After 7months’ treatment, she had improved both clinically and radiologically. Albendazole drug therapy appears to be effective for conservative treatment of patients with primary solitary hydatid disease in the lumbar spine. [Copyright &y& Elsevier]

Abstract: Extradural arachnoid cysts of the spine are a rare cause of spinal cord and nerve root compression, usually in the mid to lower thoracic spine and at the thoraco-lumbar junction in a posterior position. Local pain and myelopathy occur predominantly in young adults, and MRI reveals a well-demarcated extradural lesion, iso-intense to cerebrospinal fluid. We report a 33-year-old woman with an extradural arachnoid cyst from T11 to L1 and review the surgical techniques reported in the literature. [Copyright &y& Elsevier]