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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]

Background and Objectives: Many risk factors for postoperative C5 palsy (PC5P) have been reported regarding a "cord shift" after a posterior approach. However, there are few reports about shoulder traction as a possible risk factor of anterior cervical surgery. Therefore, we assessed the stretched nerve roots when shoulder traction was applied on cadavers. Materials and Methods: Eight cadavers were employed in this study, available based on age and the presence of foramen stenosis. After dissecting the sternocleidomastoid muscle of the cadaver, the shoulder joint was pulled with a force of 2, 5, 8, 10, 15, and 20 kg. Then, the stretched length of the fifth nerve root was measured in the extra-foraminal zone. In addition, the same measurement was performed after cutting the carotid artery to accurately identify the nerve root's origin. After an additional dissection was performed so that the superior trunk of the brachial plexus could be seen, the stretched length of the fifth and sixth nerve roots was measured again. Results: Throughout the entire experiment, the fifth nerve root stretched out for an average of 1.94 mm at 8 kg and an average of 5.03 mm at a maximum force of 20 kg. In three experiments, the elongated lengths of the C5 nerve root at 8 kg and 20 kg were 1.69/4.38 mm, 2.13/5.00 mm, and 0.75/5.31 mm, respectively, and in the third experiment, the elongated length of the C6 nerve root was 1.88/5.44 mm. Conclusions: Although this was a cadaveric experiment, it suggests that shoulder traction could be the risk factors for PC5P after anterior cervical surgery. In addition, for patients with foraminal stenosis and central stenosis, the risk would be higher. Therefore, the surgeon should be aware of this, and the patient would need sufficient explanation. [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.

Ganglioneuroblastoma (GNB) is a rare neurogenic tumor with a predilection for extracranial sites. Its primary intracranial occurrence is anecdotal, with less than ten cases reported in pediatric literature. We report two cases of this unusual entity. The first was a 1-year-old boy who presented with a progressive scalp swelling that radiologically appeared to be a mesenchymal tumor. The tumor was resected completely, and its histopathological examination was suggestive of a pigmented GNB. The clinico-radiological presentation and melanin pigmentation of the tumor were unique features of the case. The second case was a 7-year-old girl who presented with left hemiparesis and raised intracranial pressure due to a large right parietal intraparenchymal tumor that histologically proved to be a GNB. The child succumbed to disease progression a month after undergoing near-total resection of the tumor. Analysis of our cases in the light of a literature review reveals that pediatric intracranial GNBs have diverse clinico-radiological features and can easily be confused for commoner pathologies in both intra- and extra-axial locations. [ABSTRACT FROM AUTHOR]

In patients undergoing metastatic spine surgery, we sought to 1) report time to postoperative radiation therapy (RT), 2) describe the predictive factors of time to postoperative RT, and 3) determine if earlier postoperative RT is associated with improved local recurrence (LR) and overall survival (OS). A single-center retrospective cohort study was undertaken of all patients undergoing spine surgery for extradural metastatic disease and receiving RT within 3 months postoperatively between January 2010 and January 2021. Time to postoperative RT was dichotomized at <1 month versus 1–3 months. The primary outcomes were LR, OS, and 1-year survival. Secondary outcomes were wound complication, Karnofsky Performance Status, and modified McCormick Scale (MMS) score. Regression analyses controlled for age, body mass index, tumor size, preoperative RT, preoperative/postoperative chemotherapy, and type of RT. Of 76 patients undergoing spinal metastasis surgery and receiving postoperative RT within 3 months, 34 (44.7%) received RT within 1 month and 42 (55.2%) within 1–3 months. Patients with larger tumor size (β = –3.58; 95% confidence interval [CI], –6.59 to –0.57; P = 0.021) or new neurologic deficits (β = –16.21; 95% CI, –32.21 to –0.210; P = 0.047) had a shorter time to RT. No significant association was found between time to RT and LR or OS on multivariable logistic/Cox regression. However, patients who received RT between 1 and 3 months had a lower odds of 1-year survival compared with those receiving RT within 1 month (odds ratio, 0.18; 95% CI, 0.04–0.74; P = 0.022). Receiving RT within 1 month versus 1–3 months was not associated with wound complications (7.1% vs. 2.9%; P = 0.556) (odds ratio, 4.40; 95% CI, 0.40–118.0; P = 0.266) or Karnofsky Performance Status/modified McCormick Scale score. Spine surgeons, oncologists, and radiation oncologists should make every effort to start RT within 1 month to improve 1-year survival after metastatic spine tumor surgery. [ABSTRACT FROM AUTHOR]

Objectives: Spinal arachnoid cysts (SAC) are rare lesions. There are many uncertainties regarding details about Intradural and Extradural SAC. We present a series of 12 cases of SAC along with a comprehensive review of the literature. In this review, we discussed the differences between Intradural and Extradural SAC pertaining to demography, pathogenesis, surgical procedures and outcomes. Methods: We retrospectively collected the data of 12 patients of SAC treated at our Institute from 2012 to 2023. The age, gender, clinical, radiological, surgical data and outcome were noted. An extensive review of the literature was done to analyse and note the differences between Intradural and extradural SAC and their surgical management. Results: In our series of 12 patients, 7 had Extradural SAC(58.3%), 3 had Intradural SAC(25%) and 2 had Intramedullary SAC(16.7%). . Of the 12 patients, 4 were males and 8 were females (1:2). Age range was 9 to 64 years and the mean age was 34.42 ± 17.71 years. There were four paediatric patients in the series. The most common symptoms reported at presentation are weakness of limbs(81.9%),back pain(36.4%), sensory symptoms(36.4%), radicular pain (18.2%), and bladder disturbances(9.1%). Out of the 12 patients, surgery was done in 11 patients and one patient was managed conservatively. Conclusions: From the review of the literature, intradural SAC was twice as common as extradural SAC. Ventrally located SACs are more common in Intradural locations as compared to Extradural. The intradural SACs were more commonly located in the thoracic and cervical regions when compared to extradural SACs which were located commonly in the thoracolumbar, thoracic and lumbar regions. Extradural SACs were mostly Primary and the mainstay of treatment is complete or partial excision of the cyst with identification and ligation of the communicating pedicle. Selective laminectomy, partial excision of the cyst and wide fenestration to sustain CSF flow is the recommended treatment in Intradural SAC. [ABSTRACT FROM AUTHOR]

Compressive vertebral hemangiomas with neurological deficits (CVHND) form a rare, unique subset of lesions comprising of differing clinico-imaging findings, pathologic behavior and treatment, when compared to the commoner and usually incidental intra-osseus vertebral hemangiomas (VH). Though various surgical strategies and a broad array of adjuncts have evolved and changed over the years, there is paucity of comprehensive data from sizeable series of such patients treated surgically with long term follow up. The purpose of this study is to device an optimum management strategy in CVHND based on our surgical experience. The data from electronic medical records of 26 consecutive patients operated in our department from 2009 to 2019 were retrospectively analyzed. There were 11 males and 15 females with a mean age of 34.7 years. Neurological examination revealed paraparesis or paraplegia with myelopathy in all patients with Frankel score of B, C and D in 1 (3.9%), 11 (42.3%) and 14 (53.8%) patients respectively. Sixteen patients (61%) underwent laminectomy and gross total excision of extradural soft tissue component, 7 (27%) laminectomy with posterolateral fusion, three (12%) underwent additional anterior interbody support. The mean follow up was 72.4 months and at last follow-up 24 patients (92%) were Frankel E. Symptomatic recurrence was seen in two patients operated early in the series, they underwent re-surgery, gross total excision with posterolateral fusion, remaining neurologically intact at last follow up. Pre-operative embolization, surgical excision of extradural component and intra-operative vertebroplasty form the mainstay of treatment for CVHND. Instrumented posterolateral fusion with optional anterior interbody support accomplished through the same approach is required only in a minority of cases. The long-term outcome following timely and appropriate treatment is excellent. Anterior or anterolateral approaches for intervertebral support and radical procedures like total en-bloc spondylectomy (TES) are not usually required. [ABSTRACT FROM AUTHOR]

Spinal teratomas are infrequent lesions in the pediatric population. These lesions can be extradural, intradural or intramedullary. We present a case of an 8-month-old boy that was assessed for underdevelopment of motor milestones. The neurologic examination revealed hyporeflexia, decreased sensation and flaccid paraplegia. MRI of the spine revealed two simultaneous and independent lesions in the extradural and intradural compartment. A laminectomy was performed for the T4-T7 vertebrae with total resection of both lesions. The histopathological analysis confirmed both lesions to be mature cystic teratomas. At the 1-year follow-up, the patient remained with no recovery of neurological function. A debate takes place regarding the etiology of formation of these lesions in the spine. The simultaneous presentation of two independent lesions in this patient could contribute to define the flawed migration of germ cells theory as the etiology for formation of teratomatous lesions in the spine. [ABSTRACT FROM AUTHOR]

Objectives: Spinal arachnoid cysts (SAC) are rare lesions. There are many uncertainties regarding details about Intradural and Extradural SAC. We present a series of 12 cases of SAC along with a comprehensive review of the literature. In this review, we discussed the differences between Intradural and Extradural SAC pertaining to demography, pathogenesis, surgical procedures and outcomes. Methods: We retrospectively collected the data of 12 patients of SAC treated at our Institute from 2012 to 2023. The age, gender, clinical, radiological, surgical data and outcome were noted. An extensive review of the literature was done to analyse and note the differences between Intradural and extradural SAC and their surgical management. Results: In our series of 12 patients, 7 had Extradural SAC(58.3%), 3 had Intradural SAC(25%) and 2 had Intramedullary SAC(16.7%). . Of the 12 patients, 4 were males and 8 were females (1:2). Age range was 9 to 64 years and the mean age was 34.42 ± 17.71 years. There were four paediatric patients in the series. The most common symptoms reported at presentation are weakness of limbs(81.9%),back pain(36.4%), sensory symptoms(36.4%), radicular pain (18.2%), and bladder disturbances(9.1%). Out of the 12 patients, surgery was done in 11 patients and one patient was managed conservatively. Conclusions: From the review of the literature, intradural SAC was twice as common as extradural SAC. Ventrally located SACs are more common in Intradural locations as compared to Extradural. The intradural SACs were more commonly located in the thoracic and cervical regions when compared to extradural SACs which were located commonly in the thoracolumbar, thoracic and lumbar regions. Extradural SACs were mostly Primary and the mainstay of treatment is complete or partial excision of the cyst with identification and ligation of the communicating pedicle. Selective laminectomy, partial excision of the cyst and wide fenestration to sustain CSF flow is the recommended treatment in Intradural SAC.

Abstract Background Epidural hematomas have been treated with urgent surgical evacuation to prevent catastrophic neurological sequelae and death. Brain Trauma Foundation recommends EDH volume greater than 30 cm3 and warrants surgical evacuation irrespective of GCS. However, due to increase in number of patients undergoing brain CTs following head injuries, more patients have been detected with EDH causing minimal symptoms. Aims and objectives To study factors influencing patients being treated conservatively for head injury with supratentorial epidural hematomas. Material and methods Our study is a retrospective analysis of supratentorial epidural hematoma treated conservatively from august 2018 to July 2020 at Sher-i-Kashmir institute of medical sciences, Srinagar, Jammu and Kashmir. Results A total of 19 patients with EDH were treated conservatively and fulfilled the inclusion criteria.(GCS of 13–15 with no neurological deficit, mild signs of elevated ICP, EDH thickness 13 on admission. 8 patients were hospitalised for a week, whilst 2 patients stayed in the hospital for 20 and 25 days, respectively, due to problems not related to EDH. One patient in whom conservative treatment had to be changed to surgical evacuation after 6 days of observation because of worsening headache, impaired alertness repeated imaging showed slight increase in EDH. Conclusions EDH can be managed conservatively in carefully selected patients of minor head injury with radiological surveillance and close neurological monitoring. Patients with GCS on admission more than 13, midline shift of less than 5 mm, location and volume of EDH less than 30 ml. Thus, leading to optimal utilisation of hospital resources. So, we conclude that even a dreaded entity like extradural haemorrhage can be managed conservatively in selected cases with strict clinical and radiological surveillance. We have called them ‘’Benign extradural haemorrhages’’.

Background and Objectives: Many risk factors for postoperative C5 palsy (PC5P) have been reported regarding a “cord shift” after a posterior approach. However, there are few reports about shoulder traction as a possible risk factor of anterior cervical surgery. Therefore, we assessed the stretched nerve roots when shoulder traction was applied on cadavers. Materials and Methods: Eight cadavers were employed in this study, available based on age and the presence of foramen stenosis. After dissecting the sternocleidomastoid muscle of the cadaver, the shoulder joint was pulled with a force of 2, 5, 8, 10, 15, and 20 kg. Then, the stretched length of the fifth nerve root was measured in the extra-foraminal zone. In addition, the same measurement was performed after cutting the carotid artery to accurately identify the nerve root’s origin. After an additional dissection was performed so that the superior trunk of the brachial plexus could be seen, the stretched length of the fifth and sixth nerve roots was measured again. Results: Throughout the entire experiment, the fifth nerve root stretched out for an average of 1.94 mm at 8 kg and an average of 5.03 mm at a maximum force of 20 kg. In three experiments, the elongated lengths of the C5 nerve root at 8 kg and 20 kg were 1.69/4.38 mm, 2.13/5.00 mm, and 0.75/5.31 mm, respectively, and in the third experiment, the elongated length of the C6 nerve root was 1.88/5.44 mm. Conclusions: Although this was a cadaveric experiment, it suggests that shoulder traction could be the risk factors for PC5P after anterior cervical surgery. In addition, for patients with foraminal stenosis and central stenosis, the risk would be higher. Therefore, the surgeon should be aware of this, and the patient would need sufficient explanation.

Background: Epidural hematomas have been treated with urgent surgical evacuation to prevent catastrophic neurological sequelae and death. Brain Trauma Foundation recommends EDH volume greater than 30 cm3 and warrants surgical evacuation irrespective of GCS. However, due to increase in number of patients undergoing brain CTs following head injuries, more patients have been detected with EDH causing minimal symptoms. Aims and objectives: To study factors influencing patients being treated conservatively for head injury with supratentorial epidural hematomas. Material and methods: Our study is a retrospective analysis of supratentorial epidural hematoma treated conservatively from august 2018 to July 2020 at Sher-i-Kashmir institute of medical sciences, Srinagar, Jammu and Kashmir. Results: A total of 19 patients with EDH were treated conservatively and fulfilled the inclusion criteria.(GCS of 13–15 with no neurological deficit, mild signs of elevated ICP, EDH thickness < 1.5 cm on CT, EDH volume on CT < 30 ml, midline shift on CT less than or equal to 5 mm with no significant intradural pathology)Age ranged from 2 months to 70 years (average 27.15 yrs)males (89.47%) predominated females (10.53%). Motor vehicular accidents were the most common mode of injury (42.1%). EDH was localised 13 times on right side, 5 times on left side and bilateral in one, supratentorially. A midline shift of 5 mm was found in 3 of 19 patients; GCS was > 13 on admission. 8 patients were hospitalised for a week, whilst 2 patients stayed in the hospital for 20 and 25 days, respectively, due to problems not related to EDH. One patient in whom conservative treatment had to be changed to surgical evacuation after 6 days of observation because of worsening headache, impaired alertness repeated imaging showed slight increase in EDH. Conclusions: EDH can be managed conservatively in carefully selected patients of minor head injury with radiological surveillance and close neurological monitoring. Patients with GCS on admission more than 13, midline shift of less than 5 mm, location and volume of EDH less than 30 ml. Thus, leading to optimal utilisation of hospital resources. So, we conclude that even a dreaded entity like extradural haemorrhage can be managed conservatively in selected cases with strict clinical and radiological surveillance. We have called them ''Benign extradural haemorrhages". [ABSTRACT FROM AUTHOR]

Hydatidosis is a parasitic infestation whose etiological agent is the larva of the cestode Echinococcus granulosus. It is a zoonosis, and the human being behaves as an accidental intermediate host in the parasitic cycle with pediatric predominance. The most frequent clinical presentation is hepatic, followed by pulmonary, with cerebral hydatidosis being extremely rare. Imaging is characteristic, generally dealing with single cystic lesion, usually unilocular and less frequently multilocular, located mainly intraaxially. Extradural hydatid cyst, whether primary or secondary, remains very rare or even exceptional. The primary disease remains extremely rare, and its clinical picture is related to the number, size, and location of the lesions. Infection within these cerebral hydatid cysts remains an extremely rare occurrence, and only few cases were reported previously in the literature. The authors report the nosological review of the clinical, imaging, surgical, and histopathological records of a pediatric primary osteolytic extradural and complicated hydatid cyst in a 5-year-old North African male patient coming from a rural area who presented for progressive onset of a painless left parieto-occipital soft swelling without any neurological disorder with good outcomes after surgery. The authors report this case due the fact that it had not been documented before in the pediatric population and to the success of the specialized treatment. [ABSTRACT FROM AUTHOR]

The clinical manifestations of neurofibromatosis type-1 have in common the presence of neurofibromas, schwannomas and cafe`-au-lait macules, which can potentially appear within any organ system of the body, involving primarily the skeleton, skin and soft tissues. The spinal thoracic tuberculoma in neurofibromatosis is exceptional. We report here, the case of a 31-year-old male with neurofibromatosis type-1 who presented a year agoa spinal thoracic pain. The evolution was marked by the appearance of a dorsal para-vertebral mass, progressively increasing in volume for 03 months. Neurological Examination revealed normal muscle bulk and tone, and power was grade 5/5. Deep tendon reflexes were brisk and the Babinski sign was present. The sensory deficit was present below the D9 level. The remainder of the examination found a voluminous dorsal para vertebral mass ovoid, renitent, and adhering to the superficial and the deep planes. There were also "café-au-lait" spots disseminated on his body. The imagery showed a formation with respect to D11-D12, isointense on T1 and T2, heterogeneously enhanced after contrast with central necrosis, with a foraminal starting point measuring 85x78x66 mm, with external canal extension. Laminectomy D11-D12 was performed with incomplete excision of the lesion. The histological examination showed casein-follicular vertebral tuberculosis, with secondary abdominal changes. Then the patient was put on anti-bacillary drugs. The evolution was marked two weeks later by the reappearance of the back pain and the back mass. On the 42nd day of treatment, the patient had a febrile consciousness disorder with a GCS of 8, right mydriasis and meningeal stiffness. Paraclinic investigations revealed tuberculosis meningoencephalitis, responsible for an active ventricular hydrocephalus associated with a left temporoparietal extrudal hematoma. An external ventricular shunt was performed as well as a left temporo-parietal extrudal hematoma evacuation. The patient died 7 days later in a poly visceral failure chart.

Abstract 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.

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]

The aim of this study was to compare the intra and postoperative analgesic effects of sacrococcygeal epidural levobupivacaine with those of lumbosacral levobupivacaine in feline ovariohysterectomy. Thirty-six cats were premedicated with intramuscular acepromazine (0.05 mg/kg) and meperidine (6 mg/kg). Anesthesia was induced with intravenous propofol and maintained with isoflurane in oxygen. The cats were randomly assigned one of the three treatments receiving 0.33% levobupivacaine (0.3 mL/kg) into the sacrococcygeal (S-C group, n=12) or lumbosacral (L-S group, n=12) epidural space, or the same volume of 0.9% saline solution into one of the epidural approaches (Control group, n=12). Intraoperatively, cardiorespiratory variables, end-tidal isoflurane concentration (FE'ISO), and fentanyl requirements were recorded. Postoperative pain was assessed by the UNESP (Universidade Estadual Paulista)-Botucatu multidimensional composite pain scale and the Glasgow feline composite measure pain scale up to 8 hr post-extubation. Morphine was administered as rescue analgesia. Overall FE'ISO and fentanyl requirements were lower in the L-S and S-C compared to the Control (P=0.002-0.048, respectively). There was no significant difference in the cardiorespiratory variables during anesthesia, postoperative pain and rescue analgesia among groups. The time to standing after anesthesia was prolonged in the L-S and S-C groups than in the Control (P<0.001). Lumbosacral and sacrococcygeal epidural levobupivacaine resulted in similar decreases in isoflurane requirements and intraoperative fentanyl supplementation in the cats, with no postoperative benefits. [ABSTRACT FROM AUTHOR]

Abstract Spinal Ewing’s Sarcoma is a rare tumour predominantly affecting children and adolescents. We describe the case of an 18-year-old male patient who first presented with a primary extradural cervical Ewing’s sarcoma tumour, and 5 years later had a recurrence with thoracolumbar and lumbosacral intradural extramedullary Ewing’s sarcoma tumours. Both presentations were successfully treated by surgical resection and adjuvant chemo- and radiotherapy, and he remains disease-free at 12 months follow-up. This is the first reported case of seeding of tumour from an extradural primary Ewing’s sarcoma to intradural metastases. Total surgical resection of his initial cervical tumour, performed at another centre, was complicated by a dural tear and CSF leak. Thus, we propose that isolated drop metastasis via CSF fistula is the most likely mechanism for tumour spread in this case. Thus, clinicians may wish to counsel patients on the possibility of such spread if a CSF leak is encountered, and potentially increase the frequency of imaging surveillance of the whole spine in this context. [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]

Ventriculoperitoneal (VP) shunt surgeries are common neurosurgical procedure for hydrocephalus. Subdural hematoma (SDH) and extradural hematoma (EDH) are rare but potentially life-threatening complications following VP shunt surgeries. We are describing probably the first case in which a 12-year-old boy presented to the emergency room in altered sensorium and gradual onset quadriparesis following multiple shunt revision procedures done in an outside hospital. Computed tomography head showed chronic right-sided frontotemporoparietal chronic SDH and parietal dominant EDH simultaneously with multiple shunt systems in ventricles. Patient was taken for surgery in emergency and emergent evacuation of hematoma was done. Patient improved in the postoperative period. In this case report we will make an attempt to describe a rare complication of VP shunt surgery and possible mechanisms responsible for it. [ABSTRACT FROM AUTHOR]

Intracranial dermoid cysts are rare dysembryonic tumors of benign nature. These are uncommon in adults. If present, they are usually located in the midline or along the lines of embryonic fusion. The posterior fossa region is an infrequent site. Extradural or interdural locations are even more rare. In this case report, the authors report a laterally located large posterior fossa right cerebellar convexity interdural and extradural dermoid cyst over the sigmoid sinus. It was managed by totally extradural maximum possible safe decompression with microneurosurgical technique. The authors share their experience of addressing this rare pathology at the rarest location with unusual imaging findings. [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]

BackgroundMeningiomas are mostly benign and slow-growing neoplasms of the central nervous system. Spinal meningiomas account for up to 45% of all intradural spinal tumors in adults and up to 25%–45% of all spinal tumors. Spinal extradural meningiomas are rare and may be easily confused with malignant neoplasms.Case descriptionA 24-year-old woman was presented to our hospital with paraplegia and loss of sensation in the T7 dermatome and lower body. MRI findings showed T6-T7 right-sided intradural extramedullary and extradural lesion, measuring 1.4 cm × 1.5 cm × 3 cm, extending to the right foramen, compressing the spinal cord, and displacing it to the left. Hyperintense lesion on T2 and hypointense lesion on T1 were observed. The patient reported improvement after surgery and during follow-up. We recommend maximizing the decompression during surgery to achieve better clinical outcome. Extradural meningiomas represent 5% of all meningiomas; therefore, having an intradural on top of extradural meningioma with extraforaminal extensions makes this a unique and rare case.ConclusionMeningiomas can be easily missed in diagnosis depending on imaging and the pathognomonic pattern it represents, which can mimic other pathologies, such as schwannomas. Therefore, surgeons should always suspect their patient having a meningioma even if the pattern is not typical. Moreover, preoperative preparation, such as navigation and defect closure, must be taken in case it turns out be a meningioma instead of the presumed pathology.

Abstract Purpose : Patients with Extradural (EDH) and Acute Subdural Haematomas (ASDH) represent a subgroup of head-injured patients that gain the most from timely treatment. While treatment times for head injury overall improved since the introduction of Major Trauma Centres (MTCs), no data exists describing how the time to treatment of EDH and ASDH has changed. We, therefore, compared the evacuation of ASDH and EDH before and after the implementation of a major trauma network. Methods : Data was collected prospectively between 1 May 2006 to 31 May 2007 and 1 March 2014 to 31 March 2016. The study was carried out at University Hospital Southampton, designated MTC in 2012. Patients over 18 with ASDH or EDH requiring emergency surgery were included. Results : The median time (IQR) for decompression was 4.8h (3.9–6.6) in 2006-7 and 4.4h (3.4–5.9) in 2014–16, p = 0.386. The proportion treated within 4 hours was 32% in 2006–7, and 33% in 2014-16 (p = 1.000). Analysis showed a decrease in time for CT scan (p = 0.01) and acceptance by neurosurgery (p < 0.001). There were increases in time for transferring to hospital (p = 0.005), awaiting operating theatre (p = 0.005), and operative time (p = 0.018). Conclusions : Since the introduction of MTCs, there has been no significant reduction in time to treat this select group of patients despite reductions in time to treatment of most other trauma and head-injured patients. This may be because parts of the pathway have improved, but others haven’t. It is also possible that while previously head injury was poorly served, resources were prioritised to this group so finding further gains is difficult. [ABSTRACT FROM AUTHOR]

Objective: To describe the successful case management of an extradural hematoma secondary to anticoagulant rodenticide toxicity causing spinal compression and paraplegia. Case Summary: A 3‐month‐old, female intact, mixed breed dog was presented for a 12‐hour history of paraplegia. CBC and biochemistry results were unremarkable, and a coagulation panel revealed prolonged prothrombin time with normal activated partial thromboplastin time. Magnetic resonance imaging revealed an extradural compressive lesion within the vertebral canal extending from T6 to T11, most consistent with an extradural hematoma. Further coagulation testing revealed a coagulopathy caused by vitamin K1 deficiency and confirmed exposure to the anticoagulant rodenticide, diphacinone. The dog was medically managed with fresh frozen plasma, aminocaproic acid, and oral vitamin K1 therapy. A right‐sided T6 to T11 hemilaminectomy was later performed for removal of the extradural hematoma and spinal decompression. The dog's neurological status gradually improved postoperatively and, at the time of discharge, was nonambulatory paraparetic with voluntary micturition. Four weeks postoperatively, the dog had normal prothrombin and activated partial thromboplastin times and was nonambulatory paraparetic with strong motor function. New or Unique Information Provided: This is the first reported case of a dog with an extradural hematoma secondary to anticoagulant rodenticide causing spinal cord compression and neurological deficits. Surgical management of this case was successful and resulted in improvement of neurological signs. Extradural hematoma should be considered as a potential location of bleeding in rodenticide toxicity as well as a differential diagnosis in patients with neurological deficits. [ABSTRACT FROM AUTHOR]

Background: Extradural arteriovenous fistulas (AVFs) of the cervical spine are extremely rare, and typically manifest as slowly progressive myelopathy caused by mass effect. This is a unique case of extradural AVF of the cervical spine manifesting with purely radicular symptoms and treated endovascularly with coil and liquid embolization. Case Description: A 55-year-old woman presented with neck pain and right upper extremity radiculopathy persisting for 9 months. Imaging studies demonstrated an AVF spanning from C4-C6 with extension into the C5-C6 foramen supplied primarily from the deep cervical branch of the costocervical trunk. The patient underwent successful coil and liquid (Onyx) embolization. Six-week postoperatively, the patient's symptoms completely resolved and magnetic resonance imaging and angiographic imaging confirmed complete obliteration of the fistula. Conclusion: While extradural AVFs typically present with myelopathic symptoms, they may present with solely radicular symptoms and can be successfully treated endovascularly. [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.

Purpose To study the demography, incidence, symptoms, histopathology, postoperative complications and recovery in operated patients of spinal tumor. Overview of Literature Primary spinal cord tumors (SCT) are an uncommon entity. According to their location, spinal tumors are conveniently classified as extradural (ED) and intradural (ID), although some can be both inside and outside the dura. ID tumors can be intradural extramedullary (IDEM) or intramedullary SCT (IMSCT). Methods This is a retrospective study of 122 patients with spinal tumors who were surgically treated at the department of neurosurgery from 2014 to 2019 over a period of 5 years. Study Design This is a retrospective study. Results Out of 122 patients, there were 19 patients with ED tumor, 73 had IDEM, and 30 had IMSCT. As many as 73 patients were males and the rest of the 49 patients were females. Mean age at time of surgery was 40.79 years. The thoracic region of spinal canal was most frequently involved (64; 52.4%). The common clinical symptom was motor weakness (90 cases; 73.77%). Majority of the patients had symptoms for duration of 6 to 12 months. Schwannomas were the most common tumor among IDEM and extradural location. Ependymomas were the most common type in IMSCT. We observed significant improvement in most of our cases. Four patients deteriorated at 3 months follow- up. Conclusions There was a higher male:female ratio for all spinal cord tumors except meningiomas. There was also a higher proportion of nerve sheath tumors, and a lower proportion of meningiomas and neuroepithelial tumors. These results are similar to other studies from Asian countries.

Spinal angiolipomas (SALs) are very rare benign extradural neoplasms, representing 0.14%–1.2% of all spinal tumors. Andersson lesion is a localized vertebral or disco-vertebral lesion in ankylosing spondylitis. Co-occurrence of these lesions is very rare and has never been reported. We are reporting one such case of a 61-year-old man presented with features of dorsal compressive myelopathy. On magnetic resonance imaging (MRI), he was diagnosed to have a SAL at D6–D9 and Andersson lesion at D7–D8 and L1–L2. He was managed surgically with a long-segment fixation and decompression and gross total excision of the tumor. Diagnosis of a SAL was confirmed in a biopsy, and postoperatively, he showed good clinical improvement. In conclusion, given the rarity of co-occurrence of these pathologies, a strong clinical suspicion is required. MRI and CT scan help in diagnosis. Both these pathologies warrant surgical management. When diagnosed early and managed appropriately, they have a good prognosis.

Abstract Spontaneous extradural hematoma in Sickle cell disease is rare neurological complication with few cases reported in the English literature. We report a case of a 16‐year‐old male patient who was previously diagnosed with Sickle Cell Beta Thalassemia and presented with severe headache and vomiting for 3 days. An emergency CT scan of the head demonstrated right‐sided acute parietal extradural hematoma with mass effect. Patient underwent emergent craniotomy with evacuation of the hematoma. Patient recovered completely. Although calvarial infarction has been associated with extradural hematoma, an absence of it makes our case distinct. A high index of suspicion should be made in SCD patients for possibility of EDH in progressive headache.

Sinonasal undifferentiated carcinoma (SNUC) is a rare and aggressive cancer of the sinonasal tract and is often characterized by intracranial invasion. However, SNUC rarely metastasizes to the spine. In this paper, we present a case of extradural metastasis and invasion of the adjacent spine by SNUC. A 42-year-old man presented to our hospital with two-month history of anosmia and nosebleeds. Imaging studies showed a neoplasm of the ethmoid sinus with extension into the anterior cranial fossa. The patient underwent resection of the carcinoma and began chemoradiotherapy. After completing chemoradiotherapy the patient complained of neck pain radiating down the right arm, and imaging showed an extradural mass at the C5 vertebral level. The patient underwent laminectomy for debulking of this tumor. One month later, the patient complained of recurrent weakness and pain in the right shoulder and arm. Imaging showed an extradural tumor wrapping around the C7 and C8 nerve roots, as well as a separate tumor at C2 adherent to the dura. The extradural tumor at C2 was surgically resected. Further imaging showed multiple new soft tissue masses at the thoracic level. We present a case of SNUC metastasis to the extradural spine representing the second case reported in the literature. Peri-dural metastasis and resulting symptoms should be included in the differential diagnosis and assessment of patients with SNUC. [ABSTRACT FROM AUTHOR]

Introduction and Importance: Chondrosarcomas are rare malignant cartilaginous neoplasms, account for the second most common primary bone tumor. Several surgical approaches for achieving en bloc resection have been mentioned in previous studies. This study aimed to present a rare case of chondrosarcoma involving T4-T6 vertebrae that underwent total spondylectomy., Presentation of Case: A 36-year-old male was presented with signs and symptoms of thoracal foraminal stenosis due to mass effect of primary chondrosarcoma arising from the 5th thoracal vertebrae. The plain radiograph and MRI showed the characteristic features of chondrosarcoma. Biopsy result was a grade I chondrosarcoma. The patient underwent total spondylectomy of T4-T6 vertebrae, along with posterior stabilization, tubular cage insertion, thoracotomy, and bilateral chest tube insertion., Clinical Discussion: Most complaints of spinal chondrosarcomas are localized back pain, swelling, and neurological deficits. The radiological features vary significantly, starts with lysis, to a moth-eaten destruction and interrupted periosteal reaction. Biopsy may classify the disease into conventional and variant types. The former one can further classified as primary and secondary tumor, both are graded as relation to prognosis and metastases. The primary treatment is surgical excision, while radiotherapy and chemotherapy are resistant in many cases. Recurrence commonly appears within 3-5 years postoperatively., The Conclusion: As the primary modality for chondrosarcoma, surgery should aim at preserving or even improving functionality, relieving pain, and controlling local tumor recurrence, promising a prolonged survival. Besides the tumor grade, a successful operation, in terms of complete tumor excision with disease-free margins is a major independent prognostic predictor of the disease, affecting critically both local tumor control and patient survival. Spondylectomy enables wide or marginal resection of malignant lesions of the spine in most cases with acceptable morbidity. However, it induces a significant surgical challenge. The proximity of neurovascular and visceral structures combined with complex spinal anatomy makes the goal of wide margins difficult., Competing Interests: Conflict of interest statement The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

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]

Few studies have examined the prognosis for patients with baseline thrombocytopenia undergoing extradural spine tumor resection. Our objective was to evaluate mortality, readmission, and other 30-day outcomes in patients with varying degrees of preoperative thrombocytopenia undergoing osseous extradural tumor excision. A multicenter registry was queried for patients treated from 2011–2019. Patients were categorized according to baseline preoperative platelet count, in 25,000/μL increments: 125,000–149,000/μL, 100,000–125,000/μL, 75,000–100,000/μL, and <75,000/μL. These were compared to a control group with platelet count >150,000/μL. Outcomes in each cohort were analyzed using multivariate logistic regression analysis. The database search revealed 3574 patients undergoing extradural tumor resection; 2171 (60.7%) patients with platelets 125,000–149,000/μL, 114 (3.2%) with 100,000–125,000/μL, 43 (1.2%) with 75,000–100,000/μL, and 42 (1.2%) with <75,000/μL. Platelet counts <100,000/μL was associated with perioperative blood transfusion, cardiac complications, non-home discharge, and 30-day mortality. On subgroup analysis for mortality, an interaction was present between individuals with moderate/severe thrombocytopenia and cervical tumors. In patients undergoing surgery for extradural spine tumor, degree of baseline thrombocytopenia—rather than presence alone—is an independent predictor of several adverse events. Wherever possible, optimization of preoperative platelet count to at least 100,000/μL may improve outcomes. [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]

Purpose  To study the demography, incidence, symptoms, histopathology, postoperative complications and recovery in operated patients of spinal tumor. Overview of Literature  Primary spinal cord tumors (SCT) are an uncommon entity. According to their location, spinal tumors are conveniently classified as extradural (ED) and intradural (ID), although some can be both inside and outside the dura. ID tumors can be intradural extramedullary (IDEM) or intramedullary SCT (IMSCT). Methods  This is a retrospective study of 122 patients with spinal tumors who were surgically treated at the department of neurosurgery from 2014 to 2019 over a period of 5 years. Study Design  This is a retrospective study. Results  Out of 122 patients, there were 19 patients with ED tumor, 73 had IDEM, and 30 had IMSCT. As many as 73 patients were males and the rest of the 49 patients were females. Mean age at time of surgery was 40.79 years. The thoracic region of spinal canal was most frequently involved (64; 52.4%). The common clinical symptom was motor weakness (90 cases; 73.77%). Majority of the patients had symptoms for duration of 6 to 12 months. Schwannomas were the most common tumor among IDEM and extradural location. Ependymomas were the most common type in IMSCT. We observed significant improvement in most of our cases. Four patients deteriorated at 3 months follow- up. Conclusions  There was a higher male:female ratio for all spinal cord tumors except meningiomas. There was also a higher proportion of nerve sheath tumors, and a lower proportion of meningiomas and neuroepithelial tumors. These results are similar to other studies from Asian countries. [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]