18 cases of benign intradural spinal cyst (9 arachnoidal, 2 neuroepithelial, 7 endodermal) are reported and compared with 94 cases (67 arachnoidal, 7 neuroepithelial, 20 endodermal) obtained from the literature. Arachnoidal intradural cysts (AIC) have no sex preference, occur at around the fourth-fifth decades of life and have characteristic intermittent root symptoms. They prefer the thoracic level and the posterior position. (Myelography images the cystic cavity (diverticular form). Surgical removal is usually easy. Neuroepithelial intradural cysts (NIC) are rare, have a 2:1 predilection for females and occur after the fourth decade. They have a serious clinical course similar to intramedullary or extramedullary tumours. They prefer the conus-cauda and the anterolateral positions. They often give rise to manometric block and to albuminocytological dissociation. There may be substantial adhesions to the cord and roots and the intramedullary variety presents no clear plane of cleavage. Endodermal intradural cysts (EIC) have a 2:1 predilection for males and prefer the second and third decades. They may have an intermittent or serious course with signs of root and cord impairment. They prefer the cervical segment (in the anterior position) and the conus-cauda (in the posterior position). As a rule they present manometric block and albuminocytological dissociation. Their frequent tough adhesions to the roots and cord demand special care during their removal.
The authors report the late results of surgical treatment of 129 intramedullary gliomas (48 ependymomas, 53 astrocytomas, 13 spongioblastomas, five glioblastomas, one oligodendroglioma, and nine others), with follow-up periods ranging from 1 to 27 years. The value of surgical treatment is considered in relation to postoperative results.
In a series of 41 cases of hemispheric supratentorial astrocytoma (HSA) in children, 29 patients have been followed for periods ranging from 5 to 27 years. The follow-up data show that HSA's are relatively benign tumors. Twenty-two patients (76%) are still living: 12 in good, eight in fair, and two in poor neurological condition. Their mean survival is 13.3 years. Five patients died from tumor recurrence within 4 years of the operation. All five were operated on before the age of 8 years. The best results in terms of mean survival and quality of life were obtained in cases of cystic HSA, especially the pilocytic variety. In children, HSA tends to take the cystic form (often pilocytic), and its relatively benign course points up an analogy between this rare supratentorial tumor and the more common tumor of the cerebellum (the so-called "cerebellar astrocytoma").
To our knowledge this is the first reported case of a primary meningeal pheochromocytoma.
Two cases of spinal neuroepithelial cyst, both intramedullary, are presented. Another seven cases collected from the literature are carefully reviewed. Particular emphasis is paid to the histological differentiation of these cysts from those of endodermal origin.Intradural neuroepithelial (ependymal) cyst is a very rare cause of spinal cord compression. We have found only seven published cases ~, s, 10, 11, 12, 20 They have been classified by position as intramedullary, extramedullary and mixed 12. We report two cases of such cysts, both intramedullary. Case ReportsCase 1. Intramedullary cyst F. A. (case record 6582), woman aged 67 years, admitted in June 1968. The patient had a 5-year history of occasional bouts of sudden loss of strength in the left lower limb. Eight months before admission she had episodes of urinary incontinence and progressive motor deficit of the lower limbs (worse on the left side), so bad that she could not stand.Neurological examination: very severe (90%) paraparesis combined with total and global anaesthesia below L 3 on both sides, and hypaesthesia to touch, heat, and pain at D 12-L 3. Trophic disturbances of the skin of the lower limbs, and urinary incontinence. Spinal ,~ap: no signs of manometric block; cerebrospinal fluid normal. Electromyogram: severe neurogenic damage in metameres L 3 to S I bilaterally. Suboccipital myelography: total block of the contrast at D 12.Operation: (15/7/68) Laminectomy D ll-L 1: opening of the dura disclosed a cystic swelling of the cord extending about 5 cm. The cord looked blown up, with translucent zones. Four millilitre of pale fluid was drawn off: it contained two cells and 50 mg~ protein. The cyst cavity was opened, and the walls were found to be non tumoural. A biopsy specimen was taken.
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