Surgical Treatment of Primary Spinal Tumors in the Conus Medullaris

Han, Inho; Kuh, Sung Uk; Chin, Dong Kyu; Kh, Kim; Jin, Byung-Ho; Cho, Young-Eun

doi:10.3340/jkns.2008.44.2.72

Cited by 44 publications

(35 citation statements)

References 18 publications

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“…Many tumors have been treated with a combination of surgical resection/biopsy, chemotherapy, and Neurol Med Chir (Tokyo) 50, November, 2010 Intramedullary PNET radiotherapy. 1,5,6,12) However, some cases were managed by surgical resection and serial chemotherapy 4,13) or surgery followed by intensive radiation therapy. [7][8][9] Due to the rarity of this condition and the lack of case-controlled studies, the most advantageous therapy to achieve the longest survival times, whether surgical resection, chemotherapy, radiotherapy, or various combinations, has not been determined.…”

Section: Discussionmentioning

confidence: 99%

“…14) In previous cases, the degree of tumor resection and prognosis were not significantly correlated. 1,[4][5][6][7][8][9]12) Further case accumulation is essential to understand intramedullary PNET. Our patient showed improvement in motor function after subtotal tumor resection, which may be primarily attributable to the tumor location in the conus medullaris that is not directly involved in skeletal motor function.…”

Section: Discussionmentioning

confidence: 99%

“…1,3,8,9,12) Intramedullary PNET is even more rare and has been documented primarily as case presentations and short series. [4][5][6][7]13) Cauda equina syndrome refers to a constellation of symptoms that result from damage to the cauda equina. This syndrome may present as sciatica, low-back pain, saddle analgesia, decreased rectal tone, absent bulbocavernosus, patellar, and Achilles reflexes, bowel and bladder dysfunction, and lower extremity weakness.…”

Section: Introductionmentioning

confidence: 99%

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Intramedullary Primitive Neuroectodermal Tumor Presenting With Rapidly-Progressive Cauda Equina Syndrome -Case Report-

Tsutsumi

Nonaka

Abe

et al. 2010

Neurol. Med. Chir.(Tokyo)

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A 39-year-old male presented with gait disturbances with rapid deterioration for 2 weeks. Neurological examination found paraparesis, sensory loss in the L1-S5 dermatomes, and vesicorectal dysfunction. Magnetic resonance (MR) imaging revealed a fusiform intramedullary tumor at T12-L1 levels with heterogeneous enhancement. The patient underwent microsurgical tumor resection. A myelotomy exposed a highly vascular tumor that was subtotally resected. Histological examination demonstrated hypercellular tumor accompanied by significant cell atypism and mitotic figures. Immunohistochemical staining was positive for glial fibrillary acidic protein, S-100 protein, synaptophysin, and INI-1, consistent with primitive neuroectodermal tumor (PNET). Postoperatively, the patient underwent irradiation to the whole craniospinal axis. He experienced local recurrence 7 months after surgery. MR imaging performed at 10 months revealed holocord progression and intracranial dissemination. The patient died 13 months after the onset of the disease. PNET should be considered in the differential diagnosis of an intramedullary spinal cord tumor.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intramedullary Primitive Neuroectodermal Tumor Presenting With Rapidly-Progressive Cauda Equina Syndrome -Case Report-

Tsutsumi

Nonaka

Abe

et al. 2010

Neurol. Med. Chir.(Tokyo)

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“…After perusing the full content of these articles, 20 publications were selected for final inclusion in this systematic review (Table 1). 1,2,4,5,7,8,10,[12][13][14]16,17,[19][20][21][22][23]26,31,32 …”

Section: Search Strategymentioning

confidence: 99%

“…32 In articles that described the outcomes in all age groups, patients in the first 2 decades of life were selected for the analysis. 1,2,7,13,17,[19][20][21]26,32 Patients presenting with a history of previous surgery were not considered for inclusion.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Cumulative survival analysis of patients with spinal myxopapillary ependymomas in the first 2 decades of life

Kukreja¹,

Ambekar²,

Sin³

et al. 2014

PED

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Object Reports of myxopapillary ependymomas (MPEs) of the spinal cord in pediatric patients are scarce. In the literature, various authors have shared their experiences with small groups of patients, which makes it difficult to create a consensus regarding the treatment approach for spinal MPEs in young patients. The aim of this study was to perform a survival analysis of patients in the first 2 decades of life whose cases were selected from the published studies, and to examine the influence of various factors on outcomes. Methods A comprehensive search of studies published in English was performed on PubMed. Patients whose age was ≤ 20 years were included for integrative analysis. Information about age, treatment characteristics, critical events (progression, recurrence, and death), time to critical events, and follow-up duration was recorded. The degree of association of the various factors with the survival outcome was calculated by using Kaplan-Meier estimator and Cox proportional hazard model techniques. Results A total of 95 patients were included in the analysis. The overall rate of recurrence (RR) was 34.7% (n = 33), with a median time to recurrence of 36 months (range 2–100 months). Progression-free survival (PFS) and overall survival rates at 5 years were 73.7% and 98.9%, respectively. Addition of radiotherapy (RT) following resection significantly improved PFS (log-rank test, p = 0.008). In patients who underwent subtotal resection (STR), administering RT (STR + RT) improved outcome with the lowest failure rates (10.3%), superior to patients who underwent gross-total resection (GTR) alone (RR 43.1%; log-rank test, p < 0.001). Addition of RT to patients who underwent GTR was not beneficial (log-rank test, p = 0.628). In patients who had disseminated tumor at presentation, adjuvant RT controlled the disease effectively. High-dose RT (≥ 50 Gy) did not change PFS (log-rank test, p = 0.710). Conclusions Routine inclusion of RT in the treatment protocol for spinal MPEs in young patients should be considered. Complete resection is always the goal of tumor resection. However, when complete resection does not seem to be possible in complex lesions, RT should be used as an adjunct to avoid aggressive resection and to minimize inadvertent injury to the surrounding neural tissues. High-dose RT (≥ 50 Gy) did not provide additional survival benefits, although this association needs to be evaluated by prospective studies.

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Mature teratoma of conus medullaris: A case report and review of literature

Eslami,

Ilaghi,

Shahabinejad

et al. 2023

Clinical Case Reports

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Key Clinical MessageIn conus medullaris, mature teratomas are rare. We report a case of a 40‐year‐old man who presented with urinary incontinence, low back pain, and muscle weakness. Magnetic resonance imaging revealed a mass in conus medullaris (T11–L1), further confirmed as a mature teratoma by pathological examination. We identified 63 cases of conus medullaris teratoma over the past two decades by systematically analyzing the case reports. Findings demonstrated that most cases were diagnosed in the fourth decade of life, with the majority of cases (57.6%) being male. Lower back pain, radiating pain in the extremities, hypoesthesia, and urinary dysfunction are the most common clinical presentations among patients with teratoma of conus medullaris. Mature teratoma is the dominant pathologic subtype of teratomas in this region, comprising more than 95% of cases. Our case highlights the importance of considering spinal teratoma as a differential diagnosis in patients presenting with urinary incontinence and lumbar pain.

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Surgical Treatment of Primary Spinal Tumors in the Conus Medullaris

Cited by 44 publications

References 18 publications

Intramedullary Primitive Neuroectodermal Tumor Presenting With Rapidly-Progressive Cauda Equina Syndrome -Case Report-

Intramedullary Primitive Neuroectodermal Tumor Presenting With Rapidly-Progressive Cauda Equina Syndrome -Case Report-

Cumulative survival analysis of patients with spinal myxopapillary ependymomas in the first 2 decades of life

Mature teratoma of conus medullaris: A case report and review of literature

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