Thoracolumbar pilomyxoid astrocytoma concomitant with spinal scoliosis: A case report and literature review

Tabibkhooei, Alireza; Sadeghipour, Alireza; Fattahi, Arash

doi:10.25259/sni_548_2019

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…Again, intra-operative ultrasound can be used to confirm the resection extent. An expansile duraplasty is sometimes performed after biopsy or debulking to provide increased space to reduce the risk of cerebrospinal fluid leak and alleviate clinical deficits resulting from tumor growth ( 36 , 40 , 41 ).…”

Section: Managementmentioning

confidence: 99%

Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics

2022

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Intramedullary astrocytomas represent approximately 30%–40% of all intramedullary tumors and are the most common intramedullary tumor in children. Surgical resection is considered the mainstay of treatment in symptomatic patients with neurological deficits. Gross total resection (GTR) can be difficult to achieve as astrocytomas frequently present as diffuse lesions that infiltrate the cord. Therefore, GTR carries a substantial risk of new post-operative deficits. Consequently, subtotal resection and biopsy are often the only surgical options attempted. A midline or paramedian sulcal myelotomy is frequently used for surgical resection, although a dorsal root entry zone myelotomy can be used for lateral tumors. Intra-operative neuromonitoring using D-wave integrity, somatosensory, and motor evoked potentials is critical to facilitating a safe resection. Adjuvant radiation and chemotherapy, such as temozolomide, are often administered for high-grade recurrent or progressive lesions; however, consensus is lacking on their efficacy. Biopsied tumors can be analyzed for molecular markers that inform clinicians about the tumor’s prognosis and response to conventional as well as targeted therapeutic treatments. Stratification of intramedullary tumors is increasingly based on molecular features and mutational status. The landscape of genetic and epigenetic mutations in intramedullary astrocytomas is not equivalent to their intracranial counterparts, with important difference in frequency and type of mutations. Therefore, dedicated attention is needed to cohorts of patients with intramedullary tumors. Targeted therapeutic agents can be designed and administered to patients based on their mutational status, which may be used in coordination with traditional surgical resection to improve overall survival and functional status.

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Section: Managementmentioning

confidence: 99%

Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics

2022

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“…In some cases, they can cause scoliosis without initially visible neurological deficiency. [2][3][4][5][6][7][8][9][10][11] Scoliosis can be caused by spinal cord pathology and can be considered neuromuscular. Scoliosis cannot be considered idiopathic in cases of asymptomatic light cerebellar tonsil ectopia, soft syringomyelia, enlarged central spinal canal, or filum terminal lipoma with a normal conus medullaris position.…”

Section: Introductionmentioning

confidence: 99%

Hidden Neuraxial Pathology in Idiopathic Scoliosis: Original Research

Sergeenko,

Savin,

Pozdeyeva

et al. 2024

Coluna/Columna

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Objective: To evaluate the prevalence of hidden neuraxial pathology (NAP) revealed in idiopathic scoliosis (IS) in neurologically normal patients. Methods: We selected 401 patients with IS who visited our clinic. We identified patterns of NAP and its frequency. In addition to the main part of the study, we assessed the reliability of Magnetic Resonance Imaging (MRI) measuring of the pedicles to plan screw width and trajectory. Results: Among the 401 patients, 53 (13%) presented NAP. The proportion of males in this group was higher (42% vs. 21%, p=0.004), the age of onset of the deformity was lower (8.9±3.77 vs. 9.9±3.93 years old, p=0.045), the left-sided thoracic curve was more frequent (21% vs. 8%, p=0.016), thoracic kyphosis was more pronounced (p=0.070), and the percentage of revision surgeries for deformity progression or non-fusion was higher (13% vs. 5%, p=0.147). Conclusions: The spine MRI should be performed in the early stages of IS, as in some cases of NAP (Chiari, tethered spinal cord), there is the possibility of an early neurosurgical operation that will prevent the development of scoliosis. The main signs of hidden NAP in IS are early-onset IS, IS with left-sided thoracic curve, male gender, and thoracic kyphosis > 40°Cobb. Level of Evidence II; Retrospective Study.

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“…Considering the close association between the muscle and the nerves that innervate it, studying the neuromuscular reflex arc cannot be avoided when exploring the mechanism of muscle imbalance. Spinal cord injuries such as poliomyelitis and spinal cord tumours (14,15) can also cause scoliosis. However, the existing literature includes only a few case reports, and there are no articles on the clinical features of scoliosis caused by spinal cord injury.…”

Section: Introductionmentioning

confidence: 99%

Clinical features and pathogenesis of scoliosis due to spinal astrocytoma

Zhang

Han

et al. 2023

Oncol Lett

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The aetiology of scoliosis remains unclear. Some studies have focused on the theory of possible muscular imbalance. The role of the spinal cord, which directly innervates the paraspinal muscles, in muscular imbalance has not yet been studied. Spinal astrocytomas often grow on one side of the spinal cord, destroying it asymmetrically. Asymmetrical damage to the spinal cord can lead to asymmetrical changes in paraspinal muscles. The present study investigated the effect of muscular imbalance on scoliosis by observing scoliosis caused by spinal astrocytomas. Patients diagnosed with spinal astrocytomas in a single centre were analysed, and the type and side of the symptoms, sagittal tumour position, scoliosis, end vertebrae and apical vertebrae of scoliosis were recorded. The tumour side was assumed from symptom type and side, and the cross-sectional area of the paraspinal muscles on both sides of the end vertebra was outlined and compared. The incidence of astrocytoma-induced scoliosis was significantly higher in patients with unilateral symptoms. The inferred tumour side was highly consistent with the convex side of scoliosis. The distal vertebral segments of scoliosis were consistent with the spinal cord segments involved in the astrocytomas. The apical vertebrae were more caudal in astrocytoma-induced scoliosis. The cross-sectional area of the multifidus muscle on the convex side of apical-level scoliosis was significantly smaller than that on the concave side. However, no significant differences were observed in the erector spinae muscles. Overall, spinal astrocytomas can cause asymmetric destruction of the corresponding spinal cord segment, resulting in asymmetric atrophy and weakness of the multifidus muscle innervated by the spinal cord segment, thereby causing scoliosis that is convex to the weaker side. This mechanism involves asymmetric lower neuron paralysis of the multifidus muscle. This is a type of scoliosis with several differences from idiopathic scoliosis.

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Thoracolumbar pilomyxoid astrocytoma concomitant with spinal scoliosis: A case report and literature review

Cited by 5 publications

References 11 publications

Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics

Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics

Hidden Neuraxial Pathology in Idiopathic Scoliosis: Original Research

Clinical features and pathogenesis of scoliosis due to spinal astrocytoma

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