✓ This 42-year-old man presented with an intradural extramedullary mass in his lower cervical spine. On imaging studies the lesion mimicked the appearance of a meningioma. At surgery, the mass was found to be an intradural extra-arachnoid tumor. An intraoperative pathological examination determined the lesion to be a Hodgkin lymphoma. The procedure was limited to biopsy sampling and the patient was treated further with adriamycin, bleomycin, vincristine, and dacarbazine chemotherapy, after which remission was demonstrated both clinically and on images. Analysis of a frozen section obtained during the procedure aided in the diagnosis of the tumor, thus preventing further resection and the potential neurological complications associated with more radical resection. To the authors’ knowledge this is the first reported case of a presumed primary intradural extraarachnoid Hodgkin lymphoma.

No abstract

INTRODUCTION There exist 2 very different models of somatotopic organization of the spinothalamic tract (STT) in the literature: medial-to-lateral and anterior-to-posterior lamination. After correlating in Vivo macrostimulation-induced pain or temperature sensation during percutaneous cervical cordotomy with simultaneous computed tomography (CT) imaging of the electrode tip location, we present a modern description of the somatotopy of the human cervical spinothalamic tract. METHODS A total of 20 patients underwent CT-guided percutaneous cervical cordotomy to alleviate contralateral medication-refractory cancer pain. Patient responses to electrical stimulation were recorded and the electrode location for each response was documented with a contemporaneous CT scan. RESULTS Clinically the patients did well. Maximal daily pain on the contralateral side was significantly reduced (P < .001, paired t-test) from a preoperative 9.3 ± 0.5 (VAS mean ± sd) to 0.5 ± 1.2 on the first postoperative day. The average reduction in opiate medications, as measured by morphine equivalents, was 75% over 1 wk (range 40%-98%). Responses from the lower limb were represented superficially (lateral) and posteriorly within the anterolateral cord. The area with responses from the upper limb was larger and surrounded those with responses from the lower limb primarily anteriorly and medially. CONCLUSION Our work simultaneously combined awake physiologic localization of fibers within the human spinothalamic tract with neuroimaging documenting their precise anatomical localization within the spinal cord. The resultant map of the STT demonstrates, for the first time, that fibers from the lower limb are located superficially and posteriorly within the anterolateral cord with the fibers from the upper limb surrounding them primarily deep and anteriorly but also posteriorly. If these results are confirmed by others, it will solve the century-long controversy of lamination patterns within the STT and add a small but fundamental piece of knowledge to our understanding of human neuroanatomy.