Object The most appropriate method to determine the quality of life of patients with intradural primary spinal tumors (IPSTs) is not still well established. Methods Clinical data in 234 patients who underwent surgery for intradural spinal disease were collected prospectively. The 36-Item Short Form Health Survey (SF-36), a generic score scale, was administered to 148 patients with IPSTs to demonstrate if the survey can be used to effectively evaluate these patients. Forty-eight patients were excluded because they did not complete the protocol. The study was finally conducted with 100 patients (45 male and 55 female) with IPSTs, and the results were compared with those of 2 other scales: the McCormick scale and the Aminoff-Logue scale. Results Construct validity was demonstrated by confirming the hypothesized relationship between the scores of the SF-36 and the McCormick scale (p = 0.003), the Aminoff-Logue gait subscale (p = 0.025), the Aminoff-Logue micturition subscale (p = 0.013), and the Aminoff-Logue defecation subscale (p = 0.004). Reliability was demonstrated for all 8 SF-36 domain scales and the Physical Component Summary and the Mental Component Summary of the SF-36, where in each the Cronbach alpha satisfied the Nunnally criterion of > 0.85. Conclusions The authors' results demonstrated that SF-36 provides valid and reliable data for patients with IPSTs and that the survey can be used appropriately to evaluate these patients.

This rare benign vascular lesion may be clinically and histopathologically mistaken for an angiosarcoma. Because the intravascular papillary endothelial hyperplasia can be cured by complete surgical resection, it is important to distinguish between these two lesions to avoid inappropriate aggressive treatment.

-Background:Primary spinal cord intramedullary tumors are rare and present with insidious symptoms. Previous treatment protocols emphasized biopsy and radiation/chemotherapy but more aggressive protocols have emerged. Objective: To report our experience. Method: Forty-eight patients were diagnosed with primary intramedullary tumors. The cervical cord was involved in 27% and thoracic in 42% of patients. Complete microsurgical removal was attempted whenever possible without added neurological morbidity. Results: Complete resection was obtained in 33 (71%) patients. Neurological function remained stable or improved in 32 patients (66.7%). Ependymoma was the most frequent tumor (66.7%). Conclusion: Neurological outcome is superior in patients with subtle findings; aggressive microsurgical resection should be pursued with acceptable neurological outcomes.KEy words: spinal cord, spastic paraparesis, spinal cord neoplasms, ependymoma; microsurgery. tratamento cirúrgico de tumores intramedulares primários em adultosResumo -Introdução: Tumores intramedulares primários são raros e apresentam-se com sintomas insidiosos. Protocolos de tratamento anteriores enfatizavam biópsia e radio/quimioterapia, mas protocolos mais agressivos têm surgido. Objetivo: relatar nossa experiência. Método: Tumores intramedulares foram diagnosticados em 48 pacientes. o segmento cervical estava envolvido em 27% e torácico em 42% dos pacientes. remoção completa foi tentada quando possível sem aumento da morbidade neurológica. Resultados: ressecção total foi obtida em 33 (71%) pacientes. Função neurológica: permaneceu inalterada/melhorou em 32 (66,7%) pacientes. o tumor mais freqüente foi ependimoma (66,7%). Conclusão: o prognóstico é melhor em pacientes oligossintomáticos; ressecção microcirúrgica agressiva deve ser tentada sempre, com resultados clínicos aceitáveis.PALAVrAs-CHAVE: medula espinhal, paraparesia espástica, neoplasias da medula espinhal, microcirurgia.

Schwannomas are solitary, benign, slow-growing, encapsulated neoplasms composed of differentiated neoplastic Schwann cells. The melanocytic schwannoma, a schwannian tumor variant, is rarely encountered and its ocurrences have been described as single case reports 1 . The most common site of these tumors is the posterior spinal nerve root 1,2 . However, they can occur in other locations, such as the sympathetic chain, acoustic nerve, cerebellum, orbit, choroid, soft tissues, heart, oral cavity, esophageal wall, stomach, bronchus, retroperitoneum, uterine cervix and parotid gland 2,3 . The melanotic schwannomas can be related as a part of a syndrome named Carney complex (described in 1990), characterized by the association of cutaneous pigmentation, fibromyxoid tumors of the skin, myxoma of the heart, endocrine overactivity and autosomal dominant inheritance 4 . The largest series in spinal melanotic schwanommas is composed by 5 cases. In these series, we report our experience with three cases. CASESThree cases of spinal melanotic schwannoma were studied between 2006 and 2010 in authors' institution. None of the patients had a familial history or any component of Carney complex (spotty pigmentation, endocrine overactivity or myxomas).The patients were two male and one female. The mean age was 50 years (range 42-59 years). The most frequent symptom was pain followed by motor deficit. The mean duration of symptoms was 15 months. Magnetic resonance images showed intradural, extramedullary lesions iso/hyperintense in T1- (Fig A) and hypointense in T2-weighted sequences.The histological examination revealed fusiform and epithelioid cells, with highly pigmented cytoplasm ( Fig B). Immunohistochemical studies revealed intense cytoplasm and nuclear expression of S100 protein (Fig C), HMB-45 and Melan-A (Fig D). DiSCuSSionGenerally, melanotic schwannomas affect spinal nerves, the central nervous and the autonomous nervous system, but extra-nervous locations also occur 1 . The dorsal location represents 30.5% of the spinal melanotic schwannomas and clinical presentation is similar to other extramedullary spinal tumors 5 . Psammomatous melanotic schwannoma is a distinct clinicopathologic entity and may be considered as a part of the Carney complex, which is characterized by myxomas (heart, skin and breast), mucocutaneous spotty pigmentations and endocrine overactivity (due to thyroid dysfunction or hypophysial adenoma, or Cushing's syndrome secondary to primary pigmented nodular adrenocortical hyperplasia) 4 . About 50% of patients with melanotic psammomatous schwannomas are affected by the syndrome of Carney and one-fifth of them present multiple lesions 1 . None of our patients exhibits these manifestations.The preoperative diagnosis is based on magnetic resonance imaging. While conventional schwannomas are hypointense on T1-weighted and hyperintense on T2-weighted sequences, the melanotic variant is hyperintense on T1-and hypointense on T2-weighted sequences 1 . Zhang et al. 3 demonstrated that melanotic schwannomas rec...

-Intervertebral disc herniation is a rare condition in childhood and adolescence, although some cases have already been reported in the literature. We present the case of a 15 year-old-girl with low back pain and scoliosis. She had no previous history of trauma or collagen diseases. MRI showed L4-L5 and L5-S1 disc herniations and no further bone and structural changes. After two level discectomy, pain ceased and scoliosis improved, without further treatment. Based on her evolution and on what has already been reported in literature, we consider that scoliosis associated with disc herniation in young patients is most likely to be only an anthalgic position, not indicative of further structural changes.KEY WORDS: lumbar disc herniation, low back pain, scoliosis, adolescence.Hérnia de disco lombar associada a escoliose em uma jovem de 15 anos: relato de caso RESUMO -Hérnia de disco intervertebral é condição rara em crianças e adolescentes. Alguns relatos isolados e algumas séries foram publicadas. Descrevemos o caso de uma paciente de 15 anos, sem antecedentes relevantes, que apresentou hérnia de disco intervertebral em dois níveis lombares (L4-L5 e L5-S1) associada a escoliose não estrutural que melhorou após a cirurgia, sem necessidade de órtese. Baseados neste caso e no que encontramos na literatura, acreditamos que escoliose associada a hérnia de disco em jovens é resultante apenas de posição antiálgica, não representando necessariamente alteração estrutural. PALAVRAS-CHAVE: hérnia de disco lombar, escoliose, adolescente. Intervertebral disc herniation is a rare condition in children and adolescents. Wahren (1946) was the first to report a case of a disc herniation surgery in a 12 years old boy. Since then, some single cases and series have been reported [1][2][3][4][5][6] . Less than 1% of lumbar disc herniation surgery occur in patients between 10 and 20 years old and only 0.5% of these discectomies are performed in patients under 16 years. Most of these patients (40% to 70%) have a history of traumatic injuries to the lumbar spine, usually related to sport activity, falls (higher than 1m) and motor vehicle accidents. In patients under sixteen, about 2% of the cases occur at the L3-L4 level and 98% are distributed equally between L4-L5 and L5-S1 levels 7 . Pain relieve posture is described in nearly 20% of pediatrics patients with lumbar disc herniation, whereby scoliosis is usually present, with the convexity turned to the affected side 4 .We report the case of a 15-year-old girl, with no previous history of spinal disease, who presented with a non-traumatic intervertebral disc herniation in two lumbar levels (L4-L5 and L5-S1), associated with a non structural scoliosis, that improved after surgery, without need of further treatment. CASEA 15 years old girl, caucasian, otherwise healthy, with no history of previous spinal disease, was admitted with difficulty to walk and low back pain ("stabbing"), with diffuse irradiation to the left leg. The onset of symptoms occurred four months before. The pain ...