Intramedullary lesions of the conus medullaris: differential diagnosis and surgical management

Ebner, Florian; Röser, Florian; Acioly, Marcus André; Schoeber, Wolfgang; Tatagiba, Marcos

doi:10.1007/s10143-008-0173-1

Cited by 37 publications

(18 citation statements)

References 105 publications

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“…They may be secondary to ependymoma, astrocytoma, and hemangioblastoma [1‐3]. Benign intradural cysts usually are isointense with spinal fluid on MRI and show no enhancement with gadolinium–diethylenetriamine penta‐acetic acid [3‐6]. The lack of enhancement helps to differentiate such cysts from neoplastic lesions [4‐6].…”

Section: Discussionmentioning

confidence: 99%

“…Benign intradural cysts usually are isointense with spinal fluid on MRI and show no enhancement with gadolinium–diethylenetriamine penta‐acetic acid [3‐6]. The lack of enhancement helps to differentiate such cysts from neoplastic lesions [4‐6]. Benign intradural spinal cysts are histologically classified as arachnoid, enterogenousand ependymal cysts [7].…”

Section: Discussionmentioning

confidence: 99%

“…Patients present with spinal pain, paresthesias, and paraparesis [9]. Bowel and bladder dysfunction may be observed [1,5,10]. Patients typically present for medical care after the development of motor weakness [4].…”

Section: Discussionmentioning

confidence: 99%

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Conus Medullaris Enterogenous Cyst

Felix

Seidel

Murphy

et al. 2012

PM&R

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INTRODUCTIONThis report discusses the unique presentation and outcome of a patient with a conus medullaris enterogenous cyst. The incidence of enterogenous cysts, differential diagnosis, imaging, presentation, and management are discussed. The unique aspects of this case presentation include a patient of advanced age with an atypical enterogenous cyst at clinical presentation and postoperative motor recovery despite prolonged cord compression. CASE PRESENTATIONA 66-year-old white woman presented with a 2-year history of constant pain in her left anteromedial thigh and knee. She had experienced multiple falls due to left knee buckling, although she had experienced no specific left knee injury to cause the weakness. Due to this left lower extremity weakness, she required a walker to ambulate. There was no history of trauma, fever, back pain, recent weight loss, paresthesias, or changes in bowel or bladder. Her medical history was significant for obesity and hypothyroidism. Review of systems was otherwise unremarkable. Results of a physical examination revealed visible left thigh atrophy (thigh circumference was 6 cm smaller on the left side). Manual muscle testing demonstrated left iliopsoas and quadriceps strength of 2/5. Bilateral gluteus medius, hamstring, anterior tibialis, gastrocsoleus complex, and extensor hallucis longus strength, and right iliopsoas and quadriceps strength were all 5/5. Sensory examination was normal for light touch, pinprick, and vibration, with the exception of anesthesia in the left anterior and lateral thigh that extended to the proximal medial tibial region. Deep tendon reflexes were normal, with the exception of an absent left quadriceps reflex. Toes were downgoing bilaterally to plantar stimulation.Electrodiagnostic testing of the bilateral lower extremities and related paraspinals revealed a left L2-L4 radiculopathy (anterior limb muscles and posterior paraspinal denervation evident). There was no evidence of right lumbosacral radiculopathy or plexopathy. Magnetic resonance imaging (MRI) of the lumbar spine without contrast performed to evaluate for a presumed diskal-structural lesion revealed a cystic structure in the distal cord-conus medullaris. A thoracic spine MRI with contrast demonstrated an expansile lesion of T1 and T2 prolongation signal in the distal cord-conus medullaris that was approximately 15 ϫ 15 ϫ 40 mm in the anterior and posterior, transverse, and cephalocaudad diameter, without pathologic contrast enhancement (Figure 1).Initial conservative treatment included physical therapy, adaptive equipment, and observation because the patient was concerned about potential paraplegia with surgical intervention on the distal spinal cord. Needle electromyogram examination demonstrated the presence of active denervation of the left anterior thigh musculature. Physical therapy was initiated to strengthen the involved musculature, to instruct in compensatory gait mechanics and/or assistive device use, and to prevent falls. The strength of the left anterior thigh musculature did...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Conus Medullaris Enterogenous Cyst

Felix

Seidel

Murphy

et al. 2012

PM&R

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“…The most common intramedullary lesions of the conus include cystic lesions of the terminal ventricle, and epidermoid and dermoid cysts. 6 Nassar and colleagues 12 described localized cysts of the conus in association with trauma, tumors, and vascular diseases.…”

Section: Discussionmentioning

confidence: 99%

Intramedullary bronchogenic cyst of the conus medullaris

Yilmaz¹,

Gülşen²,

Sonmez³

et al. 2009

SPI

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Spinal bronchogenic cysts are rare congenital lesions. The authors describe their experience in the treatment of a 17-year-old boy who presented with back pain and paresthesia in both lower extremities. Lumbar MR imaging revealed the presence of an intramedullary cystic lesion at the conus medullaris and histopathological analysis revealed a bronchogenic cyst. To the best of the authors' knowledge, this is the first report of an intramedullary spinal bronchogenic cyst arising at the conus; all previously reported spinal bronchogenic cysts were either intradural extramedullary or not located at the conus.

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“…pinal cord ependymomas are slow growing, not very infiltrative, and well-demarcated tumors of neuroectodermal origin arising from ependymal cells in the central canal of the spinal cord and filum terminale, 1,8,21,26,31,40 or even from heterotopic ependymal cells in the spinal canal. 5,37 These ependymomas occur more frequently in middle age (40-60 years of age) and represent 60% of cases of intramedullary spinal cord tumors.…”

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Outcomes in treatment for primary spinal anaplastic ependymomas: a retrospective series of 20 patients

Liu

Sun²,

Qi³

et al. 2013

SPI

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Object Little is known regarding the anaplastic variant of primary ependymomas that involve the spinal cord. The aim of this study was to evaluate the clinical characteristics and treatment outcomes of primary spinal anaplastic ependymomas (PSAEs). Methods Medical records were reviewed in 20 patients with pathologically proven PSAEs who underwent surgical treatment at the Department of Neurosurgery in Huashan Hospital between 1999 and 2008. Results This series included 7 women and 13 men between the ages of 2 and 67 years (mean 31.9 years). The mean preoperative course was 9.3 months (range 20 days to 48 months). The most common PSAE locations were the cervical and thoracic spinal cords. The most common presenting symptom was weakness, followed by numbness, bowel or bladder dysfunction, and pain. Gross-total resection (GTR) was achieved in 17 patients, and a subtotal removal was performed in 3 patients. Nine patients received radiation therapy and/or chemotherapy. The mean follow-up duration was 83.5 months. Functional assessment of the 10 patients available at the latest follow-up evaluation showed that 2 had worsened and 8 remained unchanged from their preoperative status. There were 2 local recurrences and 1 lung metastasis. Conclusions Patients with PSAEs presented with a much shorter preoperative course than patients with Grade II ependymomas in previous studies. Patients with tumors that involved the cervical spinal cord experienced a worse outcome. Surgical removal of PSAEs, with the goal of GTR, is beneficial to patients. The role of radiation therapy and chemotherapy in PSAEs remains to be determined in further studies.

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Intramedullary lesions of the conus medullaris: differential diagnosis and surgical management

Cited by 37 publications

References 105 publications

Conus Medullaris Enterogenous Cyst

Conus Medullaris Enterogenous Cyst

Intramedullary bronchogenic cyst of the conus medullaris

Outcomes in treatment for primary spinal anaplastic ependymomas: a retrospective series of 20 patients

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