Osteoblastoma of the spine.

Acta Chir Iugosl. 2010;57(1):63-8

Authors: Poleksić ZR, Lalosević VJ, Milinković ZB

A retrograde analysis of 64 spinal osteoblastomas treated by surgery during the period 1963 - 2005 has been made. Spinal osteoblastomas were presented in 36% of all skeletal localizations. There were 44 male and 20 female patients. The average age of patients at the time of surgery was 14 years. Localizations of the osteoblastomas were cervical spine in 8 cases, dorsal spine in 16 cases, lumbar spine in 38 cases and sacrum in 2 cases. Osteoblastomas predominantly involved posterolateral vertebral elements, although in two cases a primary localization was in vertebral bodies. Neurological deficits were relatively moderate, but a paraplegia occurred in six patients. Scoliosis was present in 50% of cases, and their respective prognosis depended on the duration of the painful syndrome as well as on the age when the disease had set up. According to Enneking classification 30 patients were evaluated as stage 2 and 34 othe-rs as stage 3. Relapses were noticed in 8 (12.5%) pati-ents. Clearly delineated lesions were treated by an intralesional procedure, but aggressive ones were treated by a marginal surgery followed by additional radiotherapy (6 patients). The average follow-up period was 13 years.

PMID: 20681202 [PubMed - indexed for MEDLINE]

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The surgical management of metastatic epidural compression of the spinal cord.

J Bone Joint Surg Br. 2010 Aug;92(8):1054-60

Authors: Quraishi NA, Gokaslan ZL, Boriani S

Metastatic epidural compression of the spinal cord is a significant source of morbidity in patients with systemic cancer. With improved oncological treatment, survival in these patients is improving and metastatic cord compression is encountered increasingly often. The treatment is mostly palliative. Surgical management involves early circumferential decompression of the cord with concomitant stabilisation of the spine. Patients with radiosensitive tumours without cord compression benefit from radiotherapy. Spinal stereotactic radiosurgery and minimally invasive techniques, such as vertebroplasty and kyphoplasty, with or without radiofrequency ablation, are promising options for treatment and are beginning to be used in selected patients with spinal metastases. In this paper we review the surgical management of patients with metastatic epidural spinal cord compression.

PMID: 20675746 [PubMed - indexed for MEDLINE]

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Selective neck dissection in the management of the neck after (chemo)radiotherapy for advanced head and neck cancer. Proposal for a classification update.

Head Neck. 2010 Jun;32(6):816-9

Authors: Hamoir M, Leemans CR, Dolivet G, Schmitz S, Grégoire V, Andry G

For patients with advanced regional disease, neck dissection following (chemo)radiotherapy remains controversial. Selective neck dissection (SND) was reported as suitable after chemoradiation in patients with advanced regional disease. Reduced morbidity represents the major advantage of SND. In a situation in which there is a major fibrosis around the previously invaded nodes, resection of 1 or more nonlymphatic structures may be required. The current classification of SND could be implemented by the addition of extended selective neck dissection (ESND). The standard basic procedures for SND spare the sternocleidomastoid muscle (SCM), the internal jugular vein (IJV), and the spinal accessory nerve (SAN). When an SND is associated with the resection of 1 or more nonlymphatic structures, it should be termed ESND. All additional nonlymphatic structure(s) removed should be identified in parentheses. The proposal to subclassify SND not only in accord with the resected lymph node levels but also upon the nonlymphatic structures removed may be of some help to avoid potential misinterpretation.

PMID: 20474071 [PubMed - indexed for MEDLINE]

Ectopic thymic tissue presenting as a neck mass in children: a report of 3 cases.

Ear Nose Throat J. 2010 May;89(5):228-31

Authors: Meyer E, Mulwafu W, Fagan JJ, Brown RA, Taylor K

The presentation of ectopic cervical thymic tissue as an anterior neck mass is rare. We report 3 similar cases in 3 boys-2 who had a thymic cyst and 1 who had an ectopic cervical thymus. We discuss the radiographic presentation on ultrasound and magnetic resonance imaging in these cases. We also review the typical histologic picture; histology is the only way of diagnosing this condition.

PMID: 20461685 [PubMed - indexed for MEDLINE]

5A prospective survey of current prostate biopsy practices among oncological urologists.

Can J Urol. 2010 Apr;17(2):5071-6

Authors: Brewster S, Turkeri L, Brausi M, Ravery V, Djavan B

BACKGROUND: Needle biopsy of the prostate is a common outpatient procedure. In March 2009, the European Association of Urology (EAU) published an updated, evidence-based "Guidelines on Prostate Cancer," including recommendations for this procedure. OBJECTIVE: To survey onco-urology specialists attending the 6th European Section of Oncological Urology (ESOU) meeting in Istanbul, Turkey in January 2009, to assess their biopsy practices and compare them with March 2009 EAU guidelines. Design, setting and participants: The authors designed a questionnaire and distributed it to 606 conference delegates. It was completed by 298 delegates, of whom 156 were experienced onco-urological specialists. MEASUREMENTS: The survey results from the 156 experienced onco-urologist specialists were analyzed. RESULTS AND LIMITATIONS: Most (59%) of the 156 respondents worked in large (> 20 bed) units, and 76% said urologists always performed the biopsies. Transrectal ultrasound (TRUS)-guided biopsy was the preferred procedure for 78% of respondents. Prostate-specific antigen (PSA) cut-off points of 4 ng/mL, 3.5 ng/mL, 3 ng/mL, and 2.5 ng/ml were used by 42%, 18%, 23%, and 8% of respondents, respectively, to determine whether a biopsy was indicated. A total of 95% of respondents gave patients prophylactic antibiotics. Another of 15% and 17% of respondents did not advise patients to stop taking warfarin or clopidogrel, respectively. A total of 23% of respondents did not give patients pre-procedure anesthesia, while others gave patients periprostatic lidocaine (31% of respondents), topical lidocaine jelly (35%), or general or spinal anesthesia (5.7%). High grade prostatic intraepithelial neoplasia (HGPIN) was considered by 71% of respondents as being a pre-malignant condition requiring a repeat biopsy. If atypical small acinar proliferation (ASAP) was reported, 62% of respondents recommended a repeat biopsy. Magnetic resonance imaging (MRI) was used to help diagnose cancer (53% of respondents), help stage cancer (83%), or help diagnose cancer recurrence (62%). Study limitations include possible difficulties with the English questionnaire. CONCLUSIONS: Many surveyed specialists were not performing prostate biopsies according to March 2009 evidence-based EAU practice guidelines, which could have adverse consequences for patients.

PMID: 20398444 [PubMed - indexed for MEDLINE]

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Essentials and pitfalls in the treatment of CNS hemangioblastomas and von Hippel-Lindau disease.

Cen Eur Neurosurg. 2010 May;71(2):80-7

Authors: Gläsker S, Klingler JH, Müller K, Würtenberger C, Hader C, Zentner J, Neumann HP, Velthoven VV

Hemangioblastomas are rare CNS tumors, which are mostly located in the posterior fossa or spinal cord and occasionally in spinal nerves. They can occur sporadically or as a component tumor of von Hippel-Lindau (VHL) disease, an autosomal dominant tumor syndrome. The limited awareness of several pitfalls in the therapy of these rare lesions results in delayed or suboptimal treatment for many of these patients, especially those with VHL disease. The University of Freiburg serves as a reference center for patients with VHL disease and hemangioblastomas. The current therapeutic strategies for hemangioblastoma patients and typical pitfalls are presented here.

PMID: 20229452 [PubMed - indexed for MEDLINE]

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The Gore-Tex biomaterial mesh as temporary divisor in two times surgery for spinal and pelvic tumors.

Musculoskelet Surg. 2010 May;94(1):21-4

Authors: Zoccali C, Prencipe U, Favale L, Di Filippo F

In muscular skeletal spine and pelvic tumor, surgery can be performed by a double anterior and posterior approach to decrease the risk of bleeding and opening the tumor; in first one, neurovascular bundles are divided by the mass; in second one, the tumor is resected by posterior or postero-lateral approach. A Gore-Tex mesh could be used as divisor between neurovascular bundles and the tumor to decrease the adhesion formation risk and facilitate tumor removal during second operation if performed after more days. The cohort was composed by a consecutive series of 11 patients underwent to surgery for spine and pelvic tumor where Gore-Tex mesh spacer was placed. In this study, efficiency and tolerability of Gore-Tex mesh were evaluated. No case of adhesion between Gore-Tex mesh and surrounding structures is reported, no case of migration or complications occurred. Gore-Tex mesh use can be considered a useful and safe procedure to decrease the risk of adhesion formation between tumor and surrounding tissue so that to allow the tumor removal easier.

PMID: 20119666 [PubMed - indexed for MEDLINE]

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Intradural lipoma of the cervicothoracic spinal cord with intracranial extension.

Childs Nerv Syst. 2010 Jun;26(6):847-52

Authors: Sanli AM, Türkoğlu E, Kahveci R, Sekerci Z

INTRODUCTION: Intradural spinal lipoma is rare and seen about 1% of all tumors of the spinal cord. Lipomas of the cervical location with intracranial extension are extremely rare and are described as intramedullary or subpial location. CASE: A 12-year-old female with lipoma of the cervicothoracic spinal cord demonstrated progressive quadriparesis. The patient underwent surgery with decompression of the affected craniocervical location. DISCUSSION: In the reported case, we describe a rare intradural lipoma of the cervicothoracic spinal cord with posterior fossa extension in the child, and the relevant English medical literature is reviewed.

PMID: 20098993 [PubMed - indexed for MEDLINE]

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Pediatric cervical chordoma: report of two cases and a review of the current literature.

Childs Nerv Syst. 2010 Jun;26(6):835-40

Authors: Choi GH, Yang MS, Yoon do H, Shin HC, Kim KN, Yi S, Lee DY, Ahn PG, Ha Y

INTRODUCTION: The majority of chordomas occur between the fifth and seventh decades of life and are thus extremely rare in children, which account for less than 5% of all spinal chordoma cases. CASE REPORT: We report on the development of this rare condition in two boys aged 7 and 10 years. One patient presented with a palpable neck mass and dysphagia, while the other presented with posterior neck pain. Radiological studies revealed an extensive mass in the cervical vertebrae and paravertebral soft tissue of both patients. The tumors were subtotally removed in an attempt to improve the success of adjuvant proton beam radiotherapy. Pathological examination, which included immunohistochemical staining, revealed chordoma of the cervical spine in both patients. CONCLUSION: Although en bloc resection is the ideal modality for treatment of chordoma, such a procedure is often associated with a significant risk of surgical morbidity due to the tumor location. Therefore, piecemeal resection followed by postoperative adjuvant radiotherapy, including proton radiotherapy or radiosurgery, should be considered in such cases.

PMID: 20094721 [PubMed - indexed for MEDLINE]