Clinical Neuroscience

[Unusually located metastatic tumors of the spine]

BAZSÓ Péter, NAGY László

FEBRUARY 20, 2003

Clinical Neuroscience - 2003;56(01-02)

[Metastatic spine tumors are representing a growing number of oncological patients. In this paper the authors would like to focus on a rare type of metastatic spine tumors, the unusually located ones. Since the advent of MRI and with the progress in general oncology this formerly rare tumors became more frequently recognized. Consequently these tumors are causing a new challenge for the oncologists, neurologists and neurosurgeons as well. The aim of the authors with this paper was to raise, especially the neurologists' attention to this emerging problem.]

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Clinical Neuroscience

[The value of motor evoked potentials in the diagnosis of spondylotic myelopathy]

SIMÓ Magdolna, ARÁNYI Zsuzsanna

[Introduction - Motor evoked potential (MEP) is the only method that is able to assess the function of the corticospinal tract in various neurological conditions, such as myelopathies. Myelopathy associated with cervical spondylosis, especially at an early stage, has often slight and non-specific clinical signs, pointing to the importance of the electrophysiological assessment of the spinal cord. The authors' aim was to investigate the sensitivity of MEP examination in the detection of myelopathy secondary to cervical spondylosis. Patients and methods - Patients were classified into three groups according to clinical signs and symptoms: Group I includes patients who have cervical spondylosis as demonstrated by MRI (narrowing of the spinal canal, discal herniation, spinal cord compression) but no complaints or signs suggestive of myelopathy. Results - In Group II patients had minor, non-specific complaints, such as paraesthesia of the legs and gait disturbance raising the possibility of myelopathy, but neurological examination revealed no pyramidal signs. In Group III patients had pyramidal signs as well. In Group I corticospinal function was normal in all patients, as assessed by MEP examination. In Group II all patients had prolonged central motor conduction time or absent responses to cortical stimulation. Likewise, in Group III MEP revealed abnormal corticospinal function in all patients but one. Conclusions - In summary, MEP proved sensitive in the detection of corticospinal dysfunction in myelopathy associated with cervical spondylosis at a stage when clinical signs of pyramidal lesion are not yet present and patients have only minor complaints. On the other hand, if patients are completely symptom free with regard to myelopathy, MEP is also unlikely to disclose corticospinal dysfunction. If pyramidal lesion is evident already by clinical examination, MEP provides no further help. ’Falsenegative’ results are also possible.]

Clinical Neuroscience

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[Primary glioblastoma multiforme located intramedullary in the spinal cord is a very rare entity. The authors report eight cases and discuss the clinical features, the possibility of diagnosis, combinated treatment and pathomorphological signs focusing on the relevant literature and their experience.]

Clinical Neuroscience

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VARGA Péter Pál

[Chordoma is an uncommon malignant tumor with unusual characteristics developing in the remnants of the notochord and usually manifesting itself in patients in their forties and fifties. It is usually located in the body's symmetrical axis or attached to it. The pathological structure is rather characteristic to benign tumors. Although not painful, it is a mercilessly aggressive local tumor, in some cases resulting metastatic progression and might alter its histological picture in longlived patients. It is found most prevalently (about 60 percent) in the sacrococcygeal region and at the clivus and manifesting itself spinally (over the sacrum) most likely in the lumbar region. Between 1992 and 2002, the authors have treated surgically 37 patients with sacrococcygeal chordoma. They applied wide resection following which only seven patients required re-operation. They show detailed data regarding this patient group and discuss the technical aspects of the wide tumorresection.]

Clinical Neuroscience

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FECZKÓ József, BARÁTH István, SÁRVÁRY András

[Case report - Authors report a case of thyroid gland carcinoma. The tumor had metastases into the CV-VI-VII vertebras. Through an anterior approach, they removed the malignant tumor together with the bodies of the affected cervical vertebras and a two stage combined (anterior and posterior) cervical instrumentation was performed. The anterior fusion was carried out with iliac crest bone grafting and plate fixation. After four years the patient is alive and well, without symptoms of tumor recurrence or neurologic deficiency. The ventral fusion is stable. Conclusions - Authors present a case of a successful operation of thyroid gland malignant tumor having metastatases in the CV-VI-VII vertebras. Tumor resection, fusion and instrumentation is suggested to be carried out in one stage. The anterior and posterior instrumentation is essential. Radical removal of the tumor is mandatory even with complex instrumentation and oncotherapy procedures.]

Clinical Neuroscience

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Clinical Neuroscience

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Clinical Neuroscience

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