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Molecular and Clinical Oncology May 2019Chordoma is a rare tumor that originates from the notochord. Half of chordomas involve the sacral region. Surgery is considered to be the standard treatment for sacral...
Chordoma is a rare tumor that originates from the notochord. Half of chordomas involve the sacral region. Surgery is considered to be the standard treatment for sacral chordoma. However, carbon ion radiotherapy (CIRT) has recently emerged as a promising treatment for unresectable sacral chordoma. Little is known about the long-term complications of CIRT. We present two cases of rectotumoral fistula formation that occurred >5 years after CIRT for sacral chordoma. We considered two possible explanations for fistula formation: radiation enterocolitis after CIRT might cause formation of the fistula long-term, and tumor regrowth might compress the rectum and cause fistula formation. A biopsy in Case 1 showed that regrowth tumor was post-CIRT. It is important to be aware of the possibility of rectal complications after CIRT, and if found, resection of the rectum should be considered. This is a first report of rectotumoral fistula formation that occurred >5 years after CIRT for sacral chordoma.
PubMed: 30967943
DOI: 10.3892/mco.2019.1821 -
Journal of Cerebrovascular and... Sep 2023We describe a rare case of sacral epidural arteriovenous fistulas (edAVFs) with atypical clinical course of treatment. A 78-year-old man with a history of spinal surgery...
We describe a rare case of sacral epidural arteriovenous fistulas (edAVFs) with atypical clinical course of treatment. A 78-year-old man with a history of spinal surgery presented progressive gait disturbance and urinary incontinence. Spinal angiography demonstrated a sacral spinal AVF fed by bilateral lateral sacral arteries, draining to the venous pouch with subdural drainage. The first treatment by direct interruption of a subdural drainer was incompletely finished. Postoperative reassessment by 3D imaging analysis led to the diagnosis of sacral edAVF and 3D understanding of its angioarchitecture. The second treatment by transarterial embolization (TAE) resulted in complete occlusion of a sacral edAVF. However, spinal venous congestion didn't improve, because the recruitment of occult edAVFs at the multiple lumbar levels and complex-shaped sacral ventral epidural venous plexus (VEP) were involved in the remnant of prior subdural drainage. The third treatment was performed by TAE for three occult edAVFs and the VEP compartment connecting between a patent edAVF and subdural drainage, which resulted in complete disappearance of spinal cord edema. Endovascular embolization of VEP compartment connecting to subdural drainage in addition to fistulous occlusion may be one of the treatment options for several edAVFs at the multiple spinal levels.
PubMed: 36514239
DOI: 10.7461/jcen.2022.E2022.07.002 -
AJNR. American Journal of Neuroradiology Dec 2022This is the first study to describe CSF-venous fistulas involving the sacrum, a location that may be underrecognized on the basis of current imaging techniques. We...
This is the first study to describe CSF-venous fistulas involving the sacrum, a location that may be underrecognized on the basis of current imaging techniques. We describe a delayed decubitus flat CT myelogram technique that may be useful to identify sacral CSF-venous fistulas.
Topics: Humans; Sacrum; Myelography; Veins; Tomography, X-Ray Computed; Fistula
PubMed: 36328406
DOI: 10.3174/ajnr.A7699 -
Pediatric Surgery International Aug 2014Anorectal malformations (ARMs) without fistula occur in approximately 5 % of all cases of ARM. The high frequency of Trisomy 21 associated to this type of malformation... (Review)
Review
INTRODUCTION
Anorectal malformations (ARMs) without fistula occur in approximately 5 % of all cases of ARM. The high frequency of Trisomy 21 associated to this type of malformation has been previously described. A review of the literature revealed only one previous publication discussing ARM without fistula with or without Trisomy 21; all other publications focused their discussion in patients with Trisomy 21. We felt that ARM without fistula has very specific characteristics and therapeutic implications that deserved a special discussion, which prompted us to review our experience.
METHODS
A retrospective review of the medical records of patients with ARM without fistula was performed between September 1980 and March 2014. From a series of 2,189 cases of ARMs, 92 had no fistula identified. Information related to demographic, anatomic, and prognostic factors, as well as outcome variables was obtained and compared to those results obtained from other types of ARMs.
RESULTS
Seventy-six patients were males and 16 females. Thirty-seven patients (40 %) had Trisomy 21. Eighty-six patients were primarily operated on and six had a reoperation after a failed attempted repair at another institution. Of the six patients that were reoperated, five had an attempted repair in the newborn period without a colostomy and the operation was aborted after the rectum could not be found. The location of the blind rectum was at the level of the bulbar urethra in males or 1-2 cm from the perineal skin in females in 80 patients; and in 9 patients it was found at the level of the prostatic urethra. In five patients, during the repair, there was an incidental opening of the urethra, which was repaired with uneventful recovery. The sacrum was normal in 61 patients; 4 patients had a sacral ratio <0.4, which indicated poor prognosis for fecal continence. Sixty-four patients had normal urinary tract, four patients had an absent kidney, ten had bilateral hydronephrosis, and three unilateral. Long-term outcomes related to bowel control were available in 52 cases: 11 of 18 patients with Trisomy 21(61 %) had voluntary bowel movements and 29 of 34 (85 %) without Trisomy 21 had voluntary bowel movements. All patients without Trisomy 21 had urinary control.
CONCLUSION
Anorectal malformation without fistula is a unique defect. In our series, it occurs in 4 % of all ARMs. Even when patients do not have a fistula, the operation is not technically easier due to the presence of an extensive common wall between the rectum and urethra in males or vagina in females. The ARM with no fistula has a good reasonable functional prognosis, even in patients with associated Trisomy 21 and conveys a low frequency of associated urologic defects.
Topics: Anal Canal; Anorectal Malformations; Anus, Imperforate; Female; Global Health; Humans; Incidence; Male; Rectal Fistula; Rectum
PubMed: 24969816
DOI: 10.1007/s00383-014-3527-5 -
Journal of the College of Physicians... May 2017Echinococcus granulosus and Echinococcus multilocularis are the causes of hydatid disease and the main characteristic is endemic. Generally, it affects the liver and...
Echinococcus granulosus and Echinococcus multilocularis are the causes of hydatid disease and the main characteristic is endemic. Generally, it affects the liver and lungs. Spinal hydatidosis accounts for less than 1% of the cases. Vertebral hydatidosis is usually silent and a slowly progressive disease with a long latent period. Another rare form is the primary sacral hydatid cyst. Generally, patients suffer from back pain and neural compression symptoms. A 43-year woman was admitted with left leg pain and a fluid leakage from a cutaneous fistula on the left hip. It was diagnosed on MRI as a bilateral cystic lesion which eroded the first sacral wing, extending to the paravertebral region and left intervertebral for a men. We present a case with fluid leakage from cutaneous fistula.
Topics: Adult; Animals; Cutaneous Fistula; Echinococcosis; Echinococcus; Female; Humans; Magnetic Resonance Imaging; Sacrum; Treatment Outcome
PubMed: 28599696
DOI: No ID Found -
Radiology Case Reports Jun 2017A 66-year-old male with a history of hypertension, back pain, diverticulosis and anal fistula presents with acute onset syncopal episodes, worsening back pain, and...
A 66-year-old male with a history of hypertension, back pain, diverticulosis and anal fistula presents with acute onset syncopal episodes, worsening back pain, and altered mental status. The patient exhibited considerable leukocytosis but was hemodynamically stable. CT imaging of the head revealed a gas pattern in the posterior fossa and velum interpositum. CT imaging of the abdomen and pelvis revealed a needle-like foreign body traversing the left sacrum to the sigmoid colon. A lumbar puncture revealed meningitis. Flexible sigmoidoscopies were performed without successful visualization of the foreign body. An explorative laparoscopy was successfully performed, enabling retrieval of what was determined to be a wooden toothpick. The patient remained hemodynamically stable with persistent altered mental status and was eventually discharged after completion of antibiotics on day 47 of hospitalization. This case illustrates a rare complication of ingesting a sharp foreign body that was identified by CT of the brain and abdomen/pelvis with successful surgical repair.
PubMed: 28491166
DOI: 10.1016/j.radcr.2016.10.011 -
Surgical Neurology International 2021Cauda equina arteriovenous fistulas (AVFs) fed by the proximal radicular artery are exceedingly rare. Spinal dural arteriovenous fistulas (DAVFs) in the sacral region...
BACKGROUND
Cauda equina arteriovenous fistulas (AVFs) fed by the proximal radicular artery are exceedingly rare. Spinal dural arteriovenous fistulas (DAVFs) in the sacral region are rare and usually misdiagnosed. We report a case of a cauda equina AVF with concomitant sacral DAVF. We also review the coexistence of multiple types of spinal vascular malformations in a single patient.
CASE DESCRIPTION
A 54-year-old man presented with progressive weakness of the lower extremities for 1 month. Magnetic resonance imaging (MRI) of the lumbosacral and thoracic spine showed spinal cord congestion, extending from the conus medullaris to the level of T7, and abnormal tortuous and dilated flow void, running from the level of L5 to T12 along anterior surface of the spinal cord. Spinal angiography demonstrated the fistula at the level of L2 below the conus medullaris. Based on intraoperative findings, the cauda equina AVF supplied by the proximal radicular artery with cranial drainage through the enlarged radicular vein was confirmed and successfully obliterated. Another enlarged arterialized radicular vein running parallel to another cauda equina nerve root is observed with unknown origin. After the operation, the patient showed mild improvement of his symptoms. Follow-up MRI and contrast-enhanced MR angiography revealed an another sacral DAVF vascularized by the lateral sacral artery.
CONCLUSION
The coexistence of different spinal vascular malformations in a same patient is extremely rare. Most authors of several studies hypothesized that venous hypertension and thrombosis due to the presence or treatment of the first spinal vascular lesion may produce a second DAVF.
PubMed: 34513170
DOI: 10.25259/SNI_612_2021 -
Annals of Indian Academy of Neurology 2021
PubMed: 35002153
DOI: 10.4103/aian.AIAN_1245_20 -
World Neurosurgery Jun 2019Spinal dural arteriovenous fistula (DAVF) occurs at any spinal level; however, a sacral location of fistula is extremely rare, and the clinical characteristics of sacral... (Review)
Review
BACKGROUND
Spinal dural arteriovenous fistula (DAVF) occurs at any spinal level; however, a sacral location of fistula is extremely rare, and the clinical characteristics of sacral DAVF have not been well described. This study aimed to document the clinical features of sacral DAVF and review the existing literature.
CASE DESCRIPTION
The first patient was a 55-year-old man who had progressive weakness and numbness in his lower extremities, along with mild urinary incontinence. The second case was a 32-year-old man who had a 1-year history of progressively worsening bilateral lower extremity weakness associated with diminished sensation. The third patient was a 43-year-old woman with 6-month history of progressive motor weakness of her lower limbs. On spinal angiography, a sacral DAVF with perimedullary vein drainage in all cases was observed. The sacral fistulas were completely obliterated with surgical intervention, and the symptoms of these patients have been gradually resolved. Follow-up magnetic resonance imaging showed complete or partial resolution of the edema within the spinal cord and disappearance of the abnormal vascular flow voids.
CONCLUSIONS
Sacral DAVFs are extremely rare and are easily missed by spinal angiography. Clinicians should be aware of the possibility of the occurrence of sacral DAVFs, and spinal angiography for the complete assessment of spinal vasculature should be carried out.
Topics: Adult; Central Nervous System Vascular Malformations; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neurosurgical Procedures; Sacrum; Spinal Cord; Treatment Outcome
PubMed: 30844523
DOI: 10.1016/j.wneu.2019.02.129 -
Neurosurgery Sep 2011Type A intradural arteriovenous fistulae of the sacral filum terminale are rare lesions fed primarily by the distal anterior spinal artery. The artery is frequently too...
BACKGROUND AND IMPORTANCE
Type A intradural arteriovenous fistulae of the sacral filum terminale are rare lesions fed primarily by the distal anterior spinal artery. The artery is frequently too narrow or tortuous for endovascular obliteration, and direct surgical resection of the fistula requires an invasive sacrectomy. We present a less invasive indirect surgical approach through an L4 laminectomy and transection of the filum terminale rostral to the fistula.
CLINICAL PRESENTATION
A 62-year-old man presented with a 6-month history of progressive bilateral lower extremity paresthesias and weakness and associated incontinence and impotence. Spinal magnetic resonance imaging demonstrated perimedullary flow voids. Selective spinal angiography revealed a fistula at S2-3 between the distal anterior spinal artery and an early draining vein returning cranially along the filum terminale, diagnostic of an intradural arteriovenous fistula. An L4 laminectomy and transection of the filum terminale rostral to the lesion were performed to disrupt the medullary arterial supply to the intradural fistula and outflow to the medullary venous plexus of the spinal cord. At 10-month clinical follow, up the patient had regained bowel and bladder continence, was able to ambulate with a cane, and reported subjective improvement of lower extremity paresthesias. Selective spinal angiography at 1 year demonstrated no residual arteriovenous shunt.
CONCLUSION
Pathological venous hypertension of a type A intradural arteriovenous fistula of the sacral filum terminale can be treated by transection of the filum terminale at L4. This avoids posterior partial sacrectomy required for direct resection; however, subsequent clinical follow-up is necessary to monitor for reconstitution.
Topics: Angiography, Digital Subtraction; Arteriovenous Fistula; Cauda Equina; Edema; Humans; Laminectomy; Magnetic Resonance Imaging; Male; Middle Aged; Muscle Weakness; Neurosurgical Procedures; Paresthesia; Regional Blood Flow; Spinal Cord; Spinal Cord Diseases
PubMed: 21499152
DOI: 10.1227/NEU.0b013e31821bc64c