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Mark H. Bilsky, Ilya Laufer, Daryl R. Fourney, Michael Groff, Meic H. Schmidt, Peter Paul Varga, Frank D. Vrionis, Yoshiya Yamada, Peter C. Gerszten and Timothy R. Kuklo

, Yamada, Gerszten, Kuklo. Reviewed final version of the manuscript and approved it for submission: all authors. Statistical analysis: Bilsky. Administrative/technical/material support: Bilsky. Study supervision: Bilsky. This article contains some figures that are displayed in color online but in black and white in the print edition. References 1 Abrahm JL : Assessment and treatment of patients with malignant spinal cord compression . J Support Oncol 2 : 377 – 393 , 398 , 2004 2 Bilsky M , Smith M : Surgical approach to epidural spinal cord

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Dhiego Chaves de Almeida Bastos, Richard George Everson, Bruno Fernandes de Oliveira Santos, Ahmed Habib, Rafael A. Vega, Marilou Oro, Ganesh Rao, Jing Li, Amol J. Ghia, Andrew J. Bishop, Debra Nana Yeboa, Behrang Amini, Laurence D. Rhines and Claudio Esteves Tatsui

T he role of surgery in the management of spinal metastatic disease continues to evolve, especially regarding its pairing with recent advances in systemic treatment and radiotherapy. Improved functional outcomes have been demonstrated with decompressive surgery and spinal stabilization followed by conventional external-beam radiation therapy (cEBRT) over cEBRT alone in patients with symptomatic epidural spinal cord compression (ESCC). 12 More recently, spinal stereotactic radiosurgery (SSRS) has emerged as a highly effective treatment, overcoming the

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Claudio E. Tatsui, Telmo A. B. Belsuzarri, Marilou Oro, Laurence D. Rhines, Jing Li, Amol J. Ghia, Behrang Amini, Heron Espinoza, Paul D. Brown and Ganesh Rao

spinal laser interstitial thermotherapy (sLITT) 22 as an alternative to limited surgical decompression and stabilization (separation surgery) prior to spinal stereotactic radiosurgery (SRS). Our initial study consisted of 11 patients with epidural spinal cord compression (ESCC), without neurological deficits. The median hospital stay was 2 days, and most patients underwent spinal SRS within 3 days of the procedure. We reported improvement in the degree of epidural compression in 9 of 11 patients and one treatment failure, which was managed with circumferential

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Kei Ito, Keiji Nihei, Takuya Shimizuguchi, Hiroaki Ogawa, Tomohisa Furuya, Shurei Sugita, Takahiro Hozumi, Keisuke Sasai and Katsuyuki Karasawa

S pinal metastases are diagnosed in approximately 40% of cancer patients, 10 and metastatic epidural spinal cord compression (MESCC) occurs in up to 10% of adult cancer patients during their disease course. 17 , 18 MESCC is one of the most dreaded complications of metastatic cancer, because it usually causes progressive pain, paralysis, sensory loss, and sphincter dysfunction. A randomized, controlled trial demonstrated that, for patients with symptomatic single-level MESCC, surgical decompression followed by conventional radiation therapy (RT) of 30 Gy in 10

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Kaisorn L. Chaichana, Courtney Pendleton, Daniel M. Sciubba, Jean-Paul Wolinsky and Ziya L. Gokaslan

following surgery. However, the percentage of patients who regained ambulatory function following decompressive surgery was highest in the group of patients with primary lung cancer. Patients with primary breast or kidney cancer and those with melanoma had the longest duration of survival, with median survival times > 12 months. Metastatic epidural spinal cord compression is a common and debilitating complication of cancer, in which the lesion invades the epidural space and compresses the spinal cord. 5 , 8 , 15 This compression can lead to neurological deficits and

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Gary Rajah, Chiu Yuen To, Sandeep Sood, Steven Ham, Deniz Altinok, Janet Poulik and Abilash Haridas

Blue rubber bleb nevus syndrome (BRBNS) can present with vascular malformations throughout the body, especially in the gastrointestinal tract. Spinal cord compression from these lesions is rare, particularly in the pediatric population. The authors report a case of BRBNS involving an 18-year-old female patient who presented with back pain and an epidural thoracic mass with cord compression. She underwent an uncomplicated thoracic laminectomy and decompression, with removal of what appeared to be a venous malformation. Postoperatively her pain improved, and imaging revealed resolution of cord compression. Pathological analysis highlighted dilated venous channels with myxoid degeneration in the wall with clot, characteristic of BRBNS. The early age of presentation and location are unique based on the literature search of BRBNS. The present report highlights the multiplicity of venous malformations in BRBNS, and the management of this case.

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Scott L. Zuckerman, Ganesh Rao, Laurence D. Rhines, Ian E. McCutcheon, Richard G. Everson and Claudio E. Tatsui

epidural spinal cord compression (ESCC). An increase in the number of elderly patients along with improved systemic cancer therapies has resulted in a rise in the incidence, prevalence, and number of patients with metastatic disease. 5 , 7 , 34 The current standard of care for patients with high-grade ESCC by the Spine Oncology Study Group is surgical decompression followed by conventional radiotherapy or spinal stereotactic radiosurgery (SRS). 3 , 25 Recently, Laufer et al. 18 have described the concept of separation surgery, which includes a single-stage posterior

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Jean Yves Delattre, Ehud Arbit, Howard T. Thaler, Marc K. Rosenblum and Jerome B. Posner

W hether glucocorticoids have a beneficial effect in the therapy of epidural spinal cord compression is not well established. Some clinical reports suggest that steroids might be useful 3, 12 but their effect is difficult to assess since most patients are started on definitive treatment (surgical decompression or radiation therapy) immediately after diagnosis. Experimental evidence suggests that vasogenic edema occurs during epidural spinal cord compression, 15, 16, 18, 19 but its clinical importance and the optimal dose of steroids required to reverse it

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Anterolateral decompression for metastatic epidural spinal cord tumors

Results of a modified costotransversectomy approach

M. Chris Overby and Allen S. Rothman

bodies and/or pedicles, and are, therefore, anterolateral in location. 20 Many of these operative series were aimed only at posterior decompression, and did not deal with pathology anterior to the spinal cord. We present a series of patients with spinal epidural metastases who underwent anterolateral decompression via a modified costotransversectomy approach. The operative technique and results are described. Summary of Cases Twelve patients underwent anterolateral decompression with ventral metastatic epidural spinal cord compression at our institution

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Repeat decompression surgery for recurrent spinal metastases

Presented at the 2009 Joint Spine Section Meeting

Ilya Laufer, Andrew Hanover, Eric Lis, Yoshiya Yamada and Mark Bilsky

% of patients who underwent surgery within 4 years. 9 The development of SRS for the spine has improved local control rates compared with EBRT; however, despite SRS control rates reported at greater than 90%, recurrence of epidural spinal cord tumors continues to place patients at risk for paralysis. 1 , 2 , 23 Reoperations for recurrent epidural spinal cord compression have been reported in the literature, but no consensus exists regarding the indications or efficacy of such surgery. 8 , 19 , 20 This paper presents our experience with reoperations for metastatic