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Dilys M. Parry

T o T he E ditor : I was pleased to see the article by Dr. Dow, et al. (Dow G, Biggs N, Evans G, Gillespie J, Ramsden R, King A: Spinal tumors in neurofibromato-sis Type 2. Is emerging knowledge of genotype predictive of natural history? J Neurosurg: Spine 2: 574–579, May, 2005), in a recent online issue of the Journal . I was surprised by the sentence near the end of the introduction, however, which stated that “To date, there has been no study conducted to examine the relationships between clinical and neuroimaging factors with the NF2 genotype with

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Graham Dow, Nigel Biggs, Gareth Evans, Jimmie Gillespie, Richard Ramsden and Andrew King

clinical issues, and requires cooperation among clinicians from many specialties such as neurosurgery, neurootology, and medical genetics. Indeed, there is a cogent view that such patients are best treated in a dedicated multidisciplinary setting. 7 Because of the significant variation in clinical manifestations of NF2, uncertainty may arise when planning a patient's treatment. Many individuals present with multiple spinal tumors of varying size, type, and location. A high proportion of these tumors may be asymptomatic. 3, 20 Significant comorbidity associated with

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Matthias Millesi, Barbara Kiesel, Adelheid Woehrer, Johannes A. Hainfellner, Klaus Novak, Mauricio Martínez-Moreno, Stefan Wolfsberger, Engelbert Knosp and Georg Widhalm

In contrast, the most frequent tumor mass in the epidural compartment results from metastatic disease. 3 , 11 , 21 , 24 Currently, the primary treatment of choice for the majority of spinal tumors is gross-total resection (GTR) with preservation of neurological function. 6 , 11 , 25 , 30 , 39 , 42 In routine clinical practice, however, subtotal resection (STR) of spinal tumors is not uncommon. 9 , 11 , 31 In fact, STR is observed in up to 44% of intramedullary ependymomas despite their usually well-circumscribed growth pattern and in up to 94% of diffusely

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Michael Karsy, Jian Guan, Walavan Sivakumar, Jayson A. Neil, Meic H. Schmidt and Mark A. Mahan

I ntradural spinal tumors have an incidence of 0.64 per 100,000 person-years and account for 3% of primary CNS tumors. 78 Although intradural spinal tumors represent a limited overall tumor burden in the population, these tumors frequently cause significant morbidity associated with long-term survival. This review will focus on the known genetic and molecular underpinnings of intradural spinal tumors and on the potential clinical impact of this knowledge ( Table 1 ). TABLE 1. Summary literature overview of spinal cord tumors, their incidence, and

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Mario Nazareno Carviy Nievas and Hans-Georg Hoellerhage

the intradural disc fragments (black arrow) and the longitudinal incision and retraction of the dura mater (white arrow). The sequestered material was easily removed with forceps (arrowhead). D: Postoperative cervical radiograph demonstrating the bone defect (white arrow). TABLE 1: Summary of clinical, treatment, and outcome data in 11 patients with MR imaging findings simulating spinal tumors * Case No. Age (yrs), Sex Fragment Location/Level Differential Diagnosis Symptoms & Duration Previous Surgery

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Darryl Lau, Andrew K. Chan, Alexander A. Theologis, Dean Chou, Praveen V. Mummaneni, Shane Burch, Sigurd Berven, Vedat Deviren and Christopher Ames

T he spine is a common location for the development of primary and metastatic tumors. Metastatic spinal tumors (secondary malignancies) make up the majority of all spinal tumors. In fact, 31% of autopsies of patients who die of a malignant neoplasm harbor sites of spinal metastases. 29 Most often, metastatic spinal tumors affect the bony vertebral column and are infrequently found in the intradural space. Conversely, primary spinal tumors may be benign or malignant, are relatively rare, and have a more heterogeneous origin as they may arise from the

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Henry D. Messer and Ray A. Brinker

H ydrocephalus associated with spinal tumors is a well known but uncommon phenomenon. Over 50 such cases are reported in the neurosurgical literature, and in several of these, hydrocephalus was documented by pneumoencephalography preoperatively. In some cases, mentation improved after resection of the spinal cord lesion, but we found no case where removal of the tumor was documented to result in a reduction of the ventricular size. Case Report This 73-year-old woman was first admitted to the medical service of the Wayne County General Hospital on

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Matthew J. Viereck, George M. Ghobrial, Sara Beygi and James S. Harrop

C , Nicholas RS , Miles J , Findlay GF , Pigott TJ : Outcome predictors and complications in the management of intradural spinal tumours . Eur Spine J 15 : 203 – 210 , 2006 4 Mehta AI , Adogwa O , Karikari IO , Thompson P , Verla T , Null UT , : Anatomical location dictating major surgical complications for intradural extramedullary spinal tumors: a 10-year single-institutional experience . J Neurosurg Spine 19 : 701 – 707 , 2013 5 Nzokou A , Weil AG , Shedid D : Minimally invasive removal of thoracic and lumbar

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Ziya L. Gokaslan, Julie E. York, Garrett L. Walsh, Ian E. McCutcheon, Frederick F. Lang, Joe B. Putnam Jr., David M. Wildrick, Stephen G. Swisher, Dima Abi-Said and Raymond Sawaya

recent clinic appointment. The Kaplan—Meier 21 method was used to estimate postoperative survival. TABLE 2 Classification of analgesic medications used in patients with metastatic spinal tumors * Category Medication 1 none 2 acetaminophen, nonsteroidal antiinflammatory medication 3 codeine, hydrocodone, oxycodone, propoxyphene hydrochloride 4 morphine SR/IR, fentanyl TD, oxycodone SR/IR 5 intravenous narcotics * IR = intermediate release; SR = slow release; TD = transdermal

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Aditya V. Karhade, Viren S. Vasudeva, Hormuzdiyar H. Dasenbrock, Yi Lu, William B. Gormley, Michael W. Groff, John H. Chi and Timothy R. Smith

S pinal tumors are a major cause of morbidity and mortality among oncology patients. The incidence of tumors of the spinal column is estimated to be 0.62 per 100,000 individuals in the US. 33 , 85 Metastatic spinal tumors make up the majority of spinal tumors and are found in as many as 70% of cancer patients. 48 , 52 , 65 , 74 , 86 , 93 , 98 In addition to classification by histology, spinal tumors are generally stratified by location as extradural, intradural extramedullary, or intramedullary. The goals of surgical treatment of spinal tumors are to