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Here, we aim at developing a novel biomatrix from decellularized bovine spinal meninges for tissue engineering and regenerative medicine applications. Within this concept, the bovine spinal meninges were decellularized using 1% Triton X-100 for 48 h, and residual nuclear content was determined with double-strand DNA content analysis and agarose gel electrophoresis. The major matrix components such as sulfated GAGs and collagen before and after the decellularization process were analyzed with DMMB, hydroxyproline assay and SDS-PAGE. Subsequently, the native bovine spinal meninges (nBSM) and decellularized BSM (dBSM) were physiochemically characterized via ATR-FTIR spectroscopy, TGA, DMA and tensile strength test. The dsDNA content in the nBSM was 153.39 ± 53.93 ng/mg dry weight, versus in the dBSM was 39.47 ± 4.93 ng/mg (n = 3) dry weight and DNA fragments of more than 200 bp in length were not detected in the dBSM by agarose gel electrophoresis. The sulfated GAGs contents for nBSM and dBSM were observed to be 10.87 ± 1.2 and 11.42 ± 2.01 μg/mg dry weight, respectively. The maximum strength of dBSM in dry and wet conditions was found to be 19.67 ± 0.21 MPa and 13.97 ± 0.17 MPa, while nBSM (dry) was found to be 26.26 ± 0.28 MPa. MTT, SEM, and histology results exhibited that the cells attached to the surface of dBSM, and proliferated on the dBSM. In conclusion, the in vitro preliminary study has demonstrated that the dBSM might be a proper and new bioscaffold for tissue engineering and regenerative medicine applications.

Increased inflammation in the cerebral meninges is associated with extensive subpial cortical grey matter pathology in the forebrain and a more severe disease course in a substantial proportion of secondary progressive multiple sclerosis (SPMS) cases. It is not known whether this relationship extends to spinal cord pathology. We assessed the contribution of meningeal and parenchymal immune infiltrates to spinal cord pathology in SPMS cases characterized in the presence (F+) or absence (F−) of lymphoid‐like structures in the forebrain meninges. Transverse cryosections of cervical, thoracic and lumbar cord of 22 SPMS and five control cases were analyzed for CD20+ B cells, CD4+ and CD8+ T cells, microglia/macrophages (IBA‐1+), demyelination (myelin oligodendrocyte glycoprotein+) and axon density (neurofilament‐H+). Lymphoid‐like structures containing follicular dendritic cell networks and dividing B cells were seen in the spinal meninges of 3 out of 11 F+ SPMS cases. CD4+ and CD20+ cell counts were increased in F+ SPMS compared to F− SPMS and controls, whilst axon loss was greatest in motor and sensory tracts of the F+ SPMS cases (P

Context: Malignant mesothelioma is an aggressive tumor; median survival of patients following diagnosis is 12 months. Aims: Pleural malignant mesothelioma tends to spread along preexisting tissue planes and has the rare ability to spread along the nerve root into the spinal cord. In our case, there is an evidence of exceptional direct hematogenous spread to the spinal cord by the spinal branch of the intercostal arteries or the veins of Batson's plexus. Settings and Design: The authors report a case of intramedullary hematogenous metastasis to the cervical spinal cord from malignant mesothelioma, with a review of the literature. Materials and Methods: A 68-year-old male was admitted to our department because of a slowly progressive mild weakness of both low extremities, more pronounced on the left side. The patient has been treated for a malignant mesothelioma with left thoracotomy and subsequently underwent radiotherapy. Magnetic resonance imaging of the cervical-thoracic spine revealed a contrast-enhancing intramedullary expansive lesion of the left half of the spinal cord at the C6–C7 level. Results: The patient underwent surgical treatment through a C6–C7 laminectomy. Through a median posterior spinal cord incision, an intramedullary grayish lesion was completely removed. The paraparesis progressively improved and 20 days after surgery, the patient had regained normal lower extremity function. Conclusions: Malignant mesothelioma can spread to the spinal canal by the direct extension through the intervertebral foramina, by hematogenous spread to the spinal meninges, and by perineural growth along a single nerve root. The cleavage plane of the tissue may determine whether a successful gross total resection can be achieved with a good outcome for the patient.

Clinical neuroradiology 32(2), 325-343 (2022). doi:10.1007/s00062-021-01093-3, Published by Urban & Vogel, München

Decellularization of extracellular matrices offers an alternative source of regenerative biomaterials that preserve biochemical structure and matrix components of native tissues. In this study, decellularized bovine spinal cord meninges (dSCM)-derived extracellular matrix hydrogel (MeninGEL) is fabricated by employing a protocol that involves physical, chemical, and enzymatic processing of spinal meninges tissue and preserves the biochemical structure of meninges. The success of decellularization is characterized by measuring the contents of residual DNA, glycosaminoglycans, and hydroxyproline, while a proteomics analysis is applied to reveal the composition of MeninGEL. Frequency and temperature sweep rheometry show that dSCM forms self-supporting hydrogel at physiological temperature. The MeninGEL possesses excellent cytocompatibility. Moreover, it is evidenced with immuno/histochemistry and gene expression studies that the hydrogel induces growth-factor free differentiation of human mesenchymal stem cells into neural-lineage cells. Furthermore, MeninGEL instructs human umbilical vein endothelial cells to form vascular branching. With its innate bioactivity and low batch-to-batch variation property, the MeninGEL has the potential to be an off-the-shelf product in nerve tissue regeneration and restoration.

Study Design: Retrospective cohort study. Objective: The influence that race has on mortality rates in patients with spinal cord tumors is relatively unknown. The aim of this study was to investigate the influence of race on the outcomes of patients with primary malignant or nonmalignant tumors of the spinal cord or spinal meninges. Methods: The Surveillance, Epidemiology, and End Results (SEER) Registry was used to identify all patients with a code for primary malignant or nonmalignant tumor of the spinal cord (C72.0) or spinal meninges (C70.1) from 1973 through 2016. Racial groups (African-American/Black vs. White) were balanced using propensity-score (PS) matching using a non-parsimonious 1:1 nearest neighbor matching algorithm. Overall survival (OS) estimates were obtained using the Kaplan-Meier method and compared across non-PS-matched and PS-matched groups using log-rank tests. Associations of survival with clinical variables was assessed using doubly robust Cox proportional-hazards (CPH) regression analysis. Results: There were a total of 7,498 patients identified with 648 (6.8%) being African American. African-American patients with primary intradural spine tumors were more likely to die of all causes than were White patients in both the non-PS-matched [HR: 1.26, 95% CI: (1.04, 1.51), P = 0.01] and PS-matched cohorts [HR: 1.64, 95% CI: (1.28, 2.11), P < 0.0001]. On multivariate CPH regression analysis age at diagnosis [HR: 1.03, 95% CI: (1.02, 1.05), P < 0.0001], race [HR: 1.82, 95% CI: (1.22, 2.74), P = 0.004), and receipt of RT [HR: 2.62, 95% CI: (1.56, 4.37), P = 0.0002) were all significantly associated with all-cause mortality, when controlling for other demographic, tumor, and treatment variables. Conclusions: Our study provides population-based estimates of the prognosis for patients with primary malignant or nonmalignant tumors of the spinal cord or spinal meninges and suggests that race may impact all-cause mortality.

BACKGROUND: Prior studies have highlighted infratentorial tumor location as a prognostic factor for solitary fibrous tumor (SFT) and hemangiopericytoma (HPC) of the central nervous system (CNS), and spinal location is considered a positive prognostic factor for other tumors of the CNS. While SFT/HPC of the CNS is known to frequently arise from the spinal meninges, there are no case series that report outcomes for spinally located CNS tumors, and their prognosis in relation to intracranial and other CNS-located tumors is unknown. OBJECTIVE: To investigate outcomes for patients with SFT/HPC of the spinal meninges. METHODS: The Surveillance, Epidemiology, and End-Results Program was used to identify patients with SFT/HPC within the CNS from 1993 – 2015. We retrospectively analyzed the relationship between tumor location (spinal vs. brain and other CNS) and survival. RESULTS: We identified 551 cases of CNS SFT/HPC, 64 (11.6%) of which were primary tumors of the spinal meninges. Spinal tumors were more likely than brain and other CNS tumors to be SFT vs. HPC (37.5 vs. 12%, p < 0.001), benign (42.2 vs. 20.3%, p < 0.001), and less than 5 cm (53.1 vs. 35.7%, p < 0.001). The 10-year survival rates for spinal and brain/other CNS tumors were 85 and 58%, respectively. Median survival time was significantly longer for spinal tumors (median survival not reached vs. 138 months, p = 0.03, HR = 0.41 [95% CI 0.18 – 0.94]). On multivariable analysis, spinal tumor location was associated with improved survival over tumors located in the brain and other CNS (HR = 0.36 [95% CI 0.15 – 0.89], p = 0.03). CONCLUSION: Spinal tumor location is associated with improved survival in patients with SFT/HPC of the CNS. Larger institutional studies are necessary to characterize the relationship between tumor location and other relevant factors such as presentation and amenability to gross-total resection and adjuvant radiotherapy. Future studies exploring optimal management of spinally located tumors are also needed.

Background Brucellosis is a common zoonotic disease that may have a variety of clinical manifestations when it affects the nervous system. Ischemic stroke is a rare clinical symptom, but if it is not diagnosed and treated early, it may cause more severe consequences. Case presentation We report a 38-year-old man presenting with hearing impairment for four years and sudden weakness of the right limb for two years, recurrent aphasia, and gradual weakness of bilateral lower limbs for nine months. He had bilateral positive Babinski’s sign. Cerebrospinal fluid (CSF) showed raised protein and pleocytosis. Magnetic resonance imaging (MRI) showed ischemic infarcts in the pons and extensive enhancement of spinal meninges combined with spinal cord atrophy and ischemia. The tests revealed Brucella Rose Bengal positive in serum and CSF. Brucella culture in CSF was also positive. Next-generation sequencing (NGS) of CSF revealed positive for Brucella with 105 species were detected. He showed significant improvement with antibiotics at five months follow-up. Conclusions Neurobrucellosis may mimic stroke and transverse myelitis like syndromes. NB is a treatable infectious condition and should always be considered in the differentials, especially if there are risk factors, as in our case.

Background The spinal meninges play a mechanical protective role for the spinal cord. Better knowledge of the mechanical behavior of these tissues wrapping the cord is required to accurately model the stress and strain fields of the spinal cord during physiological or traumatic motions. Then, the mechanical properties of meninges along the spinal canal are not well documented. The aim of this study was to quantify the elastic meningeal mechanical properties along the porcine spinal cord in both the longitudinal direction and in the circumferential directions for the dura-arachnoid maters complex (DAC) and solely in the longitudinal direction for the pia mater. This analysis was completed in providing a range of isotropic hyperelastic coefficients to take into account the toe region. Methods Six complete spines (C0 – L5) were harvested from pigs (2–3 months) weighing 43±13 kg. The mechanical tests were performed within 12 h post mortem. A preload of 0.5 N was applied to the pia mater and of 2 N to the DAC samples, followed by 30 preconditioning cycles. Specimens were then loaded to failure at the same strain rate 0.2 mm/s (approximately 0.02/s, traction velocity/length of the sample) up to 12 mm of displacement. Results The following mean values were proposed for the elastic moduli of the spinal meninges. Longitudinal DAC elastic moduli: 22.4 MPa in cervical, 38.1 MPa in thoracic and 36.6 MPa in lumbar spinal levels; circumferential DAC elastic moduli: 20.6 MPa in cervical, 21.2 MPa in thoracic and 12.2 MPa in lumbar spinal levels; and longitudinal pia mater elastic moduli: 18.4 MPa in cervical, 17.2 MPa in thoracic and 19.6 MPa in lumbar spinal levels. Discussion The variety of mechanical properties of the spinal meninges suggests that it cannot be regarded as a homogenous structure along the whole length of the spinal cord.

BACKGROUND CONTEXT Racial disparities have been shown to impact various aspects of cancer care. Previous studies have demonstrated that nonwhite race is associated with inferior outcomes for patients with neurological, spinal, and other tumors. However, the influence that race has on mortality rates in patients with spinal cord tumors is relatively unknown. PURPOSE The aim of this study was to investigate the influence of race on the outcomes of patients with primary malignant or nonmalignant tumor of the spinal cord or spinal meninges. STUDY DESIGN/SETTING Retrospective study. PATIENT SAMPLE Patients with primary malignant or nonmalignant tumor of the spinal cord or spinal meninges from 1973 through 2016. OUTCOME MEASURES All-cause mortality. METHODS The Surveillance, Epidemiology, and End Results (SEER) Registry was used to identify all patients with a code for primary malignant or nonmalignant tumor of the spinal cord (C72.0) or spinal meninges (C70.1) from 1973 through 2016. Racial groups (African-American vs white) were balanced using propensity-score (PS) matching using a nonparsimonious 1:1 nearest neighbor matching algorithm. Overall survival (OS) estimates were obtained using the Kaplan-Meier method and compared across non-PS-matched and PS-matched groups using log-rank tests. Associations of survival with clinical variables was assessed using doubly robust Cox proportional-hazards (CPH) regression analysis. RESULTS There were a total of 7,498 patients identified with a primary intradural spine tumor, of which 648 (6.8%) were African-American (White: 6,850 vs African-American: 648). The mean age of diagnosis was greater for patients who were White than it was for patients who were African-American (White: 55.1±17.4 years vs African-American: 50.0±16.0 years, p CONCLUSIONS Our study provides population-based estimates of the prognosis for patients with primary malignant or nonmalignant tumor of the spinal cord or spinal meninges and suggests that race may impact all-cause mortality. Further studies are necessary to corroborate our findings. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Three layers of meninges, the pia mater, the arachnoid membrane, and the dura mater from inside out envelop the brain and the spinal cord. The relationship between these meninges and surrounding structures is somewhat different in the brain and spinal cord. In particular, understanding of the anatomical relationship in the spinal cord region is inevitable for surgical approaches to various disease conditions that occur in this region. Again, the anatomy can be more easily understood based on developmental knowledge. In this chapter, the development of the spinal meninges is briefly described first, followed sequentially by those for each meningeal membrane and the “spaces” associated with them.

BACKGROUND: Recent advances in multidisciplinary treatments for various cancers have extended the survival period of patients with spinal metastases. Radiotherapy has been widely used to treat spinal metastases; nevertheless, long-term survivors sometimes undergo more surgical intervention after radiotherapy because of local tumor relapse. Generally, intradural invasion of a spinal tumor seldom occurs because the dura mater serves as a tissue barrier against tumor infiltration. However, after radiation exposure, some spinal tumors invade the dura mater, resulting in leptomeningeal dissemination, intraoperative dural injury, or postoperative local recurrence. The mechanisms of how radiation might affect the dura have not been well-studied. QUESTIONS/PURPOSES: To investigate how radiation affects the spinal meninges, we asked: (1) What is the effect of irradiation on the meningeal barrier’s ability to protect against carcinoma infiltration? (2) What is the effect of irradiation on the meningeal barrier’s ability to protect against sarcoma infiltration? (3) What is the effect of irradiation on dural microstructure observed by scanning electron microscopy (SEM)? (4) What is the effect of irradiation on dural microstructure observed by transmission electron microscopy (TEM)? METHODS: Eighty-four 10-week-old female ddY mice were randomly divided into eight groups: mouse mammary tumor (MMT) implantation 6 weeks after 0-Gy irradiation (nonirradiation) (n = 11), MMT implantation 6 weeks after 20-Gy irradiation (n = 10), MMT implantation 12 weeks after nonirradiation (n = 10), MMT implantation 12 weeks after 20-Gy irradiation (n = 11), mouse osteosarcoma (LM8) implantation 6 weeks after nonirradiation (n = 11), LM8 implantation 6 weeks after 20-Gy irradiation (n = 11), LM8 implantation 12 weeks after nonirradiation (n = 10), and LM8 implantation 12 weeks after 20-Gy irradiation (n = 10); female mice were used for a mammary tumor metastasis model and ddY mice, a closed-colony mice with genetic diversity, were selected to represent interhuman diversity. Mice in each group underwent surgery to generate a tumor-induced spinal cord compression model at either 6 weeks or 12 weeks after irradiation to assess changes in the meningeal barrier’s ability to protect against tumor infiltration. During surgery, the mice were implanted with MMT (representative of a carcinoma) or LM8 tumor. When the mice became paraplegic because of spinal cord compression by the growing implanted tumor, they were euthanized and evaluated histologically. Four mice died from anesthesia and 10 mice per group were euthanized (MMT-implanted groups: MMT implantation occurred 6 weeks after nonirradiation [n = 10], 6 weeks after irradiation [n = 10], 12 weeks after nonirradiation [n = 10], and 12 weeks after irradiation [n = 10]; LM8-implanted groups: LM8 implantation performed 6 weeks after nonirradiation [n = 10], 6 weeks after irradiation [n = 10], 12 weeks after nonirradiation [n = 10], and 12 weeks after irradiation [n = 10]); 80 mice were evaluated. The spines of the euthanized mice were harvested; hematoxylin and eosin staining and Masson’s trichrome staining slides were prepared for histologic assessment of each specimen. In the histologic assessment, intradural invasion of the implanted tumor was graded in each group by three observers blinded to the type of tumor, presence of irradiation, and the timing of the surgery. Grade 0 was defined as no intradural invasion with intact dura mater, Grade 1 was defined as intradural invasion with linear dural continuity, and Grade 2 was defined as intradural invasion with disruption of the dural continuity. Additionally, we euthanized 12 mice for a microstructural analysis of dura mater changes by two observers blinded to the presence of irradiation. Six mice (three mice in the 12 weeks after nonirradiation group and three mice in the 12 weeks after 20-Gy irradiation group) were quantitatively analyzed for defects on the dural surface with SEM. The other six mice (three mice in the 12 weeks after nonirradiation group and three mice in the 12 weeks after 20-Gy irradiation group) were analyzed for layer structure of collagen fibers constituting dura mater by TEM. In the SEM assessment, the number and size of defects on the dural surface on images (200 μm × 300 μm) at low magnification (× 2680) were evaluated. A total of 12 images (two per mouse) were evaluated for this assessment. The days from surgery to paraplegia were compared between each of the tumor groups using the Kruskal-Wallis test. The scores of intradural tumor invasion grades and the number of defects on dural surface per SEM image were compared between irradiation group and nonirradiation group using the Mann-Whitney U test. Interobserver reliabilities of assessing intradural tumor invasion grades and the number of dural defects on the dural surface were analyzed using Fleiss’κ coefficient. P values < 0.05 were considered statistically significant. RESULTS: There was no difference in the median (range) time to paraplegia among the MMT implantation 6 weeks after nonirradiation group, the 6 weeks after irradiation group, the 12 weeks after nonirradiation group, and the 12 weeks after irradiation group (16 days [14 to 17] versus 14 days [12 to 18] versus 16 days [14 to 17] versus 14 days [12 to 15]; χ(2) = 4.7; p = 0.19). There was also no difference in the intradural invasion score between the MMT implantation 6 weeks after irradiation group and the 6 weeks after nonirradiation group (8 of 10 Grade 0 and 2 of 10 Grade 1 versus 10 of 10 Grade 0; p = 0.17). On the other hand, there was a higher intradural invasion score in the MMT implantation 12 weeks after irradiation group than the 12 weeks after nonirradiation group (5 of 10 Grade 0, 3 of 10 Grade 1 and 2 of 10 Grade 2 versus 10 of 10 Grade 0; p = 0.02). Interobserver reliability of assessing intradural tumor invasion grades in the MMT-implanted group was 0.94. There was no difference in the median (range) time to paraplegia among in the LM8 implantation 6 weeks after nonirradiation group, the 6 weeks after irradiation group, the 12 weeks after nonirradiation group, and the 12 weeks after irradiation group (12 days [9 to 13] versus 10 days [8 to 13] versus 11 days [8 to 13] versus 9 days [6 to 12]; χ(2) = 2.4; p = 0.50). There was also no difference in the intradural invasion score between the LM8 implantation 6 weeks after irradiation group and the 6 weeks after nonirradiation group (7 of 10 Grade 0, 1 of 10 Grade 1 and 2 of 10 Grade 2 versus 8 of 10 Grade 0 and 2 of 10 Grade 1; p = 0.51), whereas there was a higher intradural invasion score in the LM8 implantation 12 weeks after irradiation group than the 12 weeks after nonirradiation group (3 of 10 Grade 0, 3 of 10 Grade 1 and 4 of 10 Grade 2 versus 8 of 10 Grade 0 and 2 of 10 Grade 1; p = 0.04). Interobserver reliability of assessing intradural tumor invasion grades in the LM8-implanted group was 0.93. In the microstructural analysis of the dura mater using SEM, irradiated mice had small defects on the dural surface at low magnification and degeneration of collagen fibers at high magnification. The median (range) number of defects on the dural surface per image in the irradiated mice was larger than that of nonirradiated mice (2 [1 to 3] versus 0; difference of medians, 2/image; p = 0.002) and the median size of defects was 60 μm (30 to 80). Interobserver reliability of assessing number of defects on the dural surface was 1.00. TEM revealed that nonirradiated mice demonstrated well-organized, multilayer structures, while irradiated mice demonstrated irregularly layered structures at low magnification. At high magnification, well-ordered cross-sections of collagen fibers were observed in the nonirradiated mice. However, disordered alignment of collagen fibers was observed in irradiated mice. CONCLUSION: Intradural tumor invasion and disruptions of the dural microstructure were observed in the meninges of mice after irradiation, indicating radiation-induced disruption of the meningeal barrier. CLINICAL RELEVANCE: We conclude that in this form of delivery, radiation is associated with disruption of the dural meningeal barrier, indicating a need to consider methods to avoid or limit Postradiation tumor relapse and spinal cord compression when treating spinal metastases so that patients do not experience intradural tumor invasion. Surgeons should be aware of the potential for intradural tumor invasion when they perform post-irradiation spinal surgery to minimize the risks for intraoperative dural injury and spinal cord injury. Further research in patients with irradiated spinal metastases is necessary to confirm that the same findings are observed in humans and to seek irradiation methods that prevent or minimize the disruption of meningeal barrier function.

Meningiomas are the most common primary neoplasm of the central nervous system (CNS). They typically arise from the cranial or spinal meninges and form extra-axial mass lesions, placing them outside the brain or spinal cord parenchyma, but within the confines of the cranium or vertebral column. The classification, grading, and molecular genetic characterization of meningiomas have steadily evolved over the past decades and continue to be revised. Based on the current World Health Organization (WHO) standards for tumor classification, various meningioma subtypes are grouped into three main categories which are centered on biological behavior. These include benign meningiomas (WHO grade I), atypical meningiomas (WHO grade II), and aggressive meningiomas (WHO grade III). This review will focus on the histopathological details of various meningiomas subtypes and how they relate to the contemporary grading schemes provided by the most recent WHO update.

BACKGROUND AND PURPOSE: Intraspinal paragonimiasis is a rare entity for which imaging findings have seldom been described. The present study investigated the MR imaging features of spinal paragonimiasis, thus providing diagnostic imaging evidence and exploring the possible pathogenesis of intraspinal paragonimiasis. MATERIALS AND METHODS: The clinical and imaging findings of spinal paragonimiasis in 6 children were analyzed retrospectively. Spinal MR imaging was performed in all patients, 5 of whom also underwent enhanced MR imaging. The diagnosis was confirmed by enzyme-linked immunosorbent assay in all cases and postoperative pathology in 4 cases. RESULTS: All cases manifested as fusiform-shaped or beanlike masses in the extradural space in the thoracic spine. The extradural masses were connected with pleural lesions through the intervertebral foramen. The plain MR imaging scan showed mixed signals with predominant isointensity on T1WI and hyperintensity on T2WI, among which 5 (5/6) masses presented as patchy hemorrhage with hyperintensity on T1WI. On enhanced scans, all masses (5/5) showed heterogeneous marked enhancement, with thickening and enhancement in the adjacent spinal meninges (5/5). Various degrees of spinal cord compression and edema were found in 5 cases (5/6). CONCLUSIONS: MR imaging is sensitive for detecting and characterizing spinal paragonimiasis. The MR imaging features of intraspinal granulomas included localization to the extradural space and thoracic segment, connections between intraspinal lesions and pleural lesions through the intervertebral foramen, and hemorrhagic foci within the mass. These findings support an intraspinal mode of paragonimiasis pathogenesis: The Paragonimus larvae migrate from the chest into the extradural space through the intervertebral foramen.

Current recommendations support early surgical decompression and blood pressure augmentation after traumatic spinal cord injury (SCI). Elevated intraspinal pressure (ISP), however, has probably been underestimated in the pathophysiology of SCI. Recent studies provide some evidence that ISP measurements and durotomy may be beneficial for individuals suffering from SCI. Compression of the spinal cord against the meninges in SCI patients causes a "compartment-like" syndrome. In such cases, intentional durotomy with augmentative duroplasty to reduce ISP and improve spinal cord perfusion pressure (SCPP) may be indicated. Prior to performing these procedures routinely, profound knowledge of the spinal meninges is essential. Here, we provide an in-depth review of relevant literature along with neuroanatomical illustrations and imaging correlates.

Chordoma is a low-grade malignant bone tumor derived from embryonic notochord remnants along the axial skeleton. About 50% of chordomas occur in the sacral vertebrae and 35% in the skull base. Most chordomas are extradural and cause extensive bone destruction. Intradural spinal tumors without bone involvement are rare. We herein describe the clinical features of a patient with a chordoma as well as the imaging and pathological manifestations of the tumor. We encountered an unusual presentation of a C6 and C7 spinal intradural chordoma in a 23-year-old man. He presented with a 5-day history of discomfort over the lumbosacral region. Magnetic resonance imaging and enhanced scanning of the cervical spine showed an intradural soft tissue mass at C6 and C7 and linear enhancement of the spinal meninges. The tumor was excised because the patient had been previously misdiagnosed with an intraspinal neurogenic tumor with spinal meningitis. Postoperative pathological examination confirmed the diagnosis of chordoma. On postoperative day 7, the patient underwent brain magnetic resonance imaging because of severe headache. The images showed multiple soft tissue nodules in the skull base cistern. To the best of our knowledge, this is the first case report of an entirely extraosseous and spinal intradural chordoma with diffuse spinal leptomeningeal spread. The patient died 2 months postoperatively. An intradural spinal chordoma is difficult to distinguish from a neurogenic tumor by imaging. When the lesion is dumbbell-shaped, it is easily misdiagnosed as a schwannoma. In the present case, the tumor was intradural and located at the level of the C6 and C7 vertebrae. Preoperative diagnosis was difficult, and the final diagnosis required pathological examination.

Tuberculous meningomyelitis is a relatively rare but serious type of nervous system tuberculosis. This disease is caused by invasion of the spinal cord or the spinal meninges tuberculosis. The early symptoms are not typical and lack specificity. It can cause early changes in the MRI. Analysis of the MRI manifestations combined with the clinical manifestations and cere- brospinal fluid examination can facilitate accurate diagnosis of the disease. Early treatment has a clear effect, we want to increase knowledge of the dis- ease by sharing this case in order to reduce clinical misdiagnosis and allow more patients to be treated in time. Keywords: Tuberculous meningomyelitis, Magnetic resonance imaging

Meninges comprise three distinct layers, the dura mater, arachnoid, and pia mater that surround the brain, spinal cord and some parts of the nerves. Traditionally the meninges were believed to serve only as protection for tissues that they encase. However recent work shows they have other important functions related to development and regulation of the nervous system.\ud Given the importance of the meninges, it is surprising that we know very little about their development. The embryological origin of the meninges has been debated for over a hundred years. Some studies imply that the meninges develop from the neural crest, while others suggest that they come from the somites. \ud Here, we investigated the temporal development of meninges in birds and mice and found they form at comparable stages. We investigated the origin of avian spinal meninges using chick/quail cell tracing protocols and found they do not develop from the somites as previously thought. We propose that meningeal epithelial blood vessels may have been mistaken as meninges and led to an erroneous conclusion by previous investigators. We present data that show that avian spinal meninges originated from the neural crest supported by data demonstrating that they express the neural crest marker HNK1. Finally using the Wnt1-Cre mouse we show that trunk meninges of mammals also originate from neural crest.

Purpose The aims of this study were to describe the neuroimaging findings in hand, foot, and mouth disease and determine those who may provide prognosis. Material and Methods Magnetic resonance imaging scans in 412 severe hand, foot, and mouth disease between 2009 and 2014 were retrospectively evaluated. The patients who had the neurological signs were followed for 6 months to 1 year. According to the good or poor prognosis, 2 groups were categorized. The incidence of lesions in different sites between the 2 groups was compared, and multivariate analysis was used to look for risk factors. Results The major sites of involvement for all patients with percentages were the medulla oblongata (16.1%), spinal anterior nerve roots (12.4%), thoracic segments (11.1%), brain or spinal meninges (8.3%), and so on. There were 347 patients (84.2%) with good prognosis and 65 (15.8%) with poor prognosis in the follow-up. There was a significantly higher rate of lesions involving the cerebral white substance, thalamus, medulla oblongata, pons, midbrain, and spinal cord in the group with poor prognosis. Multivariate analysis showed 2 independent risk factors associated with poor prognosis: lesions located in the medulla oblongata (P < 0.015) and spinal cord (P < 0.001) on magnetic resonance imaging; the latter was the most significant prognostic factor (odds ratio, 29.11; P < 0.001). Conclusions We found that the distribution patterns for all patients mainly involved the medulla oblongata, spinal anterior nerve roots, thoracic segments, and brain or spinal meninges. Our findings suggested that patients with lesions located in the medulla oblongata and spinal cord may be closely monitored for early intervention and meticulous management. For children with the symptom of nervous system, they are strongly recommended for magnetic resonance examination.

The sacral canal is the continuation of the vertebral canal in the sacrum. The sacral canal contains spinal meninges, lumbar and sacral part of spinal nerves and filum terminale. So sacral canal has been used for the caudal epidural block. During routine osteology demonstration classes for undergraduate students, we observed a dry human sacrum with complete agenesis of the dorsal wall of the sacral canal. Knowledge of these variations is important to diagnose lower back pain, sciatica, caudal regression syndrome and to avoid complications related to caudal epidural block and other spinal surgeries like in placement of screw for spinal fusion.

There may be a direct relationship between size of the dural puncture hole and resulting cerebrospinal fluid (CSF) leak and between external diameter of needle and incidence of PDPH. a larger size dura-arachnoid puncture produces more CSF leakage so that incidence of hypotension and postdural puncture headache (PDPH) is probably higher. Our findings oppose the classical notion that dura mater1 composed of longitudinal fibers running parallel to each other and oriented in the same axis as the spinal cord. the concept is that several needle tips allow separation rather than cutting of dural fibers and a smaller dural lesions. We, under transmission and scanning electron microscopy, studied the human spinal dura mater, arachnoid layer and the lesion caused by 25G and 27G Whitacre needles and 22G, 25G, and 29G Quincke needles with the bevel oriented vertically and horizontally in relation to the spinal axis, performing standard punctures on the fresh cadavers.2–9 The results of dural and arachnoid lesions are shown in table 1. the lesion in the arachnoid layer was found partially open in some instances, while in others the edges were better approximated and appear almost closed. In samples with the arachnoid lesion partially open, we would often observe through the opening of the arachnoid layer, the dural laminae to be partially or fully closed. the lesions always consisted of a dural structural lesion underpinning the arachnoid lesion. In this context, ‘closed’ applies to lesion edge approximation rather than physical sealing of the hole flaps. Quincke spinal needles caused a precise and controlled cut, while Pencil (Whitacre) point tips caused greater tearing of tissue margins and folding at the edges of the lesion. the edges of dural and arachnoid lesions caused by pencil point needles were ragged and irregular. There were no significant differences between parallel and perpendicular bevel approach using the same needle type. For the arachnoid injury, which may contribute primarily to PDPH, pencil-point needle injury wounds are ‘avulsion’ lesions not ‘splitting’ lesions. The etiology and pathogenesis of PDPH cannot be solely explained by the type and size of needle used, the effect of cerebral vasodilatation also should be considered.10 References Franksson C, Gordh T. Headache after spinal anesthesia and a technique for lessoning its frequency. Acta Chirurgica Scand 1946;94:443–445. Reina MA, Lopez A, Dittmann M, De Andres JA. Structural analysis of the thickness of human dura mater with scanning electron microscopy. Rev Esp Anestesiol Reanim 1996;43:135–137. Reina MA, Lopez A, Dittmann M, De Andres JA. Analysis of the external and internal surface of human dura mater with scanning electron microscopy. Rev Esp Anestesiol Reanim 1996;43:130–134. Reina MA, Dittmann M, Lopez A, van Zundert A. New perspectives in the microscopic structure of human dura mater in the dorso lumbar region. Reg Anesth 1997;22:161–166. Reina MA, Prats-Galino A, Sola RG, Puigdellivol-Sanchez A, Arriazu Navarro R, De Andres JA. Structure of the arachnoid layer of the human spinal meninges: a barrier that regulates dural sac permeability. Rev Esp Anestesiol Reanim 2010;57:486–492. Reina MA, Lopez A, Dittmann M, De Andres JA. Ultrastructure of spinal dura mater. In: Reina MA, Ed. Atlas of Functional Anatomy of Regional Anesthesia and Pain Medicine. New York: Springer; 2015, pp.411–434. Reina MA, Pulido P, Garcia De Sola R. Ultrastructure of spinal arachnoid layer. In: Reina MA, Ed. Atlas of Functional Anatomy of Regional Anesthesia and Pain Medicine. New York: Springer; 2015, pp. 435–454. Reina MA, De Leon Casasola OA, Lopez A, De Andres JA, Martin S, Mora M. An in vitro study of dural lesions produced by 25 Gauge Quincke and Whitacre needles evaluated by scanning electron microscopy. Reg Anesth Pain Med. 2000;25:393–402. Reina MA, Lopez A, Badorrey V, De Andres JA, Martin S. Dura-arachnoids lesions produced by 22G Quincke spinal needles during a lumbar puncture. J Neurol Neurosurg Psychiatry 2004;75:893–897. https://player.vimeo.com/external/292039987.hd.mp4?s=6363d2ea7cc617dd69a7589123a25003814d2e8a&profile_id=175 revised May 19, 2019.

Background Inflammatory demyelinating disease of the central nervous system characterized by aseptic meningitis is rare and can be easily confused with intracranial infection. Here, we investigated the clinical features of neuromyelitis optica spectrum disorder (NMOSD) patients with a meningitis-like presentation. Methods From a total of six attacks, five patients were identified. Their demographic, clinical, and magnetic resonance imaging (MRI) findings, as well as treatments and prognoses were retrospectively analyzed. Results Five patients (two males with myelin oligodendrocyte glycoprotein [MOG] antibody and three females with aquaporin-4 [AQP4] antibody) experienced six attacks. Average age at onset was 31.5 ± 3.5 years-old. The earliest clinical manifestations included fever (6/6), headache (5/6), and meningeal irritation (6/6) accompanied by leukocytosis and elevated protein levels (6/6) in cerebrospinal fluid. Two attacks initially manifested as meningitis alone. Meanwhile, following the onset of meningitis-like symptoms, four attacks were accompanied by transverse myelitis on the same day. One attack was associated with leptomeningeal enhancement on MRI, four attacks with spinal meninges enhancement, and one with both leptomeningeal and spinal meninges enhancement. All patients were considered to have an intracranial infection at onset and consequently treated with anti-infective drugs. As the symptoms continuously deteriorated, flare-up of NMOSD was considered a more reasonable diagnosis. Application of glucocorticoids (with or without intravenous immunoglobulin therapy) quickly relieved the symptoms. Subsequent re-examination of cerebrospinal fluid and MRI showed significant improvements. Conclusion Aseptic meningitis may be an atypical phenotype of NMOSD flare that is easily confused with specific infection. Comprehensive evaluation to exclude an infective etiology and enable accurate diagnosis and timely immunotherapy are critical to prognosis.

Rationale: Anterior spinal meningoceles are rare neuroanatomic abnormality formed by protrusion of the spinal meninges through a defect in the vertebral column. Presently, therapeutic options for anterior spinal meningoceles are still controversial. The objective of this study is to discuss the individualized management of giant anterior spinal meningoceles. Patient concerns and Diagnoses: We analyzed 4 patients with anterior spinal meningoceles between 2007 and 2014 in our department by retrospective chart review, two of whom were anterior sacral meningoceles (ASMs), and another2 were intrathoracic meningoceles (ITMs). Interventions and outcomes: Patients mainly presented with compressive symptoms including rectal irritation, dyspnea (patient 3) and fixed neurologic deficits (patient 4). Three out of 4 patients received surgical treatment, one of which underwent reoperation. After surgery, meningoceles in 1 patient completely disappeared. Two patients acquired the stability of the size of the meningoceles. Lessons: Management of anterior spinal meningoceles often requires precise treatment based on the different conditions of each patient. Surgical intervention has been proposed for the treatment of symptomatic anterior spinal meningoceles. The goal of surgery is to safely disconnect the linkage between the cyst and CSF from subarachnoid space to prevent further enlargement of the cyst or reaccumulating of cystic fluid.

Neurocutaneous melanosis (NCM) is a rare congenital disorder. Most of the cases described in literature for this entity have involvement of the leptomeninges and other structures of brain such as brain stem, temporal lobes, and spinal meninges and no involvement of leptomeninges and presence of lesions in bilateral temporal lobes. NCM without the involvement of leptomeninges should be considered a distinct entity as the prognosis is favorable as compared to cases with leptomeningeal involvement who develop early hydrocephalus and multiple cranial nerve palsies.

Background Spinal meningiomas are found in patients typically between the ages of 75 and 84: some report the average age to be 50. They occur with an incidence of approximately 1000 patients per year in the US, are mostly single (90%) rather than multiple (10%), and arise from the spinal meninges (arachnoid/dura). Tumors are typically posterior/posterolateral (70%) in location, leaving the remaining 30% in the anterior/anterolateral spinal canal. They produce symptoms and signs of radiculopathy (nerve root) and/or myelopathy (cord compression) depending on their site of origin. Methods Meningiomas may be single/sporadic (90%) or multifocal. They may arise primarily/spontaneously, can be radiation-induced, or associated with neurofibromatosis. They are found most frequently in females vs. males in up to a 3.4:1 ratio, occur predominantly in the thoracic spine. They are found in decreasing order in the cervical and lumbar spinal canals. The diagnosis of a meningioma is based on magnetic resonance (MR) studies, where tumors are isointense on T1 weighted MR, and hyperintense onf T2-weighted MR images; they also typically uniformly enhance with Gd-DTPA. On computed tomography (CT) examinations, they are usually characterized as calcified/hyperdense. Results The neurological deficits resulting from meningiomas and the rapidity of symptom/sign progression dictate whether they are treated surgically or nonsurgically. Management choices include; stereotactic radiation therapy only, and/or in combination with varied surgical resection techniques. Conclusions The majority of benign spinal cord tumors are meningiomas (40%) that are predominantly found in the thoracic spine in middle-aged females. Tumor levels (e.g. in descending order cervical, thoracic, lumbar), and their location (e.g. anterior/anterolateral 30%; dorsal/dorsolateral 70%) best determine whether nonoperative, operative, and/or operative intervention combined with routine vs. stereotactic radiosurgery are warranted.

The spinal cord originates from the primitive neural tube, the dorsal horn arises from the alar plate, and the anterior horn arises from the basal plate. The adult cord is located in the spinal dural sac (dura + arachnoid), is continuous with the medulla at the spinal-medulla junction, and extends to spinal levels L1 to L2. Cervical spinal levels are characteristically oval in shape with large amounts of gray matter and white matter, thoracic levels are round with a very reduced gray matter and less white matter, and lumbosacral levels are also round but with large amounts of gray matter and significantly reduced white matter. Spinal nerves are formed by the joining of the posterior root (two sensory components) and ventral root (two motor components) at about the intervertebral foramen. Spinal reflexes are integral parts of most neurologic examinations; all have an afferent limb, an efferent limb, and various degrees of processing of information within the spinal cord. In addition to the sensor-motor features of the spinal reflex, collaterals of primary sensory fibers ascend in spinal tracts that convey information to higher levels of the central nervous system (CNS) for the perception of the sensory data; much of this sensory input may be transmitted to motor centers that give rise to descending tracts to the spinal cord. A wide variety of spinal-related deficits may results from trauma, neurodegenerative and neurotransmitter diseases, and lesions of the CNS above the spinal-medulla junction.

A 62-year-old man with acute paraplegia was transferred to our hospital. He had flaccid paraplegia and multiple cranial nerve palsies, such as mydriasis of the left pupil, abduction palsy of the left eye, hoarseness and dysphagia, but no meningeal irritation signs. MRI of the spinal canal showed swellings of the conus medullaris and the cauda equine, and also contrast enhancement of the spinal meninges. The cerebrospinal fluid (CSF) showed pleocytosis and protein increment. The lymph node was swollen in his right axilla. The biopsy specimen from the right axillary lymph node revealed metastasis of malignant melanoma histologically. Careful check-up of his whole body found a malignant melanoma in the subungual region of the right ring finger. Repeated cytological examination revealed melanoma cells in the CSF, confirming the diagnosis of leptomeningeal melanomatosis. His consciousness was gradually deteriorated. His family members chose supportive care instead of chemotherapy or surgical therapy after full information about his conditions. Finally, he died 60 days after transfer to our hospital. This is a rare case of leptomenigeal melanomatosis presenting with acute paraplegia and multiple cranial nerve palsies. Careful follow-up and repeated studies are vital for the early diagnosis of leptomenigeal melanomatosis in spite of atypical clinical presentation.

Enzyme replacement therapy with laronidase (recombinant human alpha-l-iduronidase) is successfully used to treat patients with mucopolysaccharidosis type I (MPS I). However, the intravenously-administered enzyme is not expected to treat or prevent neurological deterioration. As MPS I patients suffer from spinal cord compression due in part to thickened spinal meninges, we undertook a phase I clinical trial of lumbar intrathecal laronidase in MPS I subjects age 8 years and older with symptomatic (primarily cervical) spinal cord compression. The study faced significant challenges, including a heterogeneous patient population, difficulty recruiting subjects despite an international collaborative effort, and an inability to include a placebo-controlled design due to ethical concerns. Nine serious adverse events occurred in the subjects. All subjects reported improvement in symptomatology and showed improved neurological examinations, but objective outcome measures did not demonstrate change. Despite limitations, we demonstrated the safety of this approach to treating neurological disease due to MPS I.

Spinal subdural abscess is a rare central nervous system infection with just over a hundred cases reported. It is much less common than spinal epidural abscess. While most case reports have focused on route of infection and treatment options, there have not been any reports that focused on the unique MRI findings of spinal subdural abscess. We describe a case of spinal subdural abscess diagnosed by MRI in a 33-year-old male who presented with headaches after undergoing a microdiscectomy procedure, and review the underlying anatomic features of the spinal meninges which produce the appearance of a spinal subdural abscess.

It is very well known that spinal meninges are composed of three layers, dura, arachnoid and pia mater, and that the main components of pia mater are collagen and reticular fibers. However, the distribution of those fibers has not been extensively investigated but just described as a mesh of fibers. In this study, we detected novel structures, which are composed of unidirectionally arranged fibers, in a rat spinal pia mater by using a polarized light microscope. They were seen as three parallel lines, one of which ran along a posterior spinal vein and the rest two of which ran along a pair of posterior spinal arteries. Histological analysis including Masson's trichrome, picrosirius-red staining, Gordon & Sweet's staining and immunohistochemistry with anti-collagen type 1 and 3 antibodies uncovered that they are mainly composed of collagen fibers and some reticular fibers. In addition, a putative primo vessel was detected in the novel fibrous tissue, which was proven out to be different from a blood vessel. In conclusion, we report a newly detected fibrous structure in the spinal pia mater, which may contribute to provide tensile force to the spinal meninges and to harbor the primo vascular system inside.

BACKGROUND: Cauda equina tumors are histologically diverse. Cauda equina has a dedicated site code (C72.1) in the International Classification of Diseases for Oncology (ICD-O3) and is often excluded during analyses of other primary spinal cord tumors. Therefore, less is known about tumors in this location. OBJECTIVE: Using SEER data, we analyzed the demographic features, tumor types, treatment and survival of primary cauda equina tumors. METHODS: SEER data from 1997 to 2015 were reviewed for primary cauda equina tumors (C72.1) excluding the tumors of spinal meninges (C70.1). We describe demographic characteristics of the cohort, tumor types and compared these with clinical outcome using univariate analysis. Treatment and survival analysis was performed using Kaplan-Meier curves. RESULTS: Ninety-two patients with primary cauda equina tumors met the inclusion criteria. These tumors comprised ependymoma (73%), glioblastoma (5%), lymphoma (5%), Ewing sarcoma (3%) and solitary occurrences of neurilemmoma, fibrosarcoma, germinoma, teratoma etc. The median age at diagnosis was 49 years (

We report a 34-year-old woman who presented with progressive postural headache and neck tightness over 1 week. We confirmed the diagnosis of spontaneous intracranial hypotension (SIH) and spinal images showed a thoracic osteophyte caused the cerebrospinal fluid (CSF) leak. SIH caused by spinal CSF leak is generally thought to be a consequence of deficiency of the spinal meninges in conjunction with trivial trauma. Less commonly, spinal bony pathology can lead to SIH. We reviewed 13 reported patients with bony structural pathology related SIH. After two to three epidural blood patches, eight patients underwent surgery. They generally had good outcomes. In conclusion, even though surgical repair confers specific risks, it should be considered after repetitive failures of epidural blood patches. The long-term prognoses of surgical versus non-surgical patients warrants further investigation.

Spontaneous spinal cerebrospinal fluid (CSF) leaks are increasingly recognized in patients presenting with orthostatic headache and ultimately diagnosed with intracranial hypotension. While the precise cause of these spontaneous leaks is unknown, it is thought to result from underlying weakness in the spinal meninges and may be associated with meningeal diverticula or Tarlov cysts. Rarely, calcified intervertebral discs or bony osteophytes can result in CSF leakage, which has been described in the surgery literature but not well recognized in the radiology literature. The authors present three cases of patients presenting with CSF leaks from calcified thoracic disc protrusions that were successfully treated with epidural blood patches.

Infections of the spinal cord, nerve roots, and surrounding meninges are uncommon, but highly significant given their potential for severe morbidity and even mortality. Prompt diagnosis can be lifesaving, as many spinal infections are treatable. Advances in imaging technology have now firmly established magnetic resonance imaging (MRI) as the gold standard for spinal cord imaging evaluation, enabling the depiction of infectious myelopathies with exquisite detail and contrast. In this article, we aim to provide an overview of MRI findings for spinal cord infections with special focus on imaging patterns of infection that are primarily confined to the spinal cord, spinal meninges, and spinal nerve roots. In this context, we describe and organize this review around 5 distinct patterns of transverse spinal abnormality that may be detected with MRI as follows: (1) extramedullary, (2) centromedullary, (3) eccentric, (4) frontal horn, and (5) irregular. We seek to classify the most common presentations for a wide variety of infectious agents within this image-based framework while realizing that significant overlap and variation exists, including some infections that remain occult with conventional imaging techniques.

Pilocytic astrocytomas correspond to lowgrade gliomas and therefore metastasize exceedingly rare. However, pilocytic astrocytomas are able to and leptomeningeal dissemination may be seen. What are the treatment options of these cases? We present a case report of a 3-year-old child with a pilocytic astrocytoma of the optic chiasm with leptomeningeal dissemination of the spinal meninges. Partial resection of the cerebral tumor has been performed. Since the leptomeningeal dissemination was seen all over the spinal meninges, the child did not undergo further surgical treatment. A wait and watch strategy were followed. Chemotherapy was initiated, if a 25% tumor growth was seen. Leptomeningeal dissemination of a pilocytic astrocytoma is seen so infrequently that no standard therapy is established. Since these metastases may occur even up to 2 decades after primary tumor resection, long-term follow- up is indicated. In case of spinal metastases, surgical treatment should be performed if feasible. Otherwise observation should be possessed and/or chemotherapy should be initiated.

Background The clinical significance of pathologies of the spinal dura is often unclear and their management controversial. Objective To classify spinal dural pathologies analogous to vascular aneurysms, present their symptoms and surgical results. Methods Among 1519 patients with spinal space-occupying lesions, 66 patients demonstrated dural pathologies. Neuroradiological and surgical features were reviewed and clinical data analyzed. Results Saccular dural diverticula (type I, n = 28) caused by defects of both dural layers, dissections between dural layers (type II, n = 29) due to defects of the inner layer, and dural ectasias (type III, n = 9) related to structural changes of the dura were distinguished. For all types, symptoms consisted of local pain followed by signs of radiculopathy or myelopathy, while one patient with dural ectasia presented a low-pressure syndrome and 10 patients with dural dissections additional spinal cord herniation. Type I and type II pathologies required occlusion of their dural defects via extradural (type I) or intradural (type II) approaches. For type III pathologies of the dural sac no surgery was recommended. Favorable results were obtained in all 14 patients with type I and 13 of 15 patients with type II pathologies undergoing surgery. Conclusion The majority of dural pathologies involving root sleeves remain asymptomatic, while those of the dural sac commonly lead to pain and neurological symptoms. Type I and type II pathologies were treated with good long-term results occluding their dural defects, while ectasias of the dural sac (type III) were managed conservatively.

BACKGROUND: Primary tumors of the spinal cord, spinal meninges, and cauda equina are relatively rare, and a paucity of population-based data exist on tumors in these sites. This study intends to augment the current literature by examining incidence of these tumors on a national level. METHODS: Data from central cancer registries in the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) programs for 2004-2007 (covering 99.2% of US population) and 1999-2007 (covering 89.4% of US population) were analyzed. Analyses for diagnosis years 2004-2007 included cases of malignant and nonmalignant primary spinal cord, spinal meninges, and cauda equina tumors. Descriptive statistics including estimated age-adjusted incidence rates standardized to the 2000 US standard population were conducted for both malignant and nonmalignant primary spinal tumors from cases diagnosed during 2004-2007 as well as trend analyses on malignant cases of primary spinal tumors (n = 5103) for cases diagnosed during 1999-2007 using SEER*Stat 6.6.2 software. RESULTS: There were 2576 cases of malignant primary spinal tumors and 9136 cases of nonmalignant primary spinal tumors in 2004-2007. The incidence of malignant and nonmalignant primary spinal tumors combined differed by age, sex, race, and ethnicity. Results of trend analyses indicated that malignant primary spinal tumors have been stable throughout the 1999-2007 period. CONCLUSIONS: This large population-based study adds new insights into the descriptive epidemiology of primary spinal cord, spinal meninges, and cauda equina tumors by providing in-depth analyses of the incidence of these tumors on a national level. Cancer 2012. © 2012 American Cancer Society.

Spontaneous intracranial hypotension (SIH) is a clinical syndrome in which absolute or relative hypovolemia of the cerebrospinal fluid (CSF) results in various neurological symptoms. The etiology of spontaneous CSF leaks often remains unknown. However, it is believed that the most common cause is the fragility of spinal meninges at the level of radicular nerve root sleeve. These tears can be spontaneous (primary) or secondary. Spinal pathologies can cause this tear with resultant CSF leak and SIH, which include spinal trauma, degenerative diseases and spinal surgery. Uncommonly, SIH is developed by osteophyte with disc herniation without any other pathology. In this article, we reported two cases of SIH secondary to spinal dural tear due to intradural thoracic osteophyte with superimposed disc herniation, with the absence of other pathologies, which were treated successfully with epidural blood patch (EBP).

This article discusses the imaging of infectious and other inflammatory conditions that affect the spinal cord, spinal column, intradural spinal nerve roots, and spinal meninges with emphasis on magnetic resonance (MR) imaging. Inflammatory lesions of the spine are often indistinguishable on imaging and even on pathologic examination. However, infectious causes are treatable so it is important for the radiologist to make the diagnosis. The most common inflammatory and infectious conditions affecting the anatomic compartments of the spine are described, following an external to internal anatomic approach. Subsequently, several infectious pathogenic agents are discussed individually as they affect the spinal column and its contents.

ObjectPatients having a primary tumor of the spinal cord, spinal meninges or cauda equina, are relatively rare. Neurosurgeons encounter and treat such patients, and need to be aware of their clinical presentation, tumor types, treatment options, and potential complications. The purpose of this paper is to report results from a series of 430 patients with primary intraspinal tumors, taken from a larger cohort of 9661 patients with primary tumors of the CNS.MethodsExtensive information on individuals diagnosed (in the year 2000) as having a primary CNS neoplasm was prospectively collected in a Patient Care Evaluation Study conducted by the Commission on Cancer of the American College of Surgeons. Data from US hospital cancer registries were submitted directly to the National Cancer Database. Intraspinal tumor cases were identified based on ICD-O-2 topography codes C70.1, C72.0, and C72.1. Analyses were performed using SPSS.ResultsPatients with primary intraspinal tumors represented 4.5% of the CNS tumor group, and had a mean age of 49.3 years. Pain was the most common presenting symptom, while the most common tumor types were meningioma (24.4%), ependymoma (23.7%), and schwannoma (21.2%). Resection, surgical biopsy, or both were performed in 89.3% of cases. Complications were low, but included neurological worsening (2.2%) and infection (1.6%). Radiation therapy and chemotherapy were administered to 20.3% and 5.6% of patients, respectively.ConclusionsData from this study are suitable for benchmarking, describing prevailing patterns of care, and generating additional hypotheses for future studies.

An adult dog with ataxia and a lingual mass, previously diagnosed as protothecosis, was euthanized. At the postmortem examination, the lingual mass, regions of the lungs and hilar lymph nodes, liver, mesenteric and sublumbar lymph nodes, and spinal meninges had pronounced green discoloration. Histologically, pyogranulomatous inflammation and algal organisms were found in the tongue, spinal meninges, hilar and mesenteric lymph nodes, liver, and lung. The algae had cell walls positive for periodic acid-Schiff and cytoplasmic granules. Ultrastructurally, the algae had a well-defined cell wall, stacks of grana and thylakoid membrane, and dense bodies, typical of starch granules. The organisms were identified as Chlorella, a green alga, based on the results of histochemistical and electron microscopic examination. To the author's knowledge this is the first report of disseminated Chlorella infection and the first report in a companion animal.

Germ cell tumours constitute 0.1–3.4% of all intracranial tumours and germinomas are malignant intracranial germ cell tumours with a peak incidence in children and adolescents. The pineal gland is the most common site of origin constituting about 50%, followed by the suprasellar region (20–30%). Suprasellar and pineal region germinomas account for approximately 6–10% of intracranial germ cell tumours. There were numerous reports which correlated pathological and imaging findings of suprasellar germinomas and concluded that these tumours involve the hypothalamo-neurohypophyseal axis (hypothalamus, infundibulum and posterior lobe of the pituitary gland). On the basis of these findings, suprasellar germinoma is also called neurohypophyseal germinoma. Germinomas spread readily through the subarachnoid space and involve the spinal meninges and infiltrate directly into the surrounding structures. Intracranial germinomas are highly susceptible to irradiation and chemotherapy and are potentially curable. Therefore we hope to highlight the importance of differentiating germinoma from other midline sellar-suprasellar intracranial tumours and one should be more diligent in looking for possible spinal dissemination at presentation and during follow-up.