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      Lumbar Spinal Angiolipoma with Expanding Left Neural Foramen Mimicking Lumbar Schwannoma; Case Report and Review of The Literature

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          Abstract

          Aim:

          To describe a patient with lumbar angiolipoma mimicking schwannoma in the posterolateral side of the spinal canal with expansion of the left lumbar foramen and to discuss the clinical, radiologic, and surgical features of these lesions with literature.

          Methods:

          Without language restriction in this paper, the electronic databases; The Cochrane Collaboration the Cochrane, The Cochrane Library (Issue 2 of 12, Feb. 2011), ProQuest, US National Library of Medicine, National Institutes of Health (NLM) and PubMed dating from 1966 September to January Week 2 2017, were searched for comparative experimental studies using the terms: “OR”, “AND”. On-line literature searches were conducted using the key words “lumbar angiolipoma”, “schwannoma “, “spinal angiolipoma”, “spinal cord”, and “spinal canal”. We compared this research with our patient.

          Results:

          Bilateral L2 total laminectomy, excision of the tumors and bilateral L2-L3 transpedicular stabilization were performed, and complaints improved prominently. Pathological examination was reported as angiolipoma.

          Conclusion:

          The research shows that a probable diagnosis in such tumor cases could be made by sufficient pre-op scanning before surgical operations and although angiolipoma has been rarely seen in lumbar posterolateral space, it can be seen in lumbar region and mimic schwannoma as producing symptoms and signs of spinal cord and nerve root compression.

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          Most cited references34

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          Long-term outcome after removal of spinal schwannoma: a clinicopathological study of 187 cases.

          Are spinal schwannomas as benign as we think? To what extent do patients recover? Are patients prone to develop late complications such as cystic myelopathy or symptomatic spinal deformity? Is their life expectancy compromised? In an effort to answer these questions, the authors analyzed the long-term outcome for 187 patients from one neurosurgical department with surgically treated spinal schwannoma. Median follow-up period was 12.9 years (2454 patient years). One-fifth of the patients considered themselves free of symptoms at follow-up examination. The most common late complaint was local pain (46%), followed by radiating pain (43%), paraparesis (31%), radicular deficit (28%), sensory deficit due to a spinal cord lesion (27%), and difficulty voiding (19%). Late complications occurred in 21% of the patient population, including cystic myelopathy (2%), spinal arachnoiditis (6%), spinal deformity (6%), and troublesome pain (7%). Life expectancy of the patients corresponded to that of the general population.
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            Spinal extradural schwannoma.

            The authors endeavor to define the clinical and surgery-related profile of spinal nerve sheath tumors located in the extradural space outside both the dural sac and, apparently, the nerve roots' sleeve. A series of 24 extradural schwannomas was retrospectively selected after reviewing the notes of spinal nerve sheath tumors surgically treated at La Sapienza University of Rome. Clinical data, tumor-related characteristics, and outcome were analyzed. Women predominantly harbored these tumors. On admission sensory nerve root dysfunction was infrequently reported, whereas pyramidal tract deficits were often present. The tumor, generally large, was most frequently located in the intermediate thoracic segments and high cervical region; only one was reported in the lumbosacral region. Considerable erosion of vertebral bodies was reported in almost one third of the cases. In four patients eloquent nerve roots, that of C-5 in three and that of S-1 in one, were involved with the tumor. Radical tumor resection, with preservation of the nerve roots, was possible in several cases, whereas in two patients manipulation and resection of the C-5 root produced transient and permanent, respectively, root palsy. At follow-up examination patients for whom walking was impossible before surgery were now able to walk. Extradural schwannomas can be distinguished from other nerve sheath tumors growing inside the spinal canal by their clinicoradiological features and unlikely nerve root origin. After surgery, recovery from pyramidal tract deficits, even severe, is noteworthy; in the authors' experience, however, resection of an involved appendicular root is more likely to result in a permanent and significant radicular deficit.
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              Spinal extradural angiolipoma: report of two cases and review of the literature.

              Spinal angiolipomas are benign uncommon neoplasm composed of mature lipocytes admixed with abnormal blood vessels. They account for only 0.04-1.2% of all spinal tumors. We report two cases of lumbar extradural angiolipoma and review previously reported cases. We found 118 cases of spinal epidural angiolipoma (70 females and 48 males; age range 1.5-85 years, mean 44.03) spanning from 1890 to 2006. Prior to diagnosis 40.6% of the patients had weakness of the lower limbs. The interval between the initial symptoms and tumor diagnosis ranged from 1 day to 17 years (mean 20.2 months). Except for four cases diagnosed at autopsy, 109 patients underwent surgery and gross-total resection was performed in 79 cases (72.4%). Spinal angiolipomas are tumors containing angiomatous and lipomatous tissue, predominantly located in the mid-thoracic region. All angiolipomas show iso- or hyperintensity on T1-weighted images and hyperintensity on T2-weighted images and most lesions enhance with gadolinium administration. The treatment for spinal extradural angiolipomas is total surgical resection and no adjuvant therapy should be administered.
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                Author and article information

                Journal
                Open Neurol J
                Open Neurol J
                TONEUJ
                The Open Neurology Journal
                Bentham Open
                1874-205X
                26 September 2017
                2017
                : 11
                : 20-26
                Affiliations
                [1 ]Republic of Turkey, Ministry of Health, State Hospital, Department of Neurosurgery, 59100, Tekirdag, Turkey
                [2 ]Republic of Turkey, Ministry of Health, State Hospital, Department of Pathology, 59100, Tekirdag, Turkey
                [3 ]Namik Kemal University School of Medicine, Department of Neurosurgery, 59030, Tekirdag, Turkey
                [4 ]Republic of Turkey, Ministry of Health, State Hospital, Department of Radiology, 56100, Siirt, Turkey
                [5 ]Medicalpark Bahcelievler, Department of Orthopaedic and Traumatology, 34050, Istanbul, Turkey
                [6 ]Istanbul Memorial Health Group, Department of Orthopaedic and Traumatology, 34758, Istanbul, Turkey
                Author notes
                [* ]Address correspondence to this author at the Republic of Turkey Ministry of Health - Neurosurgery Tekirdag, Turkey Neurosurgery, Turkey; Tel: +905066726959; Fax: +902822603850; E-mail: yenerakyuva@ 123456hotmail.com
                Article
                TONEUJ-11-20
                10.2174/1874205X01711010020
                5678235
                6f000e8b-0ade-4a05-9435-7a90af67d9af
                © 2017 Akyuva et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 01 May 2017
                : 09 July 2017
                : 09 August 2017
                Categories
                Article

                Neurology
                lumbar angiolipoma,schwannoma,spinal angiolipoma,spinal cord,spinal canal
                Neurology
                lumbar angiolipoma, schwannoma, spinal angiolipoma, spinal cord, spinal canal

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