Anas Abdallah

Non-Traumatic Myositis Ossificans in the Lumbar Spine

Patient: Male, 31 Final Diagnosis: Myositis ossificans Symptoms: Back pain • motion restriction • tenderness in lumbar region Medication: — Clinical Procedure: — Specialty: Neurology Objective: Rare disease Background: Myositis ossificans is a non-neoplastic benign reactive bone and cartilage matrix-producing pseudotumor that develops in skeletal muscles adjacent to the joint. The clinical and pathologic appearance of myositis ossificans varies depending on the time elapsed after heterotopic bone formation. Although its etiology is unclear, it usually occurs at the site of the injured muscle, most commonly in large muscles of the extremities, especially the quadriceps and brachialis. It rarely occurs in the paravertebral muscle of the lumbar spine. Case Report: We present the rare case of a 31-year-old Turkish man with calcifying myositis ossificans not associated with trauma, referred to our hospital with severe low back pain with restriction of low back motions. Radiological investigation suggested a sclerotic osteoblastic on the left facet joint of L4–5. To confirm the diagnosis, the patient was managed surgically by total excision of the mass, which resulted in a good functional recovery. At his 12-month follow-up examination, he was neurologically intact and no recurrence was seen. Conclusions: Cases like this should be investigated well, so careful correlation of the clinical and radiologic findings with taking a biopsy is necessary to confirm diagnosis.

Solitary Osteochondroma Arising from Cervical Spina Bifida Occulta

Solitary osteochondromas are common benign long bone tumors originating from cartilage. They may produce a wide variety of symptoms and complications depending on their spinal location. These may include compressive myelopathy, nerve root compression, pathologic fracture and malignant degeneration, or in some cases only pain. Solitary cervical spine osteochondromas have been reported mostly in the neural arch or vertebral body. This report describes a patient presenting with neck pain, with a benign osteochondroma arising in the right bifid C5 lamina.

Management of Tethered Cord Syndrome in Adults: Experience of 23 Cases.

AIM Tethered cord syndrome (TCS) is rarely diagnosed in adults. It is a complex clinicopathological entity that remains poorly understood. In this study, clinical outcomes of 23 consecutive congenital TCSs diagnosed in adults have been evaluated to establish a standard approach to treat congenital TCS diagnosed in adults. MATERIAL AND METHODS Medical records were retrospectively reviewed in 73 cases of TCS who were underwent surgery in our hospital, between 2005 and 2014. Cases which diagnosed and treated surgically in adults (patient age > 18 years) were included in this study. RESULTS Twenty-three adult cases of TCSs were treated surgically and 15 of them were female and 8 were male. The mean age was 30.3±10.7 years. The mean follow-up period was 75.6±40.5 months. The most common complaint was low back pain. The most common findings in the neurological examinations were muscular weakness and urinary incontinence. The most common co-malformations were diastematomyelia and vertebral fusion anomalies. Conus medullaris was mostly terminated at the L5 level. Detethering procedure was carried out in 87% of patients and bony septum resection without detethering was applied in 13%. Laminoplasty was performed only in 39.1%. 60.9% of patients were recovered good. 34.8% of patients were improved. The most common complication was cerebrospinal fluid leakage. CONCLUSION Despite the good results obtained in our surgical interventions for symptomatic TCS in adults, tethered cord releasing is complex procedure and has serious complications. Therefore, it is suggested to plan surgery according to symptoms emphasized with full neurological examination, craniospinal imaging and urodynamic tests.

Radiation-induced meningiomas: a series of consecutive four patients and review of the literature

AIM To assess the clinical outcomes of treatment for radiation-induced meningiomas. MATERIAL AND METHODS Medical records of all cranial meningioma cases which diagnosed or/and underwent surgery in our hospital, during a 7-year period from 2009 to 2016 were retrospectively reviewed. All radiation-associated meningiomas were selected as the core sample used for this study. RESULTS This series included one female and three male patients with mean age 47.3±16.3 years on average. The mean preoperative course was less than three months. The most common presenting symptom was headache (100%). Three patients had alopecia and thin scalp skin. The mean age when received radiotherapy was 18.5±13.7. The mean latency period was 19.2±7.4 years. The first malignancies were two desmoplastic medulloblastomas (13-year-old female, 65Gy), (11-year-old male, 54Gy) and one oligodendroglioma-gradeII (39-year-old male, 30Gy). One patient received radiotherapy for chronic otitis (10-year-old male, Low-dose). The histopathological examinations were revealed (fibroblastic-gradeI, Ki-67 was 2-3%, 25.5years, cerebellopontine angle), (atypical meningioma-gradeII, ki-67 was 8%, 21years, frontal) and (transitional-gradeI, ki-67 was 3-4%, 11years, frontal), respectively. Fourth patient had three radiation-induced meningiomas and 27 radiation-induced cavernomas. This patient had treated using gamma knife. The mean follow-up period was 34.8±39.4 months. One patient had rhinorrhea, another one was experienced CSF fistula. Both of them were re-operated. The former was lost after involved with meningitis on postoperative 31st day. CONCLUSION Most radiation-induced meningiomas are low-grade, but they have high trend to recurrence. Close follow-up and yearly MRI would minimize their morbidity rate. To reduce fatal complications, surgery has to plan with plastic surgeons.