gms | German Medical Science

64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. - 29. Mai 2013, Düsseldorf

Differential diagnosis of calcified spinal lesions: Calcifying pseudoneoplasms of the neuraxis (CAPNON) – meta-analysis of all published spinal cases

Meeting Abstract

  • Sebastian Lücke - Department of Neurosurgery, Knappschafts Hospital Langendreer, Ruhr-University Bochum, Bochum, Germany
  • Amr N. Abdulazim - Department of Neuroanatomy and Molecular Brain Research, Ruhr-University Bochum, Bochum, Germany
  • Oliver P. Gautschi - Department of Neurosurgery, Geneva University Medical Center, University of Geneva, Geneva, Switzerland
  • T. Marcel Schneiderhan - Department of Neuropathology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
  • Gerhard Hildebrandt - Clinic for Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland
  • Martin N. Stienen - Clinic for Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocP 121

doi: 10.3205/13dgnc538, urn:nbn:de:0183-13dgnc5389

Veröffentlicht: 21. Mai 2013

© 2013 Lücke et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Objective: Among calcified spinal lesions, herniated disc fragments, synovial cysts, neurinomas, and psammomatous meningiomas should be taken into account. Furthermore, epidural abcesses and old calcified haematomas can appear calcified. Calcifying pseudoneoplasms of the neuraxis (CAPNON) constitute another differential diagnosis that occur in the spinal canal. Nineteen patients have been described since their initial description in 1978.

Method: We performed a meta-analysis of all so far published cases. Here, study type, anatomical area, clinical presentation, radiological presentation, therapy, duration of follow-up, incidence and type of complication, and outcome were analysed. We discuss current recommendations for the management of spinal CAPNON.

Results: A total of 19 patients with spinal CAPNON were analysed. All patients were treated surgically. The location of the spinal CAPNON was in the region of the foramen magnum in three cases (15.8 %), cervical in seven cases (36.8 %), thoracic in four cases (21.1 %), and lumbar in five cases (26.3 %). The most common clinical presentation was diffuse neck and/or back pain in 11 cases (57.9 %). Spinal CAPNON appeared hypointense in both T1- and T2-weighted MRI in seven of eight reported cases (87.5 %) and isointense in one further patient (12.5 %). On application of contrast medium, the lesion displayed enhancement in five of seven cases (71.4 %). Complete excision of the lesion was performed in 6 cases (31.6 %), and incomplete excision was performed in 12 cases (63.2 %). A median follow-up of 42.0 months (range: 16–112 months) was provided in 13 of 19 cases (68.4 %). While 12 of 13 patients were reported recurrence-free (92.31 %), one patient with an incomplete excision showed a disease recurrence with local progression of the pre-existing lesion at the 24-month follow-up. A one-tailed Fisher's exact test revealed no significant difference between complete and incomplete resection in terms of disease recurrence (p = 0.6842).

Conclusions: Calcifying pseudoneoplasms are rare benign lesions of yet unknown origin. CAPNON should be taken into consideration in the differential diagnosis of spinal calcified lesions. Although complete excision should be aimed at, incomplete excision may lead to good outcome as well.