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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Spinal tumour – a diagnosis that shouldn’t be missed in SAH – literature review and case report

Spinale Tumore – eine Diagnose, die man bei SAB nicht übersehen sollte – Literaturrecherche und Fallbericht

Meeting Abstract

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  • presenting/speaker Katerina Argiti - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Mukesch Johannes Shah - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Matthias Neef - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Jürgen Beck - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Amir El Rahal - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland; Hopitaux Universitaires de Geneve, Department of Neurosurgery, Genf, Schweiz

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP099

doi: 10.3205/21dgnc387, urn:nbn:de:0183-21dgnc3871

Veröffentlicht: 4. Juni 2021

© 2021 Argiti et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: The incidence of SAH is around 6/100 000 people annually. In 15-37% of the cases, no origin of the bleeding is found. Further diagnostics in angio-negative patients can be challenging and are not standardized. Rarely, a spinal pathology is the cause for SAH (0.5-1% of the cases). The aim of this study was to define criteria to identify the patients with a possible spinal origin of the SAH. In those few patients, a spinal axis MRI workup may be useful. We present a literature review and a case of a 61-year old patient with SAH due to spinal Schwannoma. The patient initially presented headache, vomiting and urinary retention. A cranial CT showed a SAH and no source of bleeding. Due to worsened ability to walk a spinal axis MRI was performed. An intradural tumor was found and supposed to be an ependymoma. Surgery was performed without complications, histopathology revealed a Schwannoma WHO°I.

Methods: A literature review was performed based on Pubmed/Cochrane/Google Scholar for SAH & Spinal Schwannoma / SAH & Ependymoma. The review was performed according to the PRISMA guidelines. Out of 297 resulting articles, 32 were included. We analyzed a total of 44 cases of spinal origin SAH with classical cerebral SAH symptoms such as sudden headache and nuchal rigidity between 1951 and 2020. We dichotomized symptoms according to the tumor localization and according to the SAH.

Results: 44 patients were included, 14 Schwannomas (31.8%) and 30 ependymomas (68.2%). Men represented 77% of the Schwannoma and 64% of the Ependymoma cohort. Median age was 45 years in the Schwannoma group vs 29 years in the Ependymoma group. Tumors were equally distributed between the cervical and lumbar spine for Schwannomas (cervical 36%, lumbar 29%), Ependymomas were mostly located in the lumbar spine (85%) Clinical symptoms that could topographically be localized to the spine were found in 9 out of 14 patients (65%) of the Schwannoma group: Radicular pain (28%), motor deficit (22%), and incontinence (14.5%) and were found in 93% of the Ependymoma group as: Radicular pain (40%), motor deficit (20%) and incontinence (17%).The SAH was diagnosed in 86.5% by a LP. Spinal pathologies were diagnosed through MRI or Myelogram, 14 (32%) of the cases were reported before the era of MRI and CT.

Conclusion: The key finding of our study was that the presence of any clinical symptom that can topographically be localized to the spine must prompt a complete workup of the spinal axis in patients with SAH and no cerebral source of bleeding.