Spinal cord biopsy: A review of 38 cases

Aaron A. Cohen-Gadol, Ofer M. Zikel, Gary M. Miller, Allen Jr. Aksamit, Bernd W. Scheithauer, William E. Krauss, Jean Pierre Farmer, Joseph M. Piepmeier, Jacques Brotchi, Paul C. McCormick

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

OBJECTIVE: Neurosurgeons are frequently asked to evaluate patients for spinal cord biopsies when preoperative magnetic resonance imaging studies demonstrate nonspecific features. These lesions often appear unresectable, but surgeons must decide whether a biopsy is warranted. To determine the best approach to these cases, we evaluated the clinicopathological findings for patients with unknown spinal cord lesions who underwent spinal cord biopsies. METHODS: Thirty-eight consecutive patients who underwent spinal cord biopsies at the Mayo Clinic (Rochester, MN) between August 1988 and July 1998 were studied. A detailed review of the case histories, radiological results, surgical notes, histological findings, and outcomes was performed. RESULTS: Spinal cord biopsies were performed for 21 male and 17 female patients (mean age, 42.1 yr) with progressive neurological deficits related to spinal cord lesions. All patients underwent preoperative magnetic resonance imaging evaluations. High T2-weighted signal intensity and spinal cord expansion were identified in 92 and 87% of cases, respectively. After gadolinium infusion, the majority (94%) of the inflammatory lesions demonstrated patchy and often peripherally situated enhancement. This neuroradiological pattern was less common for neoplasms (50%) and benign lesions (40%). The most common pathological findings were inflammatory changes of demyelination or sarcoidosis, which together accounted for 13 cases (34%). Nonspecific changes or benign lesions were observed in 10 cases (26%). Neoplasms were identified in eight cases (21%). One case of tuberculosis and one of schistosomiasis were found. Overall, 47% of the preoperative diagnoses made by the attending surgeon were correct. For 26% of the patients, specific treatment was based on the biopsy results. The average follow-up period was 12 months (standard deviation, 14 mo; range, 0-50 mo). CONCLUSION: Preoperative laboratory and imaging studies are often diagnostically inconclusive in cases of spinal cord lesions with nonspecific features. Biopsies should be considered for patients with progressive symptomatic lesions.

Original languageEnglish (US)
Pages (from-to)806-816
Number of pages11
JournalNeurosurgery
Volume52
Issue number4
StatePublished - Apr 1 2003

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Spinal Cord
Biopsy
Magnetic Resonance Imaging
Schistosomiasis
Gadolinium
Demyelinating Diseases
Sarcoidosis
Neoplasms
Tuberculosis

Keywords

  • Biopsy
  • Demyelinating disease
  • Inflammatory changes
  • Neoplasm
  • Sarcoid
  • Spinal cord

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Clinical Neurology

Cite this

Cohen-Gadol, A. A., Zikel, O. M., Miller, G. M., Aksamit, A. J., Scheithauer, B. W., Krauss, W. E., ... McCormick, P. C. (2003). Spinal cord biopsy: A review of 38 cases. Neurosurgery, 52(4), 806-816.

Spinal cord biopsy : A review of 38 cases. / Cohen-Gadol, Aaron A.; Zikel, Ofer M.; Miller, Gary M.; Aksamit, Allen Jr.; Scheithauer, Bernd W.; Krauss, William E.; Farmer, Jean Pierre; Piepmeier, Joseph M.; Brotchi, Jacques; McCormick, Paul C.

In: Neurosurgery, Vol. 52, No. 4, 01.04.2003, p. 806-816.

Research output: Contribution to journalArticle

Cohen-Gadol, AA, Zikel, OM, Miller, GM, Aksamit, AJ, Scheithauer, BW, Krauss, WE, Farmer, JP, Piepmeier, JM, Brotchi, J & McCormick, PC 2003, 'Spinal cord biopsy: A review of 38 cases', Neurosurgery, vol. 52, no. 4, pp. 806-816.
Cohen-Gadol AA, Zikel OM, Miller GM, Aksamit AJ, Scheithauer BW, Krauss WE et al. Spinal cord biopsy: A review of 38 cases. Neurosurgery. 2003 Apr 1;52(4):806-816.
Cohen-Gadol, Aaron A. ; Zikel, Ofer M. ; Miller, Gary M. ; Aksamit, Allen Jr. ; Scheithauer, Bernd W. ; Krauss, William E. ; Farmer, Jean Pierre ; Piepmeier, Joseph M. ; Brotchi, Jacques ; McCormick, Paul C. / Spinal cord biopsy : A review of 38 cases. In: Neurosurgery. 2003 ; Vol. 52, No. 4. pp. 806-816.
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abstract = "OBJECTIVE: Neurosurgeons are frequently asked to evaluate patients for spinal cord biopsies when preoperative magnetic resonance imaging studies demonstrate nonspecific features. These lesions often appear unresectable, but surgeons must decide whether a biopsy is warranted. To determine the best approach to these cases, we evaluated the clinicopathological findings for patients with unknown spinal cord lesions who underwent spinal cord biopsies. METHODS: Thirty-eight consecutive patients who underwent spinal cord biopsies at the Mayo Clinic (Rochester, MN) between August 1988 and July 1998 were studied. A detailed review of the case histories, radiological results, surgical notes, histological findings, and outcomes was performed. RESULTS: Spinal cord biopsies were performed for 21 male and 17 female patients (mean age, 42.1 yr) with progressive neurological deficits related to spinal cord lesions. All patients underwent preoperative magnetic resonance imaging evaluations. High T2-weighted signal intensity and spinal cord expansion were identified in 92 and 87{\%} of cases, respectively. After gadolinium infusion, the majority (94{\%}) of the inflammatory lesions demonstrated patchy and often peripherally situated enhancement. This neuroradiological pattern was less common for neoplasms (50{\%}) and benign lesions (40{\%}). The most common pathological findings were inflammatory changes of demyelination or sarcoidosis, which together accounted for 13 cases (34{\%}). Nonspecific changes or benign lesions were observed in 10 cases (26{\%}). Neoplasms were identified in eight cases (21{\%}). One case of tuberculosis and one of schistosomiasis were found. Overall, 47{\%} of the preoperative diagnoses made by the attending surgeon were correct. For 26{\%} of the patients, specific treatment was based on the biopsy results. The average follow-up period was 12 months (standard deviation, 14 mo; range, 0-50 mo). CONCLUSION: Preoperative laboratory and imaging studies are often diagnostically inconclusive in cases of spinal cord lesions with nonspecific features. Biopsies should be considered for patients with progressive symptomatic lesions.",
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