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Thread: Question for Dr Wise - T7 Hemangioma

  1. #1

    Question for Dr Wise - T7 Hemangioma

    My mother is 65 and in good health prior to SPC. In fall of 2007 she began having symptoms of numbness in her feet and it moved up her body. Around Thanksgiving she felt like her stomach muscles had dropped. She was having problems with her bowels and urniation by the time she was diagnoised in mid January with a T7 thoracic exophytic hemangioma causing cord compression.

    On February 6, 2008 the surgery plan was embolization of the hemangioma follwed by a transthoracic T7 vertebrectomy. In the recovery room following the embolization she felt a warm sensation travel up her right leg and she could not move it. She felt a tight band across her chest. The doctor decided it would be best to do a posterior decompression immediatley. After this surgery she was paralyzed from the mid chest down.

    His notes state: "Clearly, there was much anterior, but i decided not to go out too far laterally because of the potential of destablilizing her...I noticed that the nerve roots on both sides at T7 were pushed upward by the hemangioma, probably accounting for the band-like sensation, the chest pressure sensation the patient was experiencing. Again, the hemangioma itself was somewhat bloody but certainly less vascular than it would have been had it not been embolized. .......It was obviously decompressed posteriorly. There was still obviously some compression anteriorly."

    They tell us she had a spinal stroke. The doctor feels it would be risker to go ahead and have the original surgery than to do nothing. He does not plan to remove the tumor. It is not cancerous.

    He states there is obvious compression. In my mind she cannot begin to work on recovery until this mass is removed. Is it still growing? This week she has some pain around the incision site.

    She has no motor skills but has sensory all over. She cannot feel pain in her abdomen or one leg. She can void some on her own and can control her bowel movements some.

    Can you tell me what docotor's and/or clinc's that specialize in Spinal Cord Tumors? We are in Louisville, KY but can travel anywhere. I contacted a Dr. Shields in Indianapolis but he was not interested in seeing her. Today I contacted the Mayo clinic but I don't know anything about them. What do you think of the situation? I need to find someone that is familar spinal cord tumors.

    I have been reading this forum since February and you are truly dedicated to helping people with spinal cord injury. Thank you for being there.

  2. #2
    bluegrass girl,

    I am very sorry to hear about your mother. First, let me say that I think that Louisville has superb neurosurgeons and that they are very experienced. If you need to get a second opinion, I would suggest Barrows Neurological Institute which has possibly the best spinal cord surgery group, particularly Volker Sonntag (Source). Another person whose opinion I respect is John Jane at the University of Virginia (Source).

    T7 is a very special region of the spinal cord. At T6 or T7, the artery of Adamkiewicz enters the spinal column and provides the blood flow to much of the gray matter in the thoracic spinal cord. The fact that your mother's hemangioma is located in the T7 vertebra suggests that it may have involved this artery. Because she had received angiography before, you may want to talk to the neuroradiologist who did the embolization to find out where the artery was located and its relationship to the hemangioma. Another possibility is to do another another angiogram to find out that blood vessel situation in the spinal cord. This may provide some clues as to what happened.

    The question is what to do now. If the hemangioma is not pressing of the spinal cord and not bleeding into the spinal cord, it is probably the better part of valor to not do anything right now. If it is pressing of the spinal cord, it is reasonable to decompress. Some neurosurgeons may be unwilling to do so because they may believe that such surgery will not restore function and pose significant risk of further compromise of the spinal cord. This is a legitimate view.

    It is difficult to predict how much recovery your mother will have. Much depends on the extent of injuury. Unlike spinal trauma where the presence of neurological function in the anal region is often predictive of eventual recovery, I am not sure that this applies to spinal strokes. By the way, from the description, I believe that the most likely explanation of what happened is a spinal stroke.

    A hemangioma is strictly speaking not a spinal cord tumor. It is a tumor that is outside of the spinal cord and only rarely is inside the spinal cord. Most of the time, it is located in the bony spine.

    Wise.

  3. #3
    Thank you for such a quick response and I am so glad I found this forum!

  4. #4
    My mother's surgeon has sent the information and mri's to both doctors and I hope to hear from them soon. This past week we saw her surgeon for a followup visit and he does not want to remove the tumor. He feels that the spinal stroke over rides the compression issue and that because of the stroke she may not get any recovery. I questioned him on how we would ever know if we did not remove the hemangioma and he said we wouldn't. I asked if there was much compression and he said "a lot". I just don't understand his thinking. People with spinal strokes sometimes see some recovery and people that have had compressed spinal cords sometimes do see some recovery. He reluctantly said he would look at it again in 3 months.

    My mom is scheduled to attend the Day program at Shepherd at the end of May but with her cord being compressed "a lot" I'm thinking she should wait. Her control over her bowels has continued to improve but her spacticity had definitly increased.

  5. #5
    Quote Originally Posted by bluegrass girl
    My mother's surgeon has sent the information and mri's to both doctors and I hope to hear from them soon. This past week we saw her surgeon for a followup visit and he does not want to remove the tumor. He feels that the spinal stroke over rides the compression issue and that because of the stroke she may not get any recovery. I questioned him on how we would ever know if we did not remove the hemangioma and he said we wouldn't. I asked if there was much compression and he said "a lot". I just don't understand his thinking. People with spinal strokes sometimes see some recovery and people that have had compressed spinal cords sometimes do see some recovery. He reluctantly said he would look at it again in 3 months.

    My mom is scheduled to attend the Day program at Shepherd at the end of May but with her cord being compressed "a lot" I'm thinking she should wait. Her control over her bowels has continued to improve but her spacticity had definitly increased.
    bluegrass girl,

    When I was in the neurosurgery department at NYU Medical Center, I use to argue with my colleagues all the time about decompressing the spinal cord. They felt that it was not worthwhile decompressing the spinal cord of a patient with "complete" spinal cord injury because such a patient will not gain any function as a result of the surgery. On the other hand, they are often willing to decompress the spinal cord of somebody who is "incomplete" because they have experienced some patients recovering function when they decompress. However, an orthopedic surgeon by the name of Hank Bohlman decompressed many patients sometimes a year or more after injury and observed return of some function, suggesting that compression itself can suppress function and decompression can restore function. I tell you this so that you know that I believe that the spinal cord should be decompressed when possible, even in complete spinal cord injury.

    On the other hand, let me defend this particular neurosurgeon's view. I can understand his reluctance to operate for the following reasons. First. the first operation caused loss of function. This suggests that this hemangioma and the blood supply of the spinal cord is likely to be intimately linked. He is worried that further manipulation of the tumor may result in more damage to the spinal cord. This is a legitimate worry. Second, hemangiomas are bloody tumors that are difficult to remove. They would have to open her chest again to get to the tumor. Thus, the risk of the surgery is significant. Given the risk and the questionable likelihood of restoring function, I can understand his reluctance to operate. Third, he did a posterior decompression. So, basically, the spinal cord is draped across the tumor. Your mother may recover some function over the coming months without further surgery.

    Well, it would be good to get the opinion of the other surgeons.

    Wise.

  6. #6
    My mother is concerned about more surgery and does not want to make her condition any worse. Hopefully, we will hear from the other doctors soon and I will post their replies.

  7. #7
    Dr. Sonntag has reviewed her scans and replied.

    ".....which all indicate the findings consistent with a stroke of the spinal cord. This usually means, unfortunately, there is minimal room for recovery, although persistent therapy should be carried out."


    This is not the reply I was hoping for but one that I expected. Dr. Janes is scheduled to review her records on May 1st so we will see what he makes of the situation.

  8. #8
    It would be good to hear what Dr. Jane says. Wise.

    Quote Originally Posted by bluegrass girl
    Dr. Sonntag has reviewed her scans and replied.

    ".....which all indicate the findings consistent with a stroke of the spinal cord. This usually means, unfortunately, there is minimal room for recovery, although persistent therapy should be carried out."


    This is not the reply I was hoping for but one that I expected. Dr. Janes is scheduled to review her records on May 1st so we will see what he makes of the situation.

  9. #9
    Dr. Jane has replied. ...I cannot identify a significant, compressive lesion and I am afraid that even if there were such a lesion that it would be very unlikely that your paraplegia would improve. .....

    Now the good news! On May 3rd my mom moved her toes on her left foot! The doctor at Frazier has re-evaluated her and she is now an ASIA C. This qualified her for the NRN program with the Locomat treadmill which she started at Frazier last week. She goes 5 days a week. On Friday she raised her left leg! There is movement in both hip flexors, knees and toes.

    With such dismal reports from all the doctors I am trying to stay realistic about the situation but I can't help but be excited!

    Everyday she stands in her EasyStand 45 minutes and rides the motomed 30 minutes and then goes on the Locomat 5 days. The locomotor training seems to be our only hope at this point. What are your thoughts on locomotor training? If you have written something on it could you reference it to me?

  10. #10
    Quote Originally Posted by bluegrass girl
    Dr. Jane has replied. ...I cannot identify a significant, compressive lesion and I am afraid that even if there were such a lesion that it would be very unlikely that your paraplegia would improve. .....

    Now the good news! On May 3rd my mom moved her toes on her left foot! The doctor at Frazier has re-evaluated her and she is now an ASIA C. This qualified her for the NRN program with the Locomat treadmill which she started at Frazier last week. She goes 5 days a week. On Friday she raised her left leg! There is movement in both hip flexors, knees and toes.

    With such dismal reports from all the doctors I am trying to stay realistic about the situation but I can't help but be excited!

    Everyday she stands in her EasyStand 45 minutes and rides the motomed 30 minutes and then goes on the Locomat 5 days. The locomotor training seems to be our only hope at this point. What are your thoughts on locomotor training? If you have written something on it could you reference it to me?
    This is good to hear. The locomat training is helpful.

    Wise.

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