Multiple Hereditary Exostoses with Tetraparesis Due To Cervical Spine Osteochondroma

Multiple Hereditary Exostoses with Tetraparesis Due To Cervical Spine Osteochondroma

Accepted Manuscript Multiple Hereditary Exostoses with Tetraparesis due to Cervical Spine Osteochondroma Ali Akhaddar, M.D., IFAANS, Mohamed Zyani, M...

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Accepted Manuscript Multiple Hereditary Exostoses with Tetraparesis due to Cervical Spine Osteochondroma Ali Akhaddar, M.D., IFAANS, Mohamed Zyani, M.D, Issam Rharrassi, M.D. PII:

S1878-8750(18)31031-3

DOI:

10.1016/j.wneu.2018.05.078

Reference:

WNEU 8139

To appear in:

World Neurosurgery

Received Date: 16 February 2018 Revised Date:

10 May 2018

Accepted Date: 11 May 2018

Please cite this article as: Akhaddar A, Zyani M, Rharrassi I, Multiple Hereditary Exostoses with Tetraparesis due to Cervical Spine Osteochondroma, World Neurosurgery (2018), doi: 10.1016/ j.wneu.2018.05.078. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Akhaddar

ACCEPTED MANUSCRIPT

Multiple Hereditary Exostoses with Tetraparesis due to Cervical Spine Osteochondroma

Authors:

Mohamed Zyani, M.D. Issam Rharrassi, M.D.

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Mohammed V University in Rabat, Rabat, Morocco

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Ali Akhaddar, M.D., IFAANS.

Department of Neurosurgery, Avicenne Military Hospital, Marrakech, Morocco

Corresponding Address:

Department of Neurosurgery, Avicenne Military Hospital, 40000, Marrakech, Morocco.

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Email address: [email protected]

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Telephone number: (212) 670. 94. 77. 39

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Conflict of Interest: None

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ACCEPTED MANUSCRIPT Abstract: This is a case report about a 34-year-old man with hereditary multiple exostoses presented with gradual tetraparesis. Neuroimaging evaluation revealed an important posterior spinal cord compression by a C3 bony formation. Following posterior microsurgical decompression,

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the patient recovered nearly completely. Histopathological examination of the intraspinal lesion confirmed the diagnosis of benign osteochondroma. The patient returned to a normal

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life without evidence of recurrence at 2-year follow-up.

Key words:

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compression, Surgery, Tetraparesis

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Cervical spine, Multiple hereditary exostoses, Myelopathy, Osteochondroma, Spinal cord

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Conflicts of interest: None.

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The author has no conflicts of interest to declare. (No funds were received in support of this study. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript).

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ACCEPTED MANUSCRIPT A 34-year-old man with hereditary multiple exostoses presented with gradual worsening upper and lower extremities weakness (tetraparesis) and pyramidal syndrome in both lower limbs without sphincter dysfunction. He had also multiple palpable exostoses over the bones of his four limbs. Radiographs demonstrated an osseous neck mass arising from the posterior

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cervical elements. Magnetic resonance imaging and computed tomography scans showed posterior spinal cord compression by an osteochondroma in the inner posterior arch of C3 vertebral level (Figure 1).

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Patient was operated through posterior approach and the lateral aspect of C3 lamina was drilled bilaterally. Complete enbloc excision of the exophytic lesion was performed (Figure

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2). He was discharged home with only minimal weakness with power of 4+/5 in upper limbs and 5/5 in the lower limbs without sensory loss. The motor deficits resolved nearly completely after 4 weeks of rehabilitation therapy. Histological examination of the operative specimen confirmed the diagnosis of benign osteochondroma (Figure 3). The patient returned

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to a normal life without evidence of recurrence at 2-year follow-up (Figure 4).

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ACCEPTED MANUSCRIPT Legend of Figures:

Figure 1. Sagittal magnetic resonance imaging on T1 (Figure 1A), T2 (Figure 1B), and on axial T2-weighted images (Figure 1C) showing the spinal cord compression by the mass

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arising from the C3 posterior cervical elements. Axial computed tomography scan of

the cervical spine demonstrating an osseous mass at the C3 vertebral level (Figure 1D). Figure 2. Macroscopic view of the well-encapsulate exophytic bone mass completely

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removed.

Figure 3. Microscopic view of the lesion. The cartilage cap of osteochondroma was

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composed of hyaline cartilage with adjacent endochondral ossification. Medium power magnification (Hematoxylin and eosin stain).

Figure 4. Postoperative sagittal magnetic resonance imaging on T1 (Figure 4A) and T2weighted images (Figure 4B) showing complete cervical spinal cord decompression without

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tumor recurrence.

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ACCEPTED MANUSCRIPT

ACCEPTED MANUSCRIPT - Osteochondromas are the most common benign bone tumor typically seen in the appendicular skeleton and are rarely found in the spine. - Most spinal lesions are sporadic and solitary, but multiple hereditary form (autosomal dominant) may be seen.

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- We present a 34-year-old man with hereditary multiple exostoses presented with gradual tetraparesis.

- Neuroimaging evaluation revealed an important posterior spinal cord compression by a C3

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bony formation.

- Following microsurgical decompression, the patient recovered nearly completely.

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- Histopathological examination of the intraspinal lesion confirmed the diagnosis of benign

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osteochondroma.