array:21 [
  "pii" => "S2529849624000583"
  "issn" => "25298496"
  "doi" => "10.1016/j.neucie.2024.10.001"
  "estado" => "S200"
  "fechaPublicacion" => "2024-10-29"
  "aid" => "629"
  "copyright" => "The Author(s)"
  "copyrightAnyo" => "2024"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "crp"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemAnterior" => array:16 [
    "pii" => "S2529849624000352"
    "issn" => "25298496"
    "doi" => "10.1016/j.neucie.2024.06.003"
    "estado" => "S200"
    "fechaPublicacion" => "2024-07-11"
    "aid" => "615"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Clinical Research</span>"
      "titulo" => "Integrating endovascular techniques into established open neurosurgery practice&#58; a temporal analysis of treatment evolution in a dual-trained neurosurgical unit"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Integraci&#243;n de t&#233;cnicas endovasculares en la pr&#225;ctica de la neurocirug&#237;a abierta&#58; an&#225;lisis temporal de la evoluci&#243;n del tratamiento en una unidad de neurocirug&#237;a vascular dual"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1526
              "Ancho" => 2508
              "Tamanyo" => 226263
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0005"
              "detalle" => "Fig&#46; "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The graph illustrates the evolution of treatment modality preferences over time&#44; as represented by the rolling average proportion of EN &#40;ENDO&#41; and ON &#40;OPEN&#41; neurosurgical procedures&#46; The navy blue line indicates the proportion of OPEN procedures&#44; while the crimson line represents the ENDO procedures&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ignacio Arrese, Sergio Garc&#237;a-Garc&#237;a, Santiago Cepeda, Rosario Sarabia"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Ignacio"
              "apellidos" => "Arrese"
            ]
            1 => array:2 [
              "nombre" => "Sergio"
              "apellidos" => "Garc&#237;a-Garc&#237;a"
            ]
            2 => array:2 [
              "nombre" => "Santiago"
              "apellidos" => "Cepeda"
            ]
            3 => array:2 [
              "nombre" => "Rosario"
              "apellidos" => "Sarabia"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849624000352?idApp=UINPBA00004B"
    "url" => "/25298496/unassign/S2529849624000352/v1_202407110420/en/main.assets"
  ]
  "en" => array:17 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
    "titulo" => "Cauda equina malignant peripheral nerve sheath tumor presenting with subarachnoid hemorrhage&#58; a case report"
    "tieneTextoCompleto" => true
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Rafael Aponte-Caballero, Julian Alfonso Sierra-Pe&#241;a, Juan Felipe Abaunza-Camacho, William Mauricio Riveros-Castillo, Javier M&#46; Saavedra"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "Rafael"
            "apellidos" => "Aponte-Caballero"
            "email" => array:1 [
              0 => "rafael.aponte@urosario.edu.co"
            ]
            "referencia" => array:5 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
              4 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Julian Alfonso"
            "apellidos" => "Sierra-Pe&#241;a"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Juan Felipe"
            "apellidos" => "Abaunza-Camacho"
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "William Mauricio"
            "apellidos" => "Riveros-Castillo"
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Javier M&#46;"
            "apellidos" => "Saavedra"
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Center for Research and Training in Neurosurgery &#40;CIEN&#41;&#44; Bogot&#225;&#44; Colombia"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Department of Neurosurgery&#44; Hospital Universitario Mayor M&#233;deri&#44; Bogot&#225;&#44; Colombia"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Department of Neurosurgery&#44; Hospital Universitario de la Samaritana&#44; Bogot&#225;&#44; Colombia"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Universidad del Rosario School of Medicine and Health Sciences&#44; Bogot&#225;&#44; Colombia"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 916
            "Ancho" => 3508
            "Tamanyo" => 290970
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lumbar spine MRI sagittal view&#44; T1 and T2-weighted &#40;panel A&#44; B&#41; exhibiting an intradural lesion from L3 to L5 appearing isointense to CSF on T1 and hypointense on T2&#46; On the bottom of the thecal sac&#44; a slight hyperintense on T1 and low signal level on T2-weighted suggested subacute subarachnoid bleeding &#40;White circle&#41;&#46; The gadolinium-enhanced T1-weighted sagittal view &#40;panel C&#41; shows a peripheral enhancement of the intradural lesion&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The 8-month postoperative lumbar spine T2 and gadolinium-enhanced T1-weighted MRI sagittal views exhibited surgical and radiation therapy inflammatory changes without tumor recurrence &#40;panels D and E&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Malignant peripheral nerve sheath tumors &#40;MPNST&#41; are highly malignant soft tissue neoplasms that originate from the mesenchymal cells residing within the nerve sheath&#44; in most cases from Schwann cells&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> MPNST predominantly affect young people &#40;&#60;40 years old&#41;&#44; are associated with type I neurofibromatosis &#40;NF&#41; in 54&#37; of cases and are commonly found in the extremities&#44; trunk&#44; head&#44; and neck&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a> Patients with MPNST have a poor prognosis with a 5-year survival rate from 16&#37; to 44&#37; with a local recurrence expected in 38&#8211;45&#37; of cases&#46; Metastases are also frequent&#44; mainly to the lungs&#44; liver and brain &#40;42&#46;3&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">MPNST are a rare entity with an incidence of 0&#46;001&#37; that represent only 5&#37; of all soft-tissue sarcomas&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Spinal MPNST correspond to 2&#8211;3&#37; of all cases&#44; with only 6 cases of intradural lumbar MPNST reported in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Their clinical presentation and diagnostic work-up can be misleading due to the symptomatic and imaging overlap with lumbar disc herniation&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> To our knowledge&#44; this is the first case of a patient who presented with spinal subarachnoid hemorrhage &#40;SSAH&#41; secondary to an intradural MPNST&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case description</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 72-year-old man presented to the emergency department with 2 weeks of severe lower back pain that had exacerbated over the past two days&#46; His medical history was positive for being a heavy smoker and presenting non-quantified weight loss in the previous 6 months&#46; The patient did not have a parent with a type 1 NF diagnosis nor any clinical criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Neurological examination was unremarkable&#46; Complete blood count&#44; urinalysis&#44; and acute phase reactants were normal&#46; Lumbar spine X-ray exhibited spondylotic changes without other important findings&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A Gadolinium-enhanced lumbar spine MRI was performed&#46; MRI showed an irregularly shaped intradural lesion extending from L3 to L5 with a maximum length of 4&#46;5&#8239;cm&#46; The lesion exhibited a medium signal on T1 and hypointense on T2-weighted imaging with peripheral and irregular enhancement&#46; A particular finding at the bottom of the thecal sac suggested subarachnoid hemorrhage according to a slightly hyperintense level on T1 and low-signal level on T2-weighted imaging corresponding to subacute bleed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Spinal vascular malformation was considered as a differential diagnosis&#44; but spinal digital subtraction angiography showed no evidence&#46; A complete spinal MRI was performed excluding the presence of other tumors&#46; The treatment decision was surgical resection with intraoperative neurophysiological monitoring &#40;IONM&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Through an L3 to L5 laminectomy and midline durotomy&#44; a diffuse subarachnoid hemorrhage with a xanthochromatic cerebrospinal fluid &#40;CSF&#41; was found&#46; After sterile saline solution continuous irrigation&#44; a clear CSF returned was obtained&#46; A tumor tightly adherent to cauda equina nerve roots of approximately 3&#8239;cm was identified&#46; Areas of highly vascular supply were found during resection&#46; Gross total resection was achieved and IONM did not exhibit changes during tumor resection&#46; Bone samples were sent to pathology study searching for a free margin resection&#44; achieving samples free of tumor infiltration and confirming the GTR&#46; Due to the risk of spinal deformity&#44; an L3 to L5 open transpedicular fixation was completed&#46; The patient was discharged without neurological deficit and improved pain control&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Specimen examination revealed a fusocelular tumor with pleomorphic and hyperchromatic nuclei&#44; cytological atypia&#44; hypercellularity&#44; &#62;5 mitoses&#47;mm<span class="elsevierStyleSup">2</span>&#44; hemorrhage and necrosis&#46; Immunohistochemical study was positive for S100 and SOX10 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; In addition&#44; the Ki67 proliferative index was 15&#37;&#46; A diagnosis of MPNST was made&#46; Moreover&#44; bone and cartilage tissues were negative for malignancy&#46; A thoraco-abdominal CT ruled out the presence of metastases&#46; The patient underwent 25 sessions of external beam radiotherapy without adverse events with a total dose of 50&#8239;Gy&#46; At 8-months of follow-up the patient remained without neurological deficit or pain with functional independency &#40;Karnofsky performance score of 90 points&#41;&#46; A follow-up lumbar spine contrast enhanced MRI showed soft-tissues radiation changes without recurrence of lesion&#44; and the image at the thecal sac that suggested SAH disappeared &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">MPNSTs are uncommon&#44; aggressive neoplasms commonly associated with NF1 and typically present in young individuals&#46; They represent only 5&#37; of all soft-tissue sarcomas&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;7</span></a> In 2022&#44; Cao&#44; et al&#59; performed a literature review on intradural spinal MPNST finding 55 patients&#46; Remarkably&#44; none of these cases had a subarachnoid hemorrhage as a surgical finding&#44; and only in 6 patients the tumor was located at the lumbar spine&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A brief summary of the patients&#8217; characteristics with lumbar spine intradural MPNST are shown and compared in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The most frequent clinical presentation of spinal canal MPNST is characterized by local or radicular pain and motor disturbances&#46; The mean duration from onset of symptoms to preoperative diagnosis is 12&#46;6 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;9</span></a> On Gadolinium-enhanced lumbar spine MRI&#44; MPNST usually appears as isointense on T1 and T2-weighted imaging&#44; and the diameter varies from 1 to 9&#8239;cm&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;6</span></a> The irregular shape and the low level singal at the bottom of the thecal sac were signals of subarachnoid hemorrhage&#46; Our case presents notable findings in terms of the patient&#39;s age&#44; acute onset of symptoms&#44; and the unique evidence of surgical subarachnoid hemorrhage &#40;SSAH&#41;&#46; The acute debut in our case could be explained by hemorrhage with secondary subarachnoid extension of the blood creating increase in the local pressure and roots irritation as the cause of back pain&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Moreover&#44; despite recent reviews on MPNST reporting clinical and radiological findings&#44; it remains a rare entity and its diagnosis needs a thorough work-up&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In the reported cases of MPNST by Zhao et al&#46; and Wang et al&#46; the initial diagnosis was a disc herniation based on symptoms&#44; radiological findings&#44; and surgical evidence until the pathology results were obtained&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;10</span></a> However&#44; in our case&#44; the diagnostic work-up lead towards a tumor etiology due to the presence of an intradural lesion with diffuse contrast enhancement&#44; and intraoperative SSAH finding&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Among spinal hematomas&#44; SSAH has a very low frequency&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> This presentation is usually related to intracranial hemorrhage secondary to trauma or aneurysm rupture&#44; spinal tumors&#44; and less commonly coagulopathies and spinal trauma&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Furthermore&#44; intraoperative evidence of SSAH is an infrequent finding during tumor removal&#46; Kreppel et al&#46; made a review of different types of spinal hemorrhage&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> When SSAHs was tumor-related&#44; the main types of tumor were ependymoma&#44; neurofibroma&#44; and astrocytoma&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> To our knowledge&#44; this is the first report of SSAH related to intradural lumbar spine MPNST&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Besides the scarce literature&#44; the mainstay of treatment in MPNST is surgical resection&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a> An aggressive resection provides local control and have been related with better outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> In cases involving extensive bone removal for complete tumoral resection&#44; spinal fixation is necessary to mitigate the risk of postoperative deformity&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Adjuvant radiotherapy has been recommended to improve local control&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However&#44; regardless of gross total resection and adjuvant radiotherapy&#44; the reported 5-year survival rates vary from 16&#37; to 44&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In the systematic review by Cao et al&#46; of intradural MPNST The patients older than 30 years old and without metastases at diagnosis had better relapse-free survival and total survival period&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Lumbar intradural MPNST is a rare etiology&#46; The diagnosis might be challenging and initially considered in youth and NF I patients&#46; Even lumbar disc herniation can mimic its clinical presentation&#46; SSAH is a surgical novel finding on MPNST&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Consent to participate</span><p id="par0065" class="elsevierStylePara elsevierViewall">Signed informed consent by the patient&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Code availability</span><p id="par0070" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Ethics approval</span><p id="par0075" class="elsevierStylePara elsevierViewall">Institutional board&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Consent for publication</span><p id="par0080" class="elsevierStylePara elsevierViewall">Signed and consented publication by the patient&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Funding</span><p id="par0085" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Availability of data and material</span><p id="par0090" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:15 [
        0 => array:3 [
          "identificador" => "xres2283895"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1900089"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres2283894"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1900088"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case description"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusion"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Consent to participate"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Code availability"
        ]
        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Ethics approval"
        ]
        11 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Consent for publication"
        ]
        12 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Funding"
        ]
        13 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Availability of data and material"
        ]
        14 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2024-05-05"
    "fechaAceptado" => "2024-09-28"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1900089"
          "palabras" => array:3 [
            0 => "Cauda equina"
            1 => "Subarachnoid hemorrhage"
            2 => "Malignant peripheral nerve sheat tumor"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1900088"
          "palabras" => array:3 [
            0 => "Cauda equina"
            1 => "Hemorragia subaracnoidea"
            2 => "Tumor maligno de la vaina del nervio perif&#233;rico"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Malignant peripheral nerve sheath tumors &#40;MPNST&#41; are uncommon aggressive neoplasms&#44; frequently associated with type I neurofibromatosis&#46; This is the first case of intradural lumbar spine MPNST with intraoperative findings of associated subarachnoid hemorrhage &#40;SAH&#41;&#46; A 72-year-old man presented to the emergency department with severe acute low back pain&#46; Neurological examination was unremarkable&#46; Gadolinium-enhanced MRI of the lumbar spine showed an irregularly shaped intradural lesion extending from L3 to L5&#46; The lesion exhibited a medium signal both on T1 and T2-weighted imaging with peripheral enhancement&#46; Through an L3-L5 laminectomy&#44; a diffuse SAH&#44; and a tumor tightly adherent to cauda equina nerve roots were found&#46; Specimen examination revealed a fusocelular tumor with pleomorphic and hyperchromatic nuclei&#44; positive for S100&#44; and SOX10&#46; On an 8-month follow-up&#44; he had no neurological deficit&#44; with a Karnofsky performance score of 90 points&#46; Surgical evidence of SAH in lumbar spine intradural MPNST is a novel finding&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los tumores malignos de la vaina del nervio perif&#233;rico &#40;TMVNP&#41; son raros&#44; agresivos y suelen asociarse con neurofibromatosis tipo I&#46; Presentamos el primer caso de un TMVNP lumbar intradural con hallazgos intraoperatorios de hemorragia subaracnoidea &#40;HSA&#41;&#46; Un hombre de 72 a&#241;os consulta a urgencias con intenso dolor lumbar&#44; pero con examen neurol&#243;gico normal&#46; En la RM contrastada con gadolinio&#44; se observ&#243; una lesi&#243;n irregular intradural que se extend&#237;a de L3 a L5 con se&#241;al intermedia en T1 y T2&#44; con captaci&#243;n de contraste perif&#233;rico&#46; Durante la laminectom&#237;a de L3-L5&#44; se encontr&#243; HSA difusa y un tumor adherente a los nervios de la cauda equina&#46; El esp&#233;cimen tumoral mostr&#243; n&#250;cleos pleom&#243;rficos e hipercrom&#225;ticos positivos para S100 y SOX10&#46; Tras 8 meses de seguimiento&#44; el paciente carece de d&#233;ficit neurol&#243;gico y punt&#250;a 90 en la escala de rendimiento Kanofsky&#46; La evidencia de HSA en TMVNP intradural lumbar es un hallazgo novedoso&#46;</p></span>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 916
            "Ancho" => 3508
            "Tamanyo" => 290970
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lumbar spine MRI sagittal view&#44; T1 and T2-weighted &#40;panel A&#44; B&#41; exhibiting an intradural lesion from L3 to L5 appearing isointense to CSF on T1 and hypointense on T2&#46; On the bottom of the thecal sac&#44; a slight hyperintense on T1 and low signal level on T2-weighted suggested subacute subarachnoid bleeding &#40;White circle&#41;&#46; The gadolinium-enhanced T1-weighted sagittal view &#40;panel C&#41; shows a peripheral enhancement of the intradural lesion&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The 8-month postoperative lumbar spine T2 and gadolinium-enhanced T1-weighted MRI sagittal views exhibited surgical and radiation therapy inflammatory changes without tumor recurrence &#40;panels D and E&#41;&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2090
            "Ancho" => 3341
            "Tamanyo" => 1607021
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The pathological specimen on hematoxylin-eosin staining showed cellular atypia&#44; hemorrhage&#44; necrosis&#44; and elevated mitotic count &#40;panels A and B&#41;&#46; The immunohistochemical study was positive for S100 and SOX10 &#40;panel C and D&#41;&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">MPNST&#58; Malignant peripheral nerve sheath tumor&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Adapted From&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Chen J&#44; Zheng Y&#44; Chen Z&#44; Fan F&#44; Wang Y&#46; Clinical presentation and long-term outcome of primary spinal intradural malignant peripheral nerve sheath tumors&#46; <span class="elsevierStyleItalic">Clin Neurol Neurosurg</span>&#46; 2019&#59;185&#46; doi&#58;10&#46;1016&#47;j&#46;clineuro&#46;2019&#46;105484&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Location&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age &#40;year&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">History &#40;Months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Maximum diameter &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Follow-up times &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recurrence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Metastasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outcomes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Present case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L3-L5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Low back pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chen et al</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2019</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L3-S1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right lower extremity numbness and weakness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lung&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Died&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L3-L4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Low back pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Died&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yone et al&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L3-L5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left lower extremity pain&#44; low back pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes &#40;at 6 months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brain&#44; spinal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Died&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Celli et al</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1995</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pain&#44; motor disturbance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Seppala et al&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1993&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lumbar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Low back pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Died&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3703758.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Demographic&#44; clinical characteristics&#44; follow-up and prognosis of the primary sporadic intradural MPNSTs in the lumbar Spinal canal&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:12 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant peripheral nerve sheath tumor of the cauda equina with craniospinal metastasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;G&#46; Thomas"
                            1 => "C&#46; Lincoln"
                            2 => "J&#46; Clay Goodman"
                            3 => "S&#46;P&#46; Gopinath"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jocn.2014.02.028"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Clin Neurosci"
                        "fecha" => "2014"
                        "volumen" => "21"
                        "numero" => "12"
                        "paginaInicial" => "2239"
                        "paginaFinal" => "2242"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24986157"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant peripheral nerve sheath tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Gupta"
                            1 => "A&#46; Maniker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/foc.2007.22.6.13"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurosurg Focus"
                        "fecha" => "2007"
                        "volumen" => "22"
                        "numero" => "6"
                        "paginaInicial" => "1"
                        "paginaFinal" => "8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology&#44; characteristic&#44; and prognostic factors of primary sporadic intradural malignant peripheral nerve sheath tumor in the spinal canal&#58; a systematic literature review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Cao"
                            1 => "Y&#46;B&#46; Wang"
                            2 => "Y&#46; Bai"
                            3 => "X&#46;Y&#46; Tan"
                            4 => "C&#46;Y&#46; Ma"
                            5 => "Y&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3389/FONC.2022.911043/BIBTEX"
                      "Revista" => array:4 [
                        "tituloSerie" => "Front Oncol"
                        "fecha" => "2022"
                        "volumen" => "12"
                        "paginaInicial" => "3334"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment and survival differences across tumor sites in malignant peripheral nerve sheath tumors&#58; a SEER database analysis and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Martin"
                            1 => "I&#46;S&#46; Muskens"
                            2 => "J&#46;H&#46; Coert"
                            3 => "T&#46;R&#46; Smith"
                            4 => "M&#46;L&#46;D&#46; Broekman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/nop/npy025"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neuro-Oncology Pract"
                        "fecha" => "2019"
                        "volumen" => "6"
                        "numero" => "2"
                        "paginaInicial" => "134"
                        "paginaFinal" => "143"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant peripheral nerve sheath tumours - Report of 8 cases and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;M&#46; Stark"
                            1 => "R&#46; Buhl"
                            2 => "H&#46;H&#46; Hugo"
                            3 => "H&#46;M&#46; Mehdorn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s007010170090"
                      "Revista" => array:7 [
                        "tituloSerie" => "Acta Neurochir &#40;Wien&#41;"
                        "fecha" => "2001"
                        "volumen" => "143"
                        "numero" => "4"
                        "paginaInicial" => "357"
                        "paginaFinal" => "364"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11437289"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The diagnostic pitfalls of lumbar disc herniation---- malignant sciatic nerve tumour&#58; two case reports and literature review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46; Zhao"
                            1 => "J&#46; Wei"
                            2 => "C&#46; Wan"
                            3 => "S&#46; Han"
                            4 => "H&#46; Sun"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s12891-021-04728-1"
                      "Revista" => array:4 [
                        "tituloSerie" => "BMC Musculoskelet Disord"
                        "fecha" => "2021"
                        "volumen" => "22"
                        "numero" => "1"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical presentation and long-term outcome of primary spinal intradural malignant peripheral nerve sheath tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Chen"
                            1 => "Y&#46; Zheng"
                            2 => "Z&#46; Chen"
                            3 => "F&#46; Fan"
                            4 => "Y&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clineuro.2019.105484"
                      "Revista" => array:3 [
                        "tituloSerie" => "Clin Neurol Neurosurg"
                        "fecha" => "2019"
                        "paginaInicial" => "185"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Revised diagnostic criteria for neurofibromatosis type 1 and Legius syndrome&#58; an international consensus recommendation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Legius"
                            1 => "L&#46; Messiaen"
                            2 => "P&#46; Wolkenstein"
                            3 => "P&#46; Pancza"
                            4 => "R&#46;A&#46; Avery"
                            5 => "Y&#46; Berman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/S41436-021-01170-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Genet Med"
                        "fecha" => "2021"
                        "volumen" => "23"
                        "numero" => "8"
                        "paginaInicial" => "1506"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34012067"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intraosseous malignant peripheral nerve sheath tumor of 2 consecutive lumbar vertebrae&#58; a case report and literature review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46; Liu"
                            1 => "S&#46; Zhang"
                            2 => "J&#46; Liu"
                            3 => "Z&#46; Shao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/J.WNEU.2019.07.117"
                      "Revista" => array:6 [
                        "tituloSerie" => "World Neurosurg"
                        "fecha" => "2019"
                        "volumen" => "130"
                        "paginaInicial" => "459"
                        "paginaFinal" => "466"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31349078"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Giant intrapelvic malignant peripheral nerve sheath tumor mimicking disc herniation&#58; a case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Wang"
                            1 => "C&#46; Chen"
                            2 => "X&#46; Xin"
                            3 => "B&#46; Liu"
                            4 => "W&#46; Li"
                            5 => "D&#46; Yin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3892/mco.2016.1030"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mol Clin Oncol"
                        "fecha" => "2016"
                        "volumen" => "5"
                        "paginaInicial" => "653"
                        "paginaFinal" => "656"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27900106"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spinal hematomas&#58; What a radiologist needs to know"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Pierce"
                            1 => "J&#46;H&#46; Donahue"
                            2 => "N&#46;C&#46; Nacey"
                            3 => "C&#46;R&#46; Quirk"
                            4 => "M&#46;T&#46; Perry"
                            5 => "N&#46; Faulconer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/rg.2018180099"
                      "Revista" => array:7 [
                        "tituloSerie" => "Radiographics"
                        "fecha" => "2018"
                        "volumen" => "38"
                        "numero" => "5"
                        "paginaInicial" => "1516"
                        "paginaFinal" => "1535"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30207937"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spinal hematoma&#58; a literature survey with meta-analysis of 613 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Kreppel"
                            1 => "G&#46; Antoniadis"
                            2 => "W&#46; Seeling"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10143-002-0224-y"
                      "Revista" => array:7 [
                        "tituloSerie" => "Neurosurg Rev"
                        "fecha" => "2003"
                        "volumen" => "26"
                        "numero" => "1"
                        "paginaInicial" => "1"
                        "paginaFinal" => "49"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12520314"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/25298496/unassign/S2529849624000583/v1_202410291640/en/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/25298496/unassign/S2529849624000583/v1_202410291640/en/main.pdf?idApp=UINPBA00004B&text.app=https://revistaneurocirugia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849624000583?idApp=UINPBA00004B"
]
Share
Journal Information
Share
Share
Download PDF
More article options
Case Report
Available online 29 October 2024
Cauda equina malignant peripheral nerve sheath tumor presenting with subarachnoid hemorrhage: a case report
Rafael Aponte-Caballeroa,b,c,d,
Corresponding author
rafael.aponte@urosario.edu.co

Corresponding author.
, Julian Alfonso Sierra-Peñaa, Juan Felipe Abaunza-Camachoa,b,c,d, William Mauricio Riveros-Castilloa,b,c,d, Javier M. Saavedraa,b,c,d
a Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
b Department of Neurosurgery, Hospital Universitario Mayor Méderi, Bogotá, Colombia
c Department of Neurosurgery, Hospital Universitario de la Samaritana, Bogotá, Colombia
d Universidad del Rosario School of Medicine and Health Sciences, Bogotá, Colombia
Received 05 May 2024. Accepted 28 September 2024
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (2)
Tables (1)
Table 1. Demographic, clinical characteristics, follow-up and prognosis of the primary sporadic intradural MPNSTs in the lumbar Spinal canal.
Abstract

Malignant peripheral nerve sheath tumors (MPNST) are uncommon aggressive neoplasms, frequently associated with type I neurofibromatosis. This is the first case of intradural lumbar spine MPNST with intraoperative findings of associated subarachnoid hemorrhage (SAH). A 72-year-old man presented to the emergency department with severe acute low back pain. Neurological examination was unremarkable. Gadolinium-enhanced MRI of the lumbar spine showed an irregularly shaped intradural lesion extending from L3 to L5. The lesion exhibited a medium signal both on T1 and T2-weighted imaging with peripheral enhancement. Through an L3-L5 laminectomy, a diffuse SAH, and a tumor tightly adherent to cauda equina nerve roots were found. Specimen examination revealed a fusocelular tumor with pleomorphic and hyperchromatic nuclei, positive for S100, and SOX10. On an 8-month follow-up, he had no neurological deficit, with a Karnofsky performance score of 90 points. Surgical evidence of SAH in lumbar spine intradural MPNST is a novel finding.

Keywords:
Cauda equina
Subarachnoid hemorrhage
Malignant peripheral nerve sheat tumor
Resumen

Los tumores malignos de la vaina del nervio periférico (TMVNP) son raros, agresivos y suelen asociarse con neurofibromatosis tipo I. Presentamos el primer caso de un TMVNP lumbar intradural con hallazgos intraoperatorios de hemorragia subaracnoidea (HSA). Un hombre de 72 años consulta a urgencias con intenso dolor lumbar, pero con examen neurológico normal. En la RM contrastada con gadolinio, se observó una lesión irregular intradural que se extendía de L3 a L5 con señal intermedia en T1 y T2, con captación de contraste periférico. Durante la laminectomía de L3-L5, se encontró HSA difusa y un tumor adherente a los nervios de la cauda equina. El espécimen tumoral mostró núcleos pleomórficos e hipercromáticos positivos para S100 y SOX10. Tras 8 meses de seguimiento, el paciente carece de déficit neurológico y puntúa 90 en la escala de rendimiento Kanofsky. La evidencia de HSA en TMVNP intradural lumbar es un hallazgo novedoso.

Palabras clave:
Cauda equina
Hemorragia subaracnoidea
Tumor maligno de la vaina del nervio periférico

Article

These are the options to access the full texts of the publication Neurocirugía (English edition)
Member
Member of the Sociedad Española de Neurocirugía

If it is the first time you have accessed you can obtain your credentials by contacting Elsevier Spain in suscripciones@elsevier.com or by calling our Customer Service at902 88 87 40 if you are calling from Spain or at +34 932 418 800 (from 9 to 18h., GMT + 1) if you are calling outside of Spain.

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option ¿I have forgotten my password¿.

Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

Neurocirugía (English edition)

Purchase
Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
Email
Idiomas
Neurocirugía (English edition)
Article options
Tools