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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Differential diagnosis of calcified spinal lesions: Calcifying pseudoneoplasms of the neuraxis (CAPNON) – meta-analysis of all published spinal cases

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  • Sebastian Lücke - Department of Neurosurgery, Knappschafts Hospital Langendreer, Ruhr-University Bochum, Bochum, Germany
  • Amr N. Abdulazim - Department of Neuroanatomy and Molecular Brain Research, Ruhr-University Bochum, Bochum, Germany
  • Oliver P. Gautschi - Department of Neurosurgery, Geneva University Medical Center, University of Geneva, Geneva, Switzerland
  • T. Marcel Schneiderhan - Department of Neuropathology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
  • Gerhard Hildebrandt - Clinic for Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland
  • Martin N. Stienen - Clinic for Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocP 121

doi: 10.3205/13dgnc538, urn:nbn:de:0183-13dgnc5389

Published: May 21, 2013

© 2013 Lücke et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

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Objective: Among calcified spinal lesions, herniated disc fragments, synovial cysts, neurinomas, and psammomatous meningiomas should be taken into account. Furthermore, epidural abcesses and old calcified haematomas can appear calcified. Calcifying pseudoneoplasms of the neuraxis (CAPNON) constitute another differential diagnosis that occur in the spinal canal. Nineteen patients have been described since their initial description in 1978.

Method: We performed a meta-analysis of all so far published cases. Here, study type, anatomical area, clinical presentation, radiological presentation, therapy, duration of follow-up, incidence and type of complication, and outcome were analysed. We discuss current recommendations for the management of spinal CAPNON.

Results: A total of 19 patients with spinal CAPNON were analysed. All patients were treated surgically. The location of the spinal CAPNON was in the region of the foramen magnum in three cases (15.8 %), cervical in seven cases (36.8 %), thoracic in four cases (21.1 %), and lumbar in five cases (26.3 %). The most common clinical presentation was diffuse neck and/or back pain in 11 cases (57.9 %). Spinal CAPNON appeared hypointense in both T1- and T2-weighted MRI in seven of eight reported cases (87.5 %) and isointense in one further patient (12.5 %). On application of contrast medium, the lesion displayed enhancement in five of seven cases (71.4 %). Complete excision of the lesion was performed in 6 cases (31.6 %), and incomplete excision was performed in 12 cases (63.2 %). A median follow-up of 42.0 months (range: 16–112 months) was provided in 13 of 19 cases (68.4 %). While 12 of 13 patients were reported recurrence-free (92.31 %), one patient with an incomplete excision showed a disease recurrence with local progression of the pre-existing lesion at the 24-month follow-up. A one-tailed Fisher's exact test revealed no significant difference between complete and incomplete resection in terms of disease recurrence (p = 0.6842).

Conclusions: Calcifying pseudoneoplasms are rare benign lesions of yet unknown origin. CAPNON should be taken into consideration in the differential diagnosis of spinal calcified lesions. Although complete excision should be aimed at, incomplete excision may lead to good outcome as well.