Holtzman R N, Brisson P M, Pearl R E, Gruber M L
Division of Neurosurgery, Beth Israel Medical Center, New York, New York, USA.
J Neurosurg. 1999 Apr;90(2 Suppl):239-41. doi: 10.3171/spi.1999.90.2.0239.
This 56-year-old woman presented with a 1-year history of low-back pain, sciatica, and paresthesias in the right S-1 dermatome. On examination the patient was shown to have a right-sided Lasegue's sign, normal strength, hypalgesia in the right S-1 dermatome, and a slight diminution of the right Achilles tendon reflex. Magnetic resonance imaging revealed a 2-cm intradural enhancing lesion at the level of the L-4 vertebra. Laminectomy of L3-L5 vertebrae was performed, and intradural exploration disclosed a blueberry-appearing tumor that was surrounded by an intense arachnoiditis and attached to the right S-1 nerve root. A cystic collection of cerebrospinal fluid was seen caudal to the tumor. Complete removal required transection of the adherent nerve root fascicles. Histological analyses indicate that the lesion was a lobular capillary hemangioma, which, to the authors' knowledge, appears to be one of the first recorded examples of such a case.
这位56岁女性有1年的下背部疼痛、坐骨神经痛和右侧S-1皮节感觉异常病史。检查发现患者有右侧直腿抬高试验阳性、肌力正常、右侧S-1皮节痛觉减退以及右侧跟腱反射轻度减弱。磁共振成像显示L-4椎体水平有一个2厘米的硬膜内强化病变。进行了L3-L5椎体椎板切除术，硬膜内探查发现一个蓝莓样肿瘤，周围有严重的蛛网膜炎，且与右侧S-1神经根相连。在肿瘤尾侧可见一个脑脊液囊性聚集。完全切除需要横断粘连的神经根束。组织学分析表明该病变为小叶状毛细血管瘤，据作者所知，这似乎是此类病例中最早记录的例子之一。
