Fontaine D, Lot G, George B
Service de Neurochirurgie, Hopital Lariboisière, Paris, France.
Surg Neurol. 1999 Apr;51(4):435-41; discussion 441-2. doi: 10.1016/s0090-3019(98)00134-7.
Intramedullary cavernomas are rare lesions usually operated on via a posterior approach and myelotomy.
A 42-year-old woman progressively developed a tetraplegia with sphincter disturbances over a period of 26 years. Magnetic resonance imaging showed a cervical intramedullary cavernoma with an extramedullary anterolateral exophytic portion. To avoid myelotomy, this lesion was approached directly via its anterior exophytic portion. Through a cervical anterolateral approach, the vertebral body of C4 and the intervertebral discs were obliquely drilled out. The posterior longitudinal ligament and the dura mater were opened. The exophytic portion was coagulated and the intramedullary portion was completely excised. The dura mater was closed and a bone graft was inserted between C3 and C5 and secured with a plate.
After transient worsening, upper limb weakness improved from its preoperative status but paraparesis persisted after a follow-up of 12 months. The sphincter disturbances disappeared.
The anterolateral approach combined with oblique corpectomy may be an appropriate technique in case of anterior intramedullary cavernomas. It provides direct access to the lesion, avoiding additional myelotomy.
髓内海绵状血管瘤是罕见病变，通常通过后路手术和脊髓切开术进行治疗。
一名42岁女性在26年的时间里逐渐发展为四肢瘫痪并伴有括约肌功能障碍。磁共振成像显示为颈椎髓内海绵状血管瘤，伴有髓外前外侧外生性部分。为避免脊髓切开术，通过其前外侧外生性部分直接对该病变进行手术。经颈椎前外侧入路，斜行钻除C4椎体和椎间盘。打开后纵韧带和硬脑膜。对肿瘤外生性部分进行凝固，将髓内部分完全切除。关闭硬脑膜，并在C3和C5之间植入骨块并用钢板固定。
短暂病情恶化后，上肢无力较术前有所改善，但随访12个月后双下肢轻瘫仍然存在。括约肌功能障碍消失。
对于前位髓内海绵状血管瘤，前外侧入路联合斜行椎体次全切除术可能是一种合适的技术。它可直接到达病变部位，避免额外的脊髓切开术。
