Kagaya H, Abe E, Sato K, Shimada Y, Kimura A
Department of Orthopedic Surgery, Akita University School of Medicine, Japan.
Spine (Phila Pa 1976). 2000 Jan 15;25(2):268-72. doi: 10.1097/00007632-200001150-00021.
Case report.
To present a rare case of a giant schwannoma of the cauda equina.
Giant spinal schwannoma of the cauda equina, which involves many nerve roots, is rare and there is usually no ossification in the schwannoma. It is unknown whether or not complete excision is preferable if the tumor is located in the lumbar lesion.
A 57-year-old woman had a 10-year history of low back pain. Scalloping of the posterior surface of the vertebral bodies from L3 to the sacrum was found. Magnetic resonance imaging disclosed a giant cauda equina tumor with multiple cysts. Central ossification revealed by computed tomography and an unusual myelogram made the preoperative diagnosis difficult.
The patient underwent incomplete removal of the tumor, decompression of cysts, and spinal reconstruction. The tumor was proved to be a schwannoma. The postoperative course was uneventful and she has been almost free from low back pain for 3 years and 4 months.
Giant schwannoma in the lumbar spine region is usually excised incompletely, because complete removal had the risk of sacrificing many nerve roots. In spite of the incomplete removal of the tumor, the risk of recurrence is low.
病例报告。
报告一例罕见的马尾神经鞘瘤病例。
累及多个神经根的马尾神经巨大鞘瘤较为罕见，且神经鞘瘤通常无骨化。如果肿瘤位于腰椎病变部位，是否进行完整切除更优尚不清楚。
一名57岁女性有10年的腰痛病史。发现从L3至骶骨椎体后缘呈扇贝样改变。磁共振成像显示一个伴有多个囊肿的巨大马尾神经肿瘤。计算机断层扫描显示中央骨化以及异常的脊髓造影使得术前诊断困难。
患者接受了肿瘤的不完全切除、囊肿减压及脊柱重建。肿瘤被证实为神经鞘瘤。术后过程平稳，她在3年4个月的时间里几乎没有腰痛。
腰椎区域的巨大神经鞘瘤通常进行不完全切除，因为完整切除有牺牲多个神经根的风险。尽管肿瘤切除不完全，但复发风险较低。
