Asano S, Kawahara N, Kirino T
Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
Acta Neurochir (Wien). 2003 Jul;145(7):599-603; discussion 603. doi: 10.1007/s00701-003-0057-7.
Following recent progress in radiological and surgical techniques for treating skull base tumours, more attention should be paid to the relatively rare phenomenon of intradural spinal seeding in cases of clival chordoma.
A 53-year-old man harboured intradural spinal seeding from a clival chordoma 11 years after his initial surgical treatment. He had undergone skull base surgery five times with extra- and intradural approaches, and adjuvant radiotherapy. His complaints of lumbago, paraparesis, and sensory disturbance of the lower left extremity prompted us to carry out imaging studies of the spinal cord, which revealed multiple intradural, extramedullary mass lesions at the thoracic and lumbosacral spinal level. The tumours were histopathologically diagnosed as spinal seeding of the clival chordoma with high proliferative potential (Ki-67 labelling index of 8.4%).
As long-term local control of skull base chordoma appears to be improving by the introduction of skull base surgical techniques and adjuvant radiotherapy, spinal intradural seeding might emerge as a potential complication. Close observation and timely imaging studies for spinal seeding of skull base chordoma would be required in long-term postoperative follow-ups, particularly for those patients with highly proliferative tumours.
随着近期颅底肿瘤放射学和外科治疗技术的进展，对于斜坡脊索瘤病例中相对罕见的硬脊膜内脊髓播散现象应给予更多关注。
一名53岁男性在初次手术治疗11年后出现斜坡脊索瘤的硬脊膜内脊髓播散。他曾接受过5次颅底手术，采用了硬膜外和硬膜内入路，并接受了辅助放疗。他的腰痛、双下肢轻瘫以及左下肢感觉障碍促使我们对脊髓进行影像学检查，结果显示在胸段和腰骶段脊髓水平有多个硬脊膜内、髓外肿块病变。肿瘤经组织病理学诊断为斜坡脊索瘤的脊髓播散，具有较高的增殖潜能（Ki-67标记指数为8.4%）。
随着颅底手术技术和辅助放疗的引入，颅底脊索瘤的长期局部控制似乎有所改善，脊髓硬脊膜内播散可能成为一种潜在并发症。在长期术后随访中，尤其是对于那些具有高增殖性肿瘤的患者，需要密切观察并及时对颅底脊索瘤的脊髓播散进行影像学检查。
