Bunc Gorazd, Kramberger Slavko, Kovacic Srecko, Seruga Tomaz, Vorsic Matjaz
Department of Neurosurgery, Maribor Teaching Hospital, Maribor, Slovenia.
Wien Klin Wochenschr. 2004;116 Suppl 2:93-6.
Giant invasive spinal schwannoma is a new term proposed by Sridhar in 2001 for a particularly aggressive type of benign spinal schwannoma. Only a few cases have been published, the majority of these located in the lumbosacral spine, two in the thoracic and only one in the cervical spine. A rare case of such a tumor is presented. The tumor predominantly occupied level L1 and partially levels T12 and L2, and recurred 13 years after the first seemingly radical excision of a benign melanotic schwannoma. The highly vascularized tumor was radically excised using the dorsal approach, and a Sokon transpeduncular fixation was performed. Carter's lateral thoraco-abdominal access allowed the retroperitoneal and intravertebral expansions of the tumor to be removed and L1 corpectomy to be accomplished. Ventral vertebral stabilization was achieved with a titanium cage. After the operation, the pain in the patient's left leg subsided. Three years after the management, he is still pain-free, able to walk freely and to resume his usual daily activities.
巨大侵袭性脊柱神经鞘瘤是斯里达尔于2001年提出的一个新术语,用于描述一种特别具有侵袭性的良性脊柱神经鞘瘤。仅有少数病例被报道,其中大多数位于腰骶部脊柱,2例位于胸部,仅1例位于颈椎。本文报告1例罕见的此类肿瘤病例。该肿瘤主要占据L1节段,并部分累及T12和L2节段,在首次看似根治性切除良性黑素性神经鞘瘤13年后复发。采用后路入路将血供丰富的肿瘤根治性切除,并进行了Sokon经椎弓根内固定术。通过卡特侧胸腹联合入路,将肿瘤的腹膜后和椎体内扩展部分切除,并完成了L1椎体次全切除术。使用钛笼实现了椎体前路稳定。术后患者左腿疼痛缓解。治疗3年后,他仍无疼痛,能够自由行走并恢复日常活动。