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复发性巨大侵袭性胸腰椎神经鞘瘤

Recurrent giant invasive thoracolumbar schwannoma.

作者信息

Bunc Gorazd, Kramberger Slavko, Kovacic Srecko, Seruga Tomaz, Vorsic Matjaz

机构信息

Department of Neurosurgery, Maribor Teaching Hospital, Maribor, Slovenia.

出版信息

Wien Klin Wochenschr. 2004;116 Suppl 2:93-6.

Abstract

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.

摘要

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。

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