Tsuchiya Hirohito, Kokubo Yasuaki, Sakurada Kaori, Sonoda Yukihiko, Saito Shinjiro, Kayama Takamasa
Department of Neurosurgery, Yamagata University School of Medicine, Yamagata-city, Japan.
No Shinkei Geka. 2005 Aug;33(8):817-23.
We report a rare case of giant cell tumor in the atlas. A 50-year-old female presented with severe pain in her right neck and shoulder. The preoperative magnetic resonance images showed a tumor mixed with solid and cystic components in the right side of the atlas. CT scan showed that the anterior and posterior arches of the atlas were destroyed. Preoperative biopsy led to the pathological diagnosis of giant cell tumor with multinuclear giant cells and mononuclear stromal cells. A preoperative vertebral angiogram demonstrated tumor stain supplied from the muscular branches. To reduce intraoperative bleeding, the embolization of the right vertebral artery by GDC was performed before surgical removal. The tumor was subtotally removed following ligation of the right external carotid artery to reduce bleeding of tumor. We used the Olerud cervical system to prevent cervical instability after resection of the tumor. Although the symptoms disappeared completely after surgery, regrowth of tumor was observed in follow-up MRI 4 months after the operation. For this reason, local radiation therapy was performed (50 Gy). Then, the size of the tumor has not changed in the 1.5 years since the operation.
我们报告了一例罕见的寰椎巨细胞瘤病例。一名50岁女性因右颈部和肩部剧痛就诊。术前磁共振成像显示寰椎右侧有一个混合实性和囊性成分的肿瘤。CT扫描显示寰椎前后弓被破坏。术前活检病理诊断为含有多核巨细胞和单核基质细胞的巨细胞瘤。术前椎动脉造影显示肿瘤染色由肌肉分支供血。为减少术中出血，在手术切除前通过GDC对右椎动脉进行了栓塞。在结扎右颈外动脉以减少肿瘤出血后，肿瘤被次全切除。我们使用Olerud颈椎系统来防止肿瘤切除后颈椎不稳。尽管术后症状完全消失，但术后4个月的随访MRI显示肿瘤复发。因此，进行了局部放射治疗（50 Gy）。此后，自手术以来的1.5年里肿瘤大小未变。
