Rutherford Scott A, Linton Kim M, Durnian Jonathan M, Cowie Richard A
Department of Neurosurgery, Hope Hospital, Salford, Manchester, United Kingdom.
J Neurosurg Spine. 2006 Jan;4(1):71-4. doi: 10.3171/spi.2006.4.1.71.
Spinal meningiomas are reported infrequently as pure epidural tumors, and they are rarely located at the caudal end of the spine. The unique combination of a wholly epidural tumor confined entirely to the sacral canal has not been previously described. The authors describe the case of a 29-year-old man who presented with coccygeal and left-sided S2-4 dermatomal pain. Examination confirmed sensory loss in the same distribution. A magnetic resonance image revealed an enhancing mass lesion in the sacral canal scalloping the bone at S-2 and S-3. An apparent complete resection was performed. Intraoperatively the authors observed an entirely epidural tumor with a small dural attachment at the most caudal end of the thecal sac. Histological examination confirmed that the tumor was an atypical meningioma. A local recurrence developed within 1 year of surgery, and the patient underwent a hemisacrectomy for tumor removal. An additional recurrence in the lumbosacral spine and multiple pulmonary metastases developed thereafter. In addition to the unique nature of this case, the authors also observed a tumor behaving in a far more aggressive fashion than its histological findings would suggest. This adds to the differential diagnosis of tumors occurring in the sacral canal.
脊髓膜瘤作为单纯的硬膜外肿瘤报道较少，且很少位于脊柱尾端。完全局限于骶管的硬膜外肿瘤这一独特组合此前未见报道。作者描述了一例29岁男性病例，该患者表现为尾骨及左侧S2 - 4皮节疼痛。检查证实相同分布区域存在感觉丧失。磁共振成像显示骶管内有一强化肿块，使S - 2和S - 3处骨质呈扇贝样改变。进行了明显的完整切除。术中作者观察到一个完全位于硬膜外的肿瘤，在硬脊膜囊最尾端有一小的硬膜附着。组织学检查证实该肿瘤为非典型脑膜瘤。术后1年内出现局部复发，患者接受了半骶骨切除术以切除肿瘤。此后在腰骶部脊柱又出现一次复发，并发生了多处肺转移。除了该病例的独特性外，作者还观察到肿瘤的行为远比其组织学表现所提示的更具侵袭性。这增加了骶管内肿瘤的鉴别诊断难度。
