Shimada Yoichi, Miyakoshi Naohisa, Kasukawa Yuji, Hongo Michio, Ando Shigeru, Itoi Eiji
Rehabilitation Division, Akita University Hospital, 1-1-1 Hondo, Akita 010-8543, Japan.
Tohoku J Exp Med. 2006 May;209(1):1-6. doi: 10.1620/tjem.209.1.
In this study, we evaluated the clinical features of cauda equina tumors requiring surgical treatment. Medical records of 28 patients with cauda equina tumors (13 men and 15 women) undergoing surgical treatment were retrospectively reviewed. The majority of histological diagnoses indicated schwannoma (23 cases, 82%), and the remaining 5 indicated ependymoma, neurofibroma, meningioma, and ganglioneuroblastoma. In 86% of the cases, the initial symptom was pain in the lower back and/or lower extremities. Preoperatively, half of the patients had symmetrical pain in the lower back or lower extremities, severe pain in the supine position, or pain that was increased by coughing. One third of the patients needed morphine to control nocturnal pain. Tumor size, as determined by magnetic resonance imaging (MRI), correlated with preoperative symptom duration (r = 0.66, p < 0.001). These findings indicate that symmetrical lower back pain and/or pain that radiates to both lower extremities and increases in the supine position are characteristic of cauda equina tumors. The correlation between symptom duration and tumor size indicates that earlier diagnosis of this tumor is necessary. Earlier diagnosis based on these characteristic symptoms should make use of further examinations such as MRI.
在本研究中，我们评估了需要手术治疗的马尾神经肿瘤的临床特征。对28例接受手术治疗的马尾神经肿瘤患者（13例男性和15例女性）的病历进行了回顾性分析。大多数组织学诊断为神经鞘瘤（23例，82%），其余5例为室管膜瘤、神经纤维瘤、脑膜瘤和神经节神经母细胞瘤。86%的病例初始症状为下背部和/或下肢疼痛。术前，一半患者下背部或下肢疼痛对称，仰卧位时疼痛剧烈，或咳嗽时疼痛加剧。三分之一的患者需要吗啡来控制夜间疼痛。通过磁共振成像（MRI）确定的肿瘤大小与术前症状持续时间相关（r = 0.66，p < 0.001）。这些发现表明，下背部对称疼痛和/或放射至双下肢且在仰卧位时加重的疼痛是马尾神经肿瘤的特征。症状持续时间与肿瘤大小之间的相关性表明，有必要对该肿瘤进行早期诊断。基于这些特征性症状的早期诊断应借助MRI等进一步检查。
