Finstein Joseph L, Chin Kingsley R, Alvandi Firoozeh, Lackman Richard D
Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Clin Orthop Relat Res. 2006 Dec;453:335-40. doi: 10.1097/01.blo.0000229304.59771.a3.
Giant cell tumors are hypervascular tumors that represent approximately 5% of all primary bone neoplasms. Vertebral tumors often require surgery to maintain spinal stability or to relieve spinal cord and nerve root compression. However, surgical resection of hypervascular tumors like giant cell tumors can be hazardous because of the risk of excessive intraoperative hemorrhage. Preoperative embolization can be useful to decrease perioperative blood loss in primary and metastatic vertebral tumors, and preoperative embolization for vertebral tumor surgery is relatively safe. We report a patient who had the unusual but serious complications of paralysis and paresthesia at the T12 vertebra and below as a result of preoperative embolization. At 6 months followup, the patient was disease-free but without neurologic function from T12 and below. Therefore, it is imperative physicians be aware of the possible preoperative embolization complication of cord infarction and the safety measures proposed in this article to avoid this complication.
骨巨细胞瘤是富血管性肿瘤,约占所有原发性骨肿瘤的5%。椎体肿瘤通常需要手术以维持脊柱稳定性或缓解脊髓和神经根压迫。然而,像骨巨细胞瘤这样的富血管性肿瘤进行手术切除可能具有危险性,因为存在术中出血过多的风险。术前栓塞有助于减少原发性和转移性椎体肿瘤围手术期的失血量,并且椎体肿瘤手术的术前栓塞相对安全。我们报告了1例患者,其因术前栓塞出现了T12椎体及以下部位不常见但严重的瘫痪和感觉异常并发症。随访6个月时,患者无疾病,但T12及以下部位无神经功能。因此,医生必须意识到术前栓塞可能导致脊髓梗死的并发症以及本文提出的避免该并发症的安全措施。