Yoshioka Katsuhito, Kawahara Norio, Murakami Hideki, Demura Satoru, Kawaguchi Masahito, Oda Makoto, Matsumoto Isao, Tomita Katsuro
Department of Orthopedic Surgery, School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, Japan.
Orthopedics. 2009 Jul;32(7):531. doi: 10.3928/01477447-20090527-26.
This article describes a case of cervicothoracic giant cell tumor expanding into the superior mediastinum treated by total spondylectomy. A 42-year-old-man presented with back pain and paraparesis. Magnetic resonance imaging revealed the collapse of the T2 vertebral body. The spinal cord was severely compressed by the tumor mass. The tumor had spread from T2 to the mediastinum, so that the tumor was in contact with many vital structures. To resect the tumor completely, total spondylectomy from T1 to T3 was performed through a combined anterior-posterior approach. The tumor was dissected from the vital structures using an anterior low cervical approach and splitting one-third of the sternum. En bloc vertebral resection from Th1 to Th3, including the tumor pseudocapsule, was possible through a posterior approach. The tumor around the nerve roots or dura was resected piece by piece since it was possible to separate the capsulated tumor from the dura. Splitting one-third of the sternum allowed separation of the tumor from the anterior vital structures, under direct vision. This allowed en bloc vertebral resection of the tumor that had spread to the mediastinum from T2 and in the craniocaudal direction from T1 to T3. Although giant cell tumor is benign, it can be locally aggressive. Complete excision of a giant cell tumor is the best treatment option even for the cervicothoracic spine, to protect the vital structures or neural function.
本文描述了一例经全脊椎切除术治疗的向纵隔扩展的颈胸段巨大细胞瘤病例。一名42岁男性因背痛和双下肢轻瘫就诊。磁共振成像显示T2椎体塌陷。肿瘤块严重压迫脊髓。肿瘤已从T2扩散至纵隔，致使肿瘤与许多重要结构相邻。为完整切除肿瘤，经前后联合入路实施了从T1至T3的全脊椎切除术。采用低位颈椎前路入路并劈开三分之一胸骨，从重要结构上分离肿瘤。通过后路可整块切除从Th1至Th3的椎体，包括肿瘤假包膜。由于能够将包膜完整的肿瘤与硬脊膜分离，因此可逐块切除神经根或硬脊膜周围的肿瘤。劈开三分之一胸骨可在直视下将肿瘤与前方重要结构分离。这使得能够整块切除从T2扩散至纵隔且在头尾方向上从T1至T3的肿瘤。尽管巨大细胞瘤是良性的，但具有局部侵袭性。即使对于颈胸段脊柱，完整切除巨大细胞瘤仍是保护重要结构或神经功能的最佳治疗选择。
