Moon Karam, Filis Andreas K, Cohen Alan R
Division of Pediatric Neurosurgery, Rainbow Babies and Children's Hospital, The Neurological Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
J Neurosurg Pediatr. 2010 Jan;5(1):85-8. doi: 10.3171/2009.7.PEDS09244.
Mobile spinal tumors have been reported previously in the literature, with schwannomas as the most common form. A discrepancy between the location of the tumor in preoperative imaging and its actual position intraoperatively may lead to confusion. The authors present an unusual case of a mobile cauda equina ependymoma. Resection was complicated by cephalad migration of the tumor upon durotomy. Visualization was made possible by engaging a Valsalva maneuver in the patient under anesthesia, at which point the tumor was observed to migrate caudally into the operative field. Observation of this unique pathology is presented as potentially important knowledge for surgeons that might help prevent other unnecessary procedures such as a multilevel laminectomy.
先前文献中已有关于移动性脊柱肿瘤的报道，其中最常见的类型是神经鞘瘤。术前影像学检查中肿瘤的位置与术中实际位置之间的差异可能会导致混淆。作者报告了一例罕见的移动性马尾神经室管膜瘤病例。手术切除因切开硬脊膜后肿瘤向头侧移位而变得复杂。通过在麻醉状态下让患者进行瓦尔萨尔瓦动作，使肿瘤得以观察，此时发现肿瘤向尾侧移入手术视野。展示对这种独特病理情况的观察结果，对外科医生来说可能是潜在的重要知识，有助于避免其他不必要的手术，如多级椎板切除术。
