Ramesh Chandra V V, Prasad Bodapati Chandramowliswara, Varaprasad Gangumolu
Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India.
J Neurosurg Pediatr. 2013 Jan;11(1):100-2. doi: 10.3171/2012.9.PEDS12172. Epub 2012 Oct 19.
The authors report a very rare case of tuberculoma involving the ulnar nerve. The patient, a 7-year-old girl, presented with swelling over the medial aspect of her right forearm just below the elbow joint, with features of ulnar nerve palsy, including paresthesias along the little and ring fingers and claw hand deformity. There was a history of trauma and contact with a contagious case of tuberculosis. There were no other signs of tuberculosis. At surgical exploration the ulnar nerve was found to be thickened, and on opening the sheath there was evidence of caseous material enclosed in a fibrous capsule compressing and displacing the nerve fibers. The lesion, along with the capsule, was subtotally removed using curettage, and a part of the capsule that was densely adherent to the nerve fibers was left in the patient. Histopathological examination of the specimen was consistent with tuberculoma. The patient received adequate antitubercular treatment and showed significant improvement.
作者报告了一例非常罕见的累及尺神经的结核瘤病例。患者为一名7岁女孩,其右前臂肘关节下方内侧出现肿胀,并伴有尺神经麻痹的症状,包括小指和环指感觉异常以及爪形手畸形。患者有外伤史且曾接触过一例传染性肺结核病例。无其他结核病体征。手术探查时发现尺神经增粗,打开神经鞘时可见在纤维包膜内有干酪样物质,压迫并移位神经纤维。采用刮除术将病变连同包膜大部分切除,而与神经纤维紧密粘连的部分包膜则留在患者体内。标本的组织病理学检查结果与结核瘤相符。患者接受了充分的抗结核治疗,病情有显著改善。