Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
J Neurosurg Spine. 2013 Jun;18(6):611-6. doi: 10.3171/2013.3.SPINE12966. Epub 2013 Apr 19.
Resection of metastatic pheochromocytomas may be complicated by transient postoperative neurological deficits due to hypotension. The authors report the first case of en bloc excision of a spinal pheochromocytoma with associated long-term hypertensive management off all medication. Interestingly, this is the first case of transient hypotension following en bloc resection of pheochromocytoma associated with temporary hypotension-associated neurological decline that resolved completely after correction of hypotension postoperatively. A 23-year-old man with a prior adrenalectomy for pheochromocytoma presented with focal thoracic pain. He had a known T-10 vertebral body lesion for which he received chemotherapy and radiation therapy. Imaging demonstrated increased destruction of the T-10 vertebral body, which was concerning for tumor growth. The patient underwent angiographic embolization followed by single-stage posterior en bloc vertebrectomy with placement of a cage and posterior instrumentation and fusion without event. However, approximately 24 hours after surgery, the patient's systolic blood pressure was consistently no higher than 70 mm Hg. During this time, he began suffering from severe bilateral lower-extremity weakness. His systolic blood pressure increased with dopamine, and his strength immediately improved. The patient's oral regimen of adrenergic blockade was stopped, and he recovered without event. Since that time, the patient has been symptom free and requires no antihypertensive medication. The role of en bloc resection for metastatic lesions of the spine is controversial but may be warranted in cases of metastatic pheochromocytoma. En bloc resection avoids intralesional tumor resection and thus may help prevent complications of hypertensive crisis associated with hormonal secretion and extensive blood loss, which are not uncommon with pheochromocytoma resection surgeries. Additionally, the role of en bloc spondylectomy in this setting may allow for metabolic treatment as patients with actively secreting tumors may no longer require antiadrenergic medications.
由于低血压，切除转移性嗜铬细胞瘤可能会导致术后短暂的神经功能缺损。作者报告了首例整块切除脊髓嗜铬细胞瘤的病例，且术后无需任何药物即可长期控制高血压。有趣的是，这是首例整块切除嗜铬细胞瘤后出现短暂低血压的病例，与暂时性低血压相关的神经功能下降有关，术后低血压纠正后完全缓解。一名 23 岁男性因嗜铬细胞瘤行肾上腺切除术，出现局灶性胸痛。他有一个已知的 T-10 椎体病变，曾接受过化疗和放疗。影像学显示 T-10 椎体破坏增加，提示肿瘤生长。患者接受了血管造影栓塞，随后进行了一期后路整块椎体切除术，放置了一个笼子和后路器械固定融合，过程顺利。然而，大约在手术后 24 小时，患者的收缩压一直低于 70mmHg。在此期间，他开始出现严重的双侧下肢无力。他的收缩压随着多巴胺的使用而升高，其力量立即得到改善。患者的肾上腺素能阻滞剂口服方案被停止，他没有出现任何并发症而恢复。此后，患者无症状，无需服用降压药物。整块切除术治疗脊柱转移瘤的作用存在争议，但在转移性嗜铬细胞瘤的情况下可能是合理的。整块切除术可避免肿瘤内切除术，从而有助于预防与激素分泌和大量失血相关的高血压危象并发症，这些并发症在嗜铬细胞瘤切除术时并不少见。此外，在这种情况下整块脊柱切除术的作用可能允许进行代谢治疗，因为活跃分泌肿瘤的患者可能不再需要抗肾上腺素药物。
