Gonçalves Vítor M, Santiago Bruno, Ferreira Vítor C, Cunha E Sá Manuel
Neurosurgery Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2801-951 Almada, Portugal.
Case Rep Med. 2014;2014:739862. doi: 10.1155/2014/739862. Epub 2014 Sep 18.
Introduction. Spinal schwannomas are benign nerve sheath tumors. Completely extradural schwannomas of the lumbar spine are extremely rare lesions, accounting for only 0,7-4,2% of all spinal NSTs. Standard open approaches have been used to treat these tumors, requiring extensive muscle dissection, laminectomy, radical foraminotomy, and facetectomy. In this paper the authors present the case of a minimally invasive resection of a completely extradural schwannoma. Operative technique literature review is presented. Material & Methods. A 50-year-old woman presented with progressive complains of chronic right leg pain and paresthesia. The magnetic resonance imaging revealed a giant well-encapsulated dumbbell-shaped extradural lesion at the L3-L4 level. The patient underwent a minimally invasive gross total resection of the tumor using a tubular expandable retractor system. Results. The patient had complete resolution of radiculopathy in the immediate postoperative period and she was discharged home, neurologically intact, on the second postoperative day. Postoperative MRI demonstrated no evidence of residual tumor. At latest follow-up (18 months) the patient remains asymptomatic. Conclusion. Although challenging, this minimally invasive procedure is safe and effective, being an appropriate alternative, with many potential advantages, to the open approach.
引言。脊髓神经鞘瘤是良性神经鞘膜肿瘤。腰椎完全硬膜外神经鞘瘤极为罕见，仅占所有脊髓神经鞘瘤的0.7%-4.2%。标准的开放手术方法一直用于治疗这些肿瘤，需要广泛的肌肉剥离、椎板切除术、根治性椎间孔切开术和小关节切除术。在本文中，作者介绍了一例完全硬膜外神经鞘瘤的微创切除术，并对手术技术进行了文献综述。材料与方法。一名50岁女性因慢性右腿疼痛和感觉异常逐渐加重前来就诊。磁共振成像显示L3-L4水平有一个巨大的、边界清晰的哑铃形硬膜外病变。患者使用管状可扩张牵开器系统接受了肿瘤的微创全切除术。结果。患者术后立即神经根病完全缓解，术后第二天神经功能完好出院。术后MRI显示无残留肿瘤迹象。在最近一次随访（18个月）时，患者仍无症状。结论。尽管具有挑战性，但这种微创手术是安全有效的，是开放手术的合适替代方法，具有许多潜在优势。
