Yoshioka Katsuhito, Murakami Hideki, Demura Satoru, Kato Satoshi, Kawahara Norio, Tomita Katsuro, Tsuchiya Hiroyuki
Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan.
Surg J (N Y). 2015 Nov 23;1(1):e50-e53. doi: 10.1055/s-0035-1567878. eCollection 2015 Dec.
To present a previously unreported patient with recurrent spinal metastasis from subcutaneous sacrococcygeal ependymoma who was followed for 16 years. A 50-year-old man who had T9 metastasis from subcutaneous sacrococcygeal ependymoma underwent piecemeal total T9 excision at a local hospital. He was referred to our institute because of weakness in both legs and bowel-bladder dysfunction with the presence of recurrent spinal metastasis at levels T9-T11. Additional tumor excision was performed circumferentially around the dura, along with spinal reconstruction via a posterior-anterior-posterior approach. Subsequently, the patient could walk again. Thereafter, this patient was treated by repeated surgical resection, reinstrumentation, and bone grafting for thoracic spinal metastases, and an additional 14 thoracic nerve root transections (bilateral T6-T12) as a result of eight operations. These repeated operations have prevented paralysis and allowed the patient to maintain activities of daily living for 16 years. We illustrated the feasibility of repeated surgical resection of thoracic spinal metastases, involving eight operations over 16 years. We believe that this case emphasizes the need to repeatedly resect this type of tumor before the onset of paralysis to maintain normal activity levels.
报告一例先前未报道的骶尾部皮下室管膜瘤复发性脊柱转移患者，该患者接受了16年的随访。一名50岁男性，因骶尾部皮下室管膜瘤发生T9转移，在当地医院接受了T9节段的分块全切术。因双腿无力和膀胱直肠功能障碍，且在T9 - T11节段存在复发性脊柱转移，他被转诊至我院。通过后 - 前 - 后入路，在硬脊膜周围进行了环形肿瘤切除，并进行了脊柱重建。随后，患者能够再次行走。此后，该患者因胸椎脊柱转移接受了多次手术切除、再次内固定和植骨治疗，由于8次手术还进行了额外的14次胸神经根横断术（双侧T6 - T12）。这些反复的手术预防了瘫痪，并使患者能够维持16年的日常生活活动能力。我们展示了胸椎脊柱转移瘤反复手术切除的可行性，在16年内进行了8次手术。我们认为该病例强调了在瘫痪发生前反复切除此类肿瘤以维持正常活动水平的必要性。
