Lee Ju Hyung, Oh Sung Han, Cho Pyung Goo, Han Eun Mi, Hong Je Beom
Department of Neurosurgery, Bundang Jesaeng General Hospital, Seongnam, Korea.
Department of Pathology, Bundang Jesaeng General Hospital, Seongnam, Korea.
Korean J Spine. 2017 Sep;14(3):99-102. doi: 10.14245/kjs.2017.14.3.99. Epub 2017 Sep 30.
We report a case of a solitary osteochondroma as a dumbbell tumor compressing the spinal cord and its surgical strategy. The patient is a 16-year-old female with longstanding posterior neck pain and left arm abduction weakness. She was examined by plain X-ray, three-dimensional-computed tomography, magnetic resonance imaging, and vertebral angiography. The analyses indicated a calcified extradural mass compressing the cord in the C3-4 portion extending into the neural and vertebral foramen with eroded vertebral body. The tumor was successfully excised using a modified combined anterior and posterior approach. Histopathologic study of the resected material confirmed the diagnosis. The postoperative assessment was followed by clinical and radiologically therapy for 5 years after surgery. Osteochondroma arises from enchondral bone but it rarely involves the spine, especially not as s dumbbell type. In this patient, the tumor may have arisen from the neural arch and extended into the extradural and extraforaminal space over a long period. We successfully removed the dumbbell tumor with a combined anterior oblique and posterior approach. However, further observation is essential because of the possibility of recurrence and sarcomatous change.
我们报告一例孤立性骨软骨瘤作为哑铃状肿瘤压迫脊髓及其手术策略。患者为16岁女性,长期存在后颈部疼痛和左臂外展无力。对其进行了X线平片、三维计算机断层扫描、磁共振成像和椎体血管造影检查。分析显示,一个钙化的硬膜外肿块压迫C3-4节段的脊髓,延伸至神经孔和椎间孔,并伴有椎体侵蚀。采用改良的前后联合入路成功切除肿瘤。对切除标本进行组织病理学研究确诊。术后随访5年,进行临床和影像学治疗。骨软骨瘤起源于软骨内成骨,但很少累及脊柱,尤其是哑铃型。在该患者中,肿瘤可能起源于神经弓,并长期延伸至硬膜外和椎间孔外间隙。我们通过前后联合斜行入路成功切除了哑铃状肿瘤。然而,由于存在复发和肉瘤样变的可能性,进一步观察至关重要。