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一只猫的椎体血管瘤病手术及放射治疗后的长期预后

Long-term outcome following surgical and radiation treatment of vertebral angiomatosis in a cat.

作者信息

Hans Eric C, Dudley Robert M, Watson Adam T, Chalkley Mark, Foss Kari D, Bancroft Ann, Prescott Deborah M

出版信息

J Am Vet Med Assoc. 2018 Dec 15;253(12):1604-1609. doi: 10.2460/javma.253.12.1604.

Abstract

CASE DESCRIPTION A 2-year-old 5.2-kg (11.4-lb) neutered male domestic shorthair cat was referred because of a 6-week history of progressive paraparesis. CLINICAL FINDINGS Neurologic examination revealed moderate ambulatory paraparesis with marked spinal hyperesthesia at the thoracolumbar junction. The lesion was localized to the T3-L3 spinal cord segment. Clinicopathologic testing, thoracic radiography, and abdominal ultrasonography revealed no abnormalities to explain the observed clinical signs. Advanced spinal imaging with MRI revealed an extradural right-lateralized mass originating from the L2 vertebral pedicle and causing severe spinal cord compression. TREATMENT AND OUTCOME Surgical decompression was achieved by performance of a right-sided hemilaminectomy at L2. Histologic examination of biopsy samples obtained from the mass revealed an ill-defined zone of mature vascular proliferation extending through the preexisting vertebral bone, consistent with vertebral angiomatosis. After surgical recovery, adjuvant radiation therapy was initiated with a total dose of 48 Gy administered in 16 fractions of 3 Gy each over a 3-week period. Neurologic function rapidly improved to full ambulation with only minimal monoparesis of the right pelvic limb. Results of neurologic and MRI examination performed 26 months after surgery indicated no change in neurologic status or evidence of recurrence. CLINICAL RELEVANCE To the authors' knowledge, this report was the first to describe the long-term outcome for vertebral angiomatosis in a cat. Surgical decompression and radiation therapy provided an excellent outcome in this case. Vertebral angiomatosis should be considered as a differential diagnosis for any young cat with thoracolumbar myelopathy secondary to a mass associated with the vertebral pedicle.

摘要

病例描述

一只2岁、体重5.2千克(11.4磅)的去势雄性家养短毛猫因进行性截瘫6周病史前来就诊。

临床发现

神经学检查显示中度行走性截瘫,胸腰段交界处有明显的脊髓感觉过敏。病变定位于T3 - L3脊髓节段。临床病理检查、胸部X线摄影和腹部超声检查均未发现异常来解释所观察到的临床症状。MRI高级脊柱成像显示一个硬膜外右侧肿块,起源于L2椎弓根,导致严重脊髓压迫。

治疗与结果

通过在L2进行右侧半椎板切除术实现手术减压。对肿块活检样本的组织学检查显示,一个界限不清的成熟血管增生区域延伸穿过先前存在的椎骨,符合椎体血管瘤病。手术恢复后,开始辅助放疗,总剂量48 Gy,在3周内分16次给予,每次3 Gy。神经功能迅速改善至完全行走,仅右后肢有轻微单瘫。术后26个月进行的神经学和MRI检查结果显示神经状态无变化,也无复发迹象。

临床意义

据作者所知,本报告首次描述了猫椎体血管瘤病的长期预后。在该病例中,手术减压和放疗取得了良好效果。对于任何因椎弓根相关肿块继发胸腰段脊髓病的幼猫,椎体血管瘤病应被视为鉴别诊断之一。

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