You Wei, Hu Weipeng, Wang Fan, Pan Zhigang, Zhu Qiangbin, Zhou Jianfeng, Hu Weipeng
Department of Neurosurgery, Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian Province, China.
Department of Neurosurgery, Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian Province, China; Department of Neurosurgery, HuiAn County Hospital, Quanzhou, Fujian Province, China.
World Neurosurg. 2020 Nov;143:129-133. doi: 10.1016/j.wneu.2020.07.166. Epub 2020 Jul 31.
We sought to analyze the clinical data and imaging features from a rare case presenting an intravertebral mobile nerve sheath tumor of the lumbar spine, review the relevant literature, discuss the imaging features and possible causes of the tumor, and propose preventive measures and solutions.
The clinical data and imaging data of a patient with a lumbar spinal canal mobile nerve sheath tumor were retrospectively analyzed in conjunction with the relevant literature. The first preoperative lumbar spine magnetic resonance imaging (MRI) showed the tumor located at level L1-2. Further lumbar spine MRI, which was performed 5 days later, showed the tumor was at level L3-4, with a range of motion of 8 cm. End spinal resection of the tumor was performed under general anesthesia, and a tumor, which was cystic solid, was found to be located at level L3-4. The tumor originated from a distinctly twisted and elongated posterior root of the spinal cord, with complete fusion of the tumor-bearing nerve. Both the tumor and tumor-carrying nerve were removed. Postoperative pathologic examination confirmed that the tumor was a nerve sheath tumor. Lumbar MRI on postoperative day 10 showed complete resection of the tumor in the L3-4 spinal canal. The patient was discharged with normal urination and defecation, normal sensation in both lower extremities, grade 5 muscle strength, normal muscle tone, and normal reflexes in both knee and Achilles tendons.
Intravertebral mobile nerve sheath tumors are rare, and the marked distortion and elongation of the carrier nerve seen on MRI are important imaging features of this disease. The possible causes of tumor movement include tumor texture, location, positional changes, and altered cerebrospinal fluid dynamics. Acute changes in intraabdominal pressure caused by forceful defecation may be a high-risk factor for tumor migration. Multiple preoperative MRIs to localize the tumor are particularly important.
我们试图分析一例罕见的腰椎椎体移动性神经鞘瘤的临床资料和影像学特征，回顾相关文献，探讨该肿瘤的影像学特征及可能病因，并提出预防措施和解决方案。
回顾性分析1例腰椎管移动性神经鞘瘤患者的临床资料和影像学资料，并结合相关文献。术前首次腰椎磁共振成像（MRI）显示肿瘤位于L1-2水平。5天后进行的进一步腰椎MRI显示肿瘤位于L3-4水平，移动范围为8 cm。在全身麻醉下进行肿瘤的终丝切除术，发现一个囊实性肿瘤位于L3-4水平。肿瘤起源于明显扭曲和拉长的脊髓后根，肿瘤所在神经完全融合。肿瘤和携带肿瘤的神经均被切除。术后病理检查证实肿瘤为神经鞘瘤。术后第10天的腰椎MRI显示L3-4椎管内肿瘤完全切除。患者排尿和排便正常，双下肢感觉正常，肌力5级，肌张力正常，膝腱和跟腱反射正常，随后出院。
椎体移动性神经鞘瘤罕见，MRI上可见的携带神经的明显扭曲和拉长是该病的重要影像学特征。肿瘤移动的可能原因包括肿瘤质地、位置、位置变化以及脑脊液动力学改变。用力排便引起的腹内压急性变化可能是肿瘤迁移的高危因素。术前多次MRI定位肿瘤尤为重要。
