Honda Akira, Iizuka Yoichi, Mieda Tokue, Sonoda Hiroyuki, Ishiwata Sho, Kakuta Yohei, Tsunoda Daisuke, Takasawa Eiji, Tajika Tsuyoshi, Koshi Hiromi, Chikuda Hirotaka
Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511, Japan.
Clinical Department of Pathology, Gunma University Hospital, 3-39-22, Showa, Maebashi, Gunma 371-8511, Japan.
Case Rep Orthop. 2020 Sep 14;2020:6709819. doi: 10.1155/2020/6709819. eCollection 2020.
Spinal mobile tumors are very rare. We herein report a case of paraplegia caused by migration and incarceration of thoracic mobile schwannoma after myelography. . A 25-year-old man who had weakness and numbness in both his legs also had pain radiating to the back that was induced by back flexion or extension and jumping. Magnetic resonance imaging (MRI) showed an intradural extramedullary lesion at the T10 and T11 levels. Myelography was performed but discontinued due to his back and lower limb pain. Computed tomography after myelography revealed a rostrally migrated intradural mass with a discrepancy in the exact location in comparison to the MRI findings. He underwent a second lumbar puncture and drained the cerebrospinal fluid (CSF) to aid the spinal cord, because the symptoms gradually worsened and led to paraplegia. After the drainage of the CSF, his symptoms were immediately resolved. The day after myelography, he underwent complete resection of the tumor with the diagnosis of schwannoma. One year after the surgery, he had been working despite having hyperreflexia in his lower limbs with no weakness or sensory disturbance.
Severe neurological deficits associated with spinal cord damage can occur due to migration of mobile tumors.
脊柱移动性肿瘤非常罕见。我们在此报告一例脊髓造影术后胸段移动性神经鞘瘤移位并嵌顿导致截瘫的病例。一名25岁男性,双下肢无力、麻木,且背部屈曲、伸展及跳跃时会引发背部放射性疼痛。磁共振成像(MRI)显示在T10和T11水平有硬膜内髓外病变。进行了脊髓造影,但由于其背部和下肢疼痛而中断。脊髓造影后的计算机断层扫描显示硬膜内肿块向上移位,与MRI结果相比,确切位置存在差异。由于症状逐渐加重并导致截瘫,他接受了第二次腰椎穿刺并引流脑脊液以辅助脊髓。脑脊液引流后,他的症状立即得到缓解。脊髓造影术后第二天,他接受了肿瘤全切手术,诊断为神经鞘瘤。术后一年,尽管他下肢反射亢进,但仍能工作,没有无力或感觉障碍。
移动性肿瘤的移位可导致与脊髓损伤相关的严重神经功能缺损。