Nishimura Yusuke, Hara Masahito, Awaya Takayuki, Ando Ryo, Eguchi Kaoru, Nagashima Yoshitaka, Wakabayashi Toshihiko, Ginsberg Howard J
Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan.
Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Canada.
NMC Case Rep J. 2020 Sep 15;7(4):195-199. doi: 10.2176/nmccrj.cr.2019-0236. eCollection 2020 Sep.
We describe a rare case of 42-year-old female who had possible double crush syndrome caused by iatrogenic spinal epidermoid tumor (ET) associated with lumbar puncture as well as concomitant sacral Tarlov cyst in close proximity. She presented with progressive left-sided perianal pain. She had a history of a Caesarean section with lumbar spinal anesthesia. Magnetic resonance imaging (MRI) demonstrated a relatively small intradural extramedullary solid lesion at L5/S1 level and cystic lesion at S2 level. We considered there were two different lesions, such as a tumor and Tarlov cyst; however, we could not rule out the possibility of a single lesion with two different components. Furthermore, there was a distinct compression at more than one locations along the course of the left S2 nerve root and we suspected possible double crush syndrome. We conducted tumor removal and the lesion turned out to be two different pathologies, such as an ET and Tarlov cyst. Both lesions were intraopertively pinching the left S2 nerve root at different sites as expected. The tumor was successfully removed and the cyst wall was imbricated and sutured. We need to take the possibility of ET into consideration if the patient underwent invasive spinal procedure previously. We also have to pay attention to the possibility of double crush syndrome if the nerve root possibly holding the responsibility for symptoms is compressed at two or more sites. This is the first report of possible double crush syndrome caused by acquired spinal tumor and congenital Tarlov cyst.
我们描述了一例罕见病例，一名42岁女性，可能患有由医源性脊髓表皮样肿瘤（ET）与腰椎穿刺相关联，以及紧邻的骶部Tarlov囊肿共同导致的双重压迫综合征。她表现为进行性左侧肛周疼痛。她有剖宫产及腰椎脊髓麻醉史。磁共振成像（MRI）显示在L5/S1水平有一个相对较小的硬膜内髓外实性病变，在S2水平有一个囊性病变。我们认为存在两种不同病变，即肿瘤和Tarlov囊肿；然而，我们不能排除单一病变包含两种不同成分的可能性。此外，在左侧S2神经根走行的多个位置存在明显压迫，我们怀疑可能存在双重压迫综合征。我们进行了肿瘤切除，结果发现病变为两种不同病理情况，即ET和Tarlov囊肿。如预期的那样，术中两个病变在不同部位压迫左侧S2神经根。肿瘤被成功切除，囊肿壁被重叠缝合。如果患者先前接受过侵入性脊柱手术，我们需要考虑ET的可能性。如果可能对症状负责的神经根在两个或更多部位受压，我们还必须注意双重压迫综合征的可能性。这是关于由后天性脊柱肿瘤和先天性Tarlov囊肿引起的可能的双重压迫综合征的首例报告。
