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老年患者感染性骶前肿块合并 Currarino 综合征的外科治疗:技术细节及文献复习。

Surgical management of Currarino syndrome in elderly patient with infected pre-sacral mass: Technical nuances and review of literature.

机构信息

Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA.

College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.

出版信息

Clin Neurol Neurosurg. 2022 Nov;222:107470. doi: 10.1016/j.clineuro.2022.107470. Epub 2022 Oct 13.

Abstract

OBJECTIVE

Currarino Syndrome (CS) is a rare autosomal dominant genetic disorder that is defined by a triad of: presacral mass, anorectal malformations, and sacral bone dysplasia. Once discovered, these lesions are often surgically treated to avoid life threatening complications such as meningitis and malignant transformation of a sacral teratoma. As this syndrome is usually diagnosed in childhood, accurate diagnosis in adults presenting with this syndrome can be challenging and delay treatment. We present a case report with diagnostic and surgical management strategies of CS presenting in an elderly patient with accompanying review of literature.

METHODS

We performed a literature review by searching PubMed, Ovid Embase, and Scopus electronic databases with the predetermined inclusion criteria of cases of CS in the adult population.

RESULTS

A 70-year-old male with newly diagnosed CS and meningitis successfully underwent resection of his lesion as an interdisciplinary case between neurosurgery and colorectal surgery. At six-month follow up, the patient reports resolution of constipation and urinary symptoms, no longer has signs of infection, and remains neurologically full strength in his lower extremities. A review of literature revealed only 5 previously reported cases of CS presenting in the adult population with 3 of these cases requiring surgical intervention.

CONCLUSION

Currarino Syndrome (CS) is an autosomal dominant genetic disorder characterized by a presacral mass, sacral bony deformities, and anorectal malformations. It is usually diagnosed in pediatric age group. In this article, we present a case of a 70-year-old male presenting with meningitis, encephalopathy, and gastrointestinal disturbances.

摘要

目的

Currarino 综合征(CS)是一种罕见的常染色体显性遗传疾病,其特征为三联征:骶前肿块、肛门直肠畸形和骶骨骨发育不良。一旦发现这些病变,通常会通过手术治疗以避免危及生命的并发症,如脑膜炎和骶尾部畸胎瘤的恶性转化。由于这种综合征通常在儿童期诊断,因此对于出现这种综合征的成年患者的准确诊断可能具有挑战性,并会延迟治疗。我们报告了一例老年患者 CS 的病例,伴有诊断和手术治疗策略,并对文献进行了回顾。

方法

我们通过在 PubMed、Ovid Embase 和 Scopus 电子数据库中进行文献检索,使用预先确定的成人 CS 病例纳入标准进行了文献回顾。

结果

一名 70 岁男性新诊断为 CS 合并脑膜炎,成功接受了神经外科和结直肠外科联合治疗的病变切除术。在 6 个月的随访中,患者报告便秘和泌尿系统症状得到缓解,不再有感染迹象,下肢神经功能完全正常。文献回顾仅发现 5 例先前报道的成人 CS 病例,其中 3 例需要手术干预。

结论

Currarino 综合征(CS)是一种常染色体显性遗传疾病,其特征为骶前肿块、骶骨骨畸形和肛门直肠畸形。它通常在儿童时期诊断。在本文中,我们报告了一例 70 岁男性患者,表现为脑膜炎、脑病和胃肠道紊乱。

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