Samargandi Ramy, Alesawi Abdulrahman, Le Nail Louis-Romée, Abualross Osamah
Department of Orthopedic Surgery and Traumatology, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours, FRA.
Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah, SAU.
Cureus. 2023 Jun 15;15(6):e40490. doi: 10.7759/cureus.40490. eCollection 2023 Jun.
Spinal ependymomas are rare primary central nervous system tumors that often exhibit vague symptoms before being identified. In extremely rare situations, it can be identified after a neurological decline following a history of spinal anesthesia, indicating intraspinal hemorrhages from an incidental lumbar ependymoma that was not previously diagnosed. Spinal anesthesia is widely utilized in numerous orthopedic surgical procedures, as it is a well-tolerated invasive procedure with a low risk of complications. The patient in this case study underwent elective orthopedic surgery under general anesthesia following two unsuccessful trials with spinal anesthesia. Subsequently, the patient developed paraplegia as a result of an incidental hemorrhagic spinal ependymoma. The patient had an L3 laminectomy for decompression of the dural sheath, and an ependymoma was confirmed based on the histopathological assessment. This case report aims to raise awareness regarding the potential complication of spinal anesthesia arising from incidental tumors of the spinal cord, thereby emphasizing the imperative of early recognition and management in order to mitigate adverse outcomes.
脊髓室管膜瘤是罕见的原发性中枢神经系统肿瘤，在确诊之前通常表现出模糊的症状。在极为罕见的情况下，脊髓室管膜瘤可在脊髓麻醉史后出现神经功能衰退后被发现，提示先前未诊断出的偶然发生的腰椎室管膜瘤导致脊髓内出血。脊髓麻醉广泛应用于众多骨科手术中，因为它是一种耐受性良好、并发症风险低的侵入性手术。本病例研究中的患者在两次脊髓麻醉尝试失败后接受了全身麻醉下的择期骨科手术。随后，该患者因偶然发生的出血性脊髓室管膜瘤而出现截瘫。患者接受了L3椎板切除术以减压硬膜鞘，并根据组织病理学评估确诊为室管膜瘤。本病例报告旨在提高对脊髓偶然肿瘤引起的脊髓麻醉潜在并发症的认识，从而强调早期识别和处理以减轻不良后果的必要性。
