Piovesan Eduardo Cattapan, Silva Werner Petry, Mallmann Adroaldo Baseggio, Guiroy Alfredo José, Carazzo Charles André
Department of Neurosurgery, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil.
Department of Neurosurgery, São Vicente de Paulo Hospital, Passo Fundo, Rio Grande do Sul, Brazil.
Surg Neurol Int. 2023 Jun 8;14:197. doi: 10.25259/SNI_399_2023. eCollection 2023.
Disseminated histoplasmosis involving the central nervous system occurs in 5-10% of cases. However, intramedullary spinal cord lesions are extremely rare. Here, 45-year-old female with a T8-9 intramedullary lesion did well following surgical extirpation.
For 2 weeks, a 45-year-old female experienced progressive lower back pain, paresthesias, and paraparesis. The magnetic resonance imaging showed an intramedullary expansive lesion at the T8-T9 level that markedly enhanced with contrast. Surgery, consisting of T8-T10 laminectomies performed using neuronavigation, an operating microscope, and intraoperative monitoring, revealed a well-demarcated lesion that proved to be a focus of histoplasmosis; it was readily completely excised.
Surgery is the gold standard for treating spinal cord compression attributed to intramedullary histoplasmosis unresponsive to medical management.
播散性组织胞浆菌病累及中枢神经系统的病例占5%-10%。然而，脊髓髓内病变极为罕见。在此，一名45岁患有T8-9节段髓内病变的女性在手术切除后恢复良好。
一名45岁女性持续2周出现进行性下背部疼痛、感觉异常和下肢轻瘫。磁共振成像显示T8-T9节段有一个髓内膨胀性病变，增强扫描后明显强化。手术采用神经导航、手术显微镜和术中监测进行T8-T10椎板切除术，发现一个边界清晰的病变，经证实为组织胞浆菌病病灶；该病灶很容易被完全切除。
对于药物治疗无效的脊髓髓内组织胞浆菌病所致脊髓压迫，手术是治疗的金标准。
