Salamah Hazem Mohamed, Eltokhy Ahmed G, Ezzat Mohammad, Alkheder Ahmad, Taha Mahmoud M
Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Department of Neurosurgery, Zagazig University, Zagazig, Egypt.
Int J Surg Case Rep. 2024 Apr;117:109479. doi: 10.1016/j.ijscr.2024.109479. Epub 2024 Mar 6.
Spinal tumors comprise 15 % of all central nervous system tumors, with schwannomas accounting for 30 % of primary intraspinal neoplasms. While predominantly extramedullary-intradural, spinal schwannomas rarely manifest intramedullary occurrences (0.3 % of intraspinal tumors). This study sheds light on two rare cases of thoracic intramedullary schwannomas, emphasizing their diagnostic complexities and surgical management, alongside a literature review.
Case 1 involves a 50-year-old female presenting with worsening back pain, right lower limb weakness, and urinary incontinence. MRI revealed an intradural intramedullary soft tissue mass, diagnosed as a schwannoma with an associated organizing hematoma. Surgical removal led to gradual improvement. Case 2 features a 25-year-old male with back pain, partial foot drop, and weakness in the right knee and hip. MRI demonstrated an intradural intramedullary lesion, later confirmed as an intradural intramedullary schwannoma. Surgery resulted in a smooth recovery without adverse effects.
This article presents two cases of intradural intramedullary thoracic schwannomas initially misdiagnosed as astrocytomas. Surgical resection confirmed the diagnosis, underscoring challenges in preoperative MRI diagnosis. The review of 174 reported cases reveals an equal distribution between the cervical and thoracic regions, with males affected 1.5 times more frequently than females. The average age of onset is 40, and surgical treatment demonstrates a 90 % improvement rate. The complex pathogenesis encompasses six proposed explanations. Clinical suspicion, considering pain and neurological symptoms, is paramount due to potential misdiagnosis and the imperative for histological confirmation.
Although rare, intramedullary schwannomas (IMS) have significant clinical implications, necessitating precise treatment. Surgical resection yields favorable outcomes, with subtotal resection considered based on adhesion factors. Pre-surgical diagnosis requires a comprehensive integration of radiological and clinical data, with intraoperative analysis ensuring optimal treatment strategies.
脊柱肿瘤占所有中枢神经系统肿瘤的15%，其中神经鞘瘤占原发性椎管内肿瘤的30%。虽然脊柱神经鞘瘤主要位于髓外硬膜内，但很少表现为髓内病变（占椎管内肿瘤的0.3%）。本研究揭示了两例罕见的胸段髓内神经鞘瘤病例，强调了其诊断复杂性和手术治疗方法，并进行了文献综述。
病例1为一名50岁女性，出现背痛加重、右下肢无力和尿失禁症状。磁共振成像（MRI）显示硬膜内髓内软组织肿块，诊断为神经鞘瘤并伴有机化血肿。手术切除后病情逐渐好转。病例2为一名25岁男性，有背痛、足部轻度下垂以及右膝和右髋无力症状。MRI显示硬膜内髓内病变，后来确诊为硬膜内髓内神经鞘瘤。手术顺利恢复，无不良反应。
本文介绍了两例最初被误诊为星形细胞瘤的硬膜内髓内胸段神经鞘瘤病例。手术切除后确诊，凸显了术前MRI诊断的挑战。对174例报告病例的回顾显示，颈段和胸段发病情况均等，男性受累频率比女性高1.5倍。平均发病年龄为40岁，手术治疗有效率达90%。复杂的发病机制有六种推测解释。鉴于可能的误诊以及组织学确诊的必要性，基于疼痛和神经症状进行临床怀疑至关重要。
尽管髓内神经鞘瘤罕见，但具有重要临床意义，需要精准治疗。手术切除效果良好，根据粘连情况考虑次全切除。术前诊断需要综合放射学和临床数据，术中分析确保制定最佳治疗策略。
