Parr Matthew S, Williams Sanford R, Mooney James H, Atchley Travis J, Okor Mamerhi O
J Neurosurg Case Lessons. 2024 Apr 8;7(15). doi: 10.3171/CASE23706.
Intradural spinal tumors are an uncommon entity with a variety of pathologies and symptom patterns. Few cases reports in the literature have described tumor migration within the spinal canal.
A 38-year-old male presented with bilateral upper lumbar radicular symptoms of anterior thigh pain, with an enhancing tumor of the cauda equina initially located at L1-2. He declined surgery initially, and at a follow-up 3 years later, his symptoms were unchanged but the tumor was now located at T12-L1. He again declined surgery, but 3 months later, he had a significant change in his pain distribution, which was now along his posterolateral right leg to his foot with associated dorsiflexion and extensor hallicus longus weakness. At this time, the tumor had migrated to L2-3. He underwent laminectomy and tumor resection with resolution of his radicular symptoms and improvement in his strength back to baseline by the 1-month follow-up. Pathology was consistent with a World Health Organization grade I schwannoma.
Migratory schwannoma is a rare entity but should be considered when radicular symptoms acutely change in the setting of a known intradural tumor. Repeat imaging should be performed to avoid wrong-level surgery. Intraoperative imaging can also be used for tumor localization.
硬脊膜内脊髓肿瘤是一种少见的疾病，具有多种病理类型和症状表现。文献中鲜有病例报告描述肿瘤在椎管内的迁移情况。
一名38岁男性出现双侧上腰部神经根症状，表现为大腿前部疼痛，马尾区有一强化肿瘤，最初位于L1-2水平。他最初拒绝手术，3年后随访时，症状未变，但肿瘤现已位于T12-L1水平。他再次拒绝手术，但3个月后，其疼痛分布出现显著变化，现沿右下肢后外侧至足部，并伴有背屈和拇长伸肌无力。此时，肿瘤已迁移至L2-3水平。他接受了椎板切除术和肿瘤切除术，神经根症状得以缓解，至1个月随访时肌力恢复至基线水平。病理结果符合世界卫生组织I级神经鞘瘤。
迁移性神经鞘瘤是一种罕见的疾病，但在已知硬脊膜内肿瘤的情况下，当神经根症状急性改变时应予以考虑。应重复进行影像学检查以避免手术节段错误。术中影像学检查也可用于肿瘤定位。
