Burdenko Neurosurgical Center, Moscow, Russia.
Sechenov First Moscow State Medical University, Moscow, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2024;88(4):78-84. doi: 10.17116/neiro20248804178.
Cervical lipomas accompanied by neurovascular compression are extremely rare and require surgical treatment in case of appropriate symptoms. The preferable method is gross total resection, as otherwise they tend to recur. Invasive growth is not typical for lipomas. However, large tumors can involve adjacent nerves and vessels and significantly complicate resection.
We present a 57-year-old patient who underwent resection of giant soft tissue cervical lipoma invading neurovascular bundle and compressing the oropharynx and esophagus with dysphagia and positional asphyxia. The patient was followed-up for previous 5 years. Resection was necessary due to tumor enlargement with appropriate symptoms. Searching for literature data was performed in the Pubmed, Medline, EMBASE, Cochrane Library and eLibrary databases.
Gross total resection of 7-cm tumor was accompanied by mobilization of hypoglossal and vagus nerves, common, external and internal carotid arteries and jugular vein with repositioning of the oropharynx and esophagus. There was mild Horner's syndrome in early postoperative period. The patient was discharged in 4 days after surgery with regression of complaints. We found only 5 reports describing giant cervical lipomas invading neurovascular bundle.
Giant cervical lipomas are extremely rare, and total resection with preservation of critical structures is possible in a specialized hospital.
伴有神经血管压迫的颈椎脂肪瘤极为罕见，如有适当症状需行手术治疗。优选方法是大体全切除，否则有复发倾向。脂肪瘤通常不会侵袭性生长。然而，大型肿瘤可能累及相邻神经和血管，使切除显著复杂化。
我们报告了一位 57 岁的患者，他因吞咽困难和位置性窒息，接受了巨大的软组织颈椎脂肪瘤侵犯神经血管束和压迫口咽和食管的切除术。该患者随访了 5 年。由于肿瘤增大并伴有相应症状，因此需要进行切除。在 Pubmed、Medline、EMBASE、Cochrane Library 和 eLibrary 数据库中进行了文献数据搜索。
对 7cm 肿瘤进行大体全切除，同时移动舌下神经和迷走神经、颈总动脉、颈外动脉、颈内动脉、颈内静脉和颈内静脉，重新定位口咽和食管。术后早期出现轻度霍纳氏综合征。患者术后 4 天出院，症状消退。我们仅发现 5 篇描述侵犯神经血管束的巨大颈椎脂肪瘤的报告。
巨大的颈椎脂肪瘤极为罕见，在专科医院行保留关键结构的大体全切除是可行的。
