Reina M A, López-García A, Dittmann M, de Andrés J A, Blázquez M G
Servicio de Anestesiología y Reanimación, Hospital General de Móstoles, Madrid.
Rev Esp Anestesiol Reanim. 1996 Apr;43(4):142-6.
INTRODUCTION. Epidermoid tumors in the spinal canal are rare. Whether congenitally or iatrogenically caused, they form as the result of epidermal cells implanted within the spinal channel. Such implantation can occur during a variety of procedures and events such as bullet wounds, surgery, myelography or punctures for diagnosis, anesthesia or treatment. Although this complication is not discussed in books or journals on anesthesiology, we have found it mentioned in over 100 published cases reporting iatrogenically caused spinal epidermoid tumors. ETIOPATHOGENESIS. Iatrogenic epidermoid tumors of the spine derive from the implantation of epidermal tissue transported inside the spinal canal during lumbar punctures without guidance or with inadequate guidance. There is ample evidence that such tumors are iatrogenic. All cases occur in patients with a history of lumbar puncture. They are rarely associated with congenital anomalies. They are extramedullary. They tend to develop near sites of earlier lumbar puncture, usually near the conus medullaris and the cauda equina. Iatrogenic epidermoid tumors of the spine have been reproduced experimentally in two studies in which autologous skin fragments were implanted in the spinal canal. CLINICAL SIGNS. These tumors are well tolerated by patients for extended periods of time, ranging from 2 to 10 years. At the cauda equinus, tumors can grow slowly for long periods without signs of nerve compression. Symptoms are directly related to tumor size and site. All patients with tumors at the cauda equinus report severe pain radiating toward the roots of compressed nerves. Nuclear magnetic resonance makes it possible to detect the tumor without administration of intrathecal contrast. At present gadolinium-DTPA improves the image so that these tumors can be distinguished from other types. The prognosis for epidermoid tumors of the spine is good, as they are histologically benign. Treatment is always surgical. CONCLUSION. Although the causal relation between epidermoid spinal tumors and lumbar puncture is well documented, anesthesiologists are not sufficiently aware of this possible complication. Between 1977 and 1995, 28 new cases were published. We believe that a deeper understanding of such rare complications will show us how to prevent them while providing appropriate use of epidural and subarachnoid anesthesia.
引言。椎管内表皮样肿瘤较为罕见。无论是先天性还是医源性原因导致，它们都是由植入椎管内的表皮细胞形成的。这种植入可发生在多种手术和事件过程中，如枪伤、手术、脊髓造影或用于诊断、麻醉或治疗的穿刺。尽管麻醉学书籍和期刊中未讨论这种并发症，但我们发现超过100例已发表的医源性椎管内表皮样肿瘤病例报告中提及了它。
病因发病机制。脊柱医源性表皮样肿瘤源于在无引导或引导不足的腰椎穿刺过程中，椎管内输送的表皮组织植入。有充分证据表明此类肿瘤是医源性的。所有病例均发生在有腰椎穿刺病史的患者中。它们很少与先天性异常相关。它们位于髓外。它们倾向于在早期腰椎穿刺部位附近发展，通常靠近脊髓圆锥和马尾。两项研究通过将自体皮肤碎片植入椎管内，在实验中再现了脊柱医源性表皮样肿瘤。
临床症状。这些肿瘤患者在较长时间内（2至10年）耐受性良好。在马尾部位，肿瘤可长时间缓慢生长而无神经受压迹象。症状与肿瘤大小和部位直接相关。所有马尾部位有肿瘤的患者均报告有向受压神经根放射的剧痛。核磁共振无需鞘内注射造影剂即可检测到肿瘤。目前钆喷酸葡胺可改善图像，以便将这些肿瘤与其他类型区分开来。脊柱表皮样肿瘤的预后良好，因为它们在组织学上是良性的。治疗始终是手术治疗。
结论。尽管表皮样脊柱肿瘤与腰椎穿刺之间的因果关系已有充分记录，但麻醉医生对这种可能的并发症认识不足。1977年至1995年期间，有28例新病例发表。我们认为，对这种罕见并发症的更深入了解将向我们展示如何预防它们，同时合理使用硬膜外麻醉和蛛网膜下腔麻醉。
