Mori Y, Takayasu M, Saito K, Seki Y, Shibuya M, Yoshida J
Department of Neurosurgery, Nagoya University School of Medicine, Showa, Japan.
Surg Neurol. 1998 Mar;49(3):274-7. doi: 10.1016/s0090-3019(97)00190-0.
The majority of benign spinal osteoblastomas arise from the posterior elements of the spine; there have been no published reports of the tumor in the odontoid process of the axis. Accurate preoperative localization of the tumor is important for planning minimally invasive surgery on such benign tumors. However, the magnetic resonance imaging (MRI) findings may be misleading, because peritumoral changes may be confusing.
We report the case of a 20-year-old man, who presented with a 4-year history of protracted left posterior neck pain. Preoperative computed tomography (CT) revealed a discrete mixed-density mass within the odontoid process. MRI showed diffusely abnormal signal intensity and enhancement both in the odontoid process and the body of the axis, including regions from which biopsy specimens were normal or had minimal inflammatory changes. Precise preoperative localization of the tumor margins using CT and biopsy allowed for successful resection of the tumor via a transoral approach with preservation of a part of the axis and the odontoid process. Consequently, stabilization of the spine was unnecessary, and the patient remained symptom-free for 3.5 years.
We reported a rare case of benign osteoblastoma of the odontoid process of the axis. The tumor was successfully resected via a transoral approach, preserving a part of the axis and the odontoid process. We have emphasized an advantage of CT over MRI for accurate localization of the tumor.
大多数良性脊柱成骨细胞瘤起源于脊柱的后部结构；目前尚无关于枢椎齿突出现该肿瘤的报道。对于此类良性肿瘤，准确的术前肿瘤定位对于规划微创手术至关重要。然而，磁共振成像（MRI）结果可能会产生误导，因为肿瘤周围的变化可能令人困惑。
我们报告了一名20岁男性的病例，他有4年的左侧后颈部长期疼痛病史。术前计算机断层扫描（CT）显示齿突内有一个离散的混合密度肿块。MRI显示齿突和枢椎体均有弥漫性异常信号强度及强化，包括活检标本正常或仅有轻微炎症改变的区域。术前通过CT和活检精确确定肿瘤边界，使得通过经口入路成功切除肿瘤，同时保留了部分枢椎和齿突。因此，无需进行脊柱稳定手术，患者在3.5年内一直无症状。
我们报告了一例罕见的枢椎齿突良性成骨细胞瘤病例。通过经口入路成功切除肿瘤，保留了部分枢椎和齿突。我们强调了CT在准确肿瘤定位方面优于MRI的优势。
