Anract P, Babinet A, de Pinieux G, Carlioz A, Forest M, Tomeno B
Service de Chirurgie Orthopédique B, Hôpital Cochin, Paris.
Rev Chir Orthop Reparatrice Appar Mot. 1998 May;84(3):239-46.
Giant sacral schwannoma is a very rare tumor (25 cases reported). The authors report 3 cases of giant sacral schwannoma treated by curettage through posterior approach and discuss symptoms and treatment. These tumors were characterized by their minimal symptoms compared to radiographic findings. Magnetic resonance imaging must be performed in order to detect extraosseous tissue component and intradural invasion. A biopsy was performed to confirm the diagnosis before definitive treatment. Wide resection was proposed by many authors because of the high recurrence rate. We believe that a wide resection is too sever as it causes neurologic sacrifices. A curettage through posterior approach preserves nerve function, and if a local recurrence occurs it remains possible to perform a wide resection. When sacroiliac joint instability is detected, a lumboiliac arthrodesis is indicated. Osteosynthesis could be performed with spine device (using pedicular and iliac screws).
巨大骶骨神经鞘瘤是一种非常罕见的肿瘤(仅报道过25例)。作者报告了3例经后路刮除术治疗的巨大骶骨神经鞘瘤病例,并讨论了其症状及治疗方法。这些肿瘤的特点是与影像学表现相比症状轻微。必须进行磁共振成像以检测骨外组织成分及硬膜内侵犯情况。在进行确定性治疗前需进行活检以确诊。由于复发率高,许多作者建议行广泛切除。我们认为广泛切除过于激进,因为会导致神经损伤。后路刮除术可保留神经功能,若发生局部复发仍可行广泛切除。当检测到骶髂关节不稳时,需行腰髂关节融合术。可使用脊柱器械(椎弓根螺钉和髂骨螺钉)进行骨固定。