累及后纵膈巨大椎管内神经鞘瘤:1例报告与综述

Huge dumbbell- shaped intraspinal schwannoma involving posterior mediastinum: a case report and literature review

摘要:

本文报告 1 例高龄患者的上胸椎复发性巨大哑铃状神经鞘瘤，肿瘤侵犯了后纵隔。患者首次手术切除了椎管内及椎间孔内肿物，以解除脊髓压迫改善神经功能。术后 44 个月，患者症状反复，后纵膈内肿物短期复发，且较前次明显增大。遂进行了二次手术，全麻下行经后路神经鞘瘤切除，椎弓根螺钉内固定，植骨融合术，术中完整切除肿瘤并重建脊柱稳定性，疗效良好。根据本例经验，采用后正中入路完整切除肿瘤可能是部分后纵膈巨大哑铃状神经鞘瘤的一种安全术式。

Abstract:

We present an elderly patient who suffered from recurrent huge dumbbell-shaped schwannoma in upper thoracic spine in- volving the posterior mediastinum. The patient underwent the first surgical resection of intraspinal and foraminal masses to relieve spinal cord compression and promote neurological recovery. Forty-four months later, the patient had recurrent symptoms with posterior mediastinal mass growth, which was significantly larger than the previous one. Under general anesthesia, the second operation was performed, involving schwannoma resection, pedicle screw internal fixation and bone grafting through posterior midline approach. The tumor was completely re- sected and spinal stability was reconstructed. Based on the experience of this case, complete resection of the tumor by the posterior midline approach may be a safe procedure for partial dumbbell-shaped schwannomas involving the posterior mediastinum.