巨大颈鼻神经鞘瘤。

Q3 Pharmacology, Toxicology and Pharmaceutics Journal of Experimental Therapeutics and Oncology Pub Date : 2019-12-01
Sudha Ram, V Vivek, Ravi Shekhar, Abhirama Chandra Gabbita, K Ganesh
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摘要

目的:神经鞘瘤是由产生髓磷脂的雪旺细胞引起的生长缓慢的良性肿瘤。颈背神经鞘瘤是一种罕见的良性肿瘤,发病缓慢,有时无症状,功能不活跃。巨大的神经鞘瘤延伸超过两个或两个以上的椎体水平已被记录,并试图在现有文献中对其进行分类,但不充分。影像方式和显微外科的进步使这些肿瘤的治疗变得更好。本文报告一例罕见的硬膜内髓外颈背神经鞘瘤,沿7个椎体水平延伸至胸椎水平,患者为55岁男性,进行性虚弱和麻木超过一年半。颈椎MRI在t1矢状位上显示病变不均一,脊髓水肿至D7水平。组织学检查显示包裹性梭形细胞病变,伴细胞少或细胞多区,胞体,偶见奇异核,血管透明,无坏死/非典型有丝分裂,提示神经鞘瘤。俯卧位,行C4至D7椎板闭合切开术,全部切除硬膜内髓外病变。术后CT扫描显示椎管尺寸正常,植入物原位。术后每季度随访一年,患者四肢力量接近正常,膀胱功能正常。
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Giant Cervicodorsal Schwannoma.

Objective: Schwannomas are benign slow growing tumors that arise from myelin producing Schwann cells. Schwannomas developing in cervical-dorsal region are rare benign neoplasms which are emerges leisurely remains asymptomatic some times and functionally inactive tumours. Giant Schwannomas extending over two or more vertebral levels have been documented and attempts have been made to classify these in available literature, however inadequate. Advancement in imaging modalities and microsurgery has bettered management of these tumors. A rare case of intradural extramedullary cervicodorsal schwannoma extending along seven vertebral levels to thoracic levels is reported in a 55 year old male patient with progressive weakness and numbness of over one and a half years. MRI of cervical spine showed a heterogeneously lesion with cord oedema till D7 level on T1contrast saggital view. Histological examination revealed encapsulated spindle cell lesion with hypocellular and hypercellular areas with verucay bodies, occasional bizzare nuclei, hyalinized blood vessels, with no evidence of necrosis/atypical mitosis, suggestive of schwannoma. In the prone position, C4 to D7 enbloc laminotomy was done and total excision of intradural extramedullary lesion was done. Post-operative CT scans revealed normal spinal canal dimensions with implants in situ. At quarterly follow up upto one year post-operative, the patient had near normal power in all four limbs and normal bladder function.

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