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뇌경색으로 오인되었던 흉추부 경막내 척수외 종양에 의한 척수증 -증례보고-
소재완,신병준,이재철,박성용,박종석 대한척추외과학회 2012 대한척추외과학회지 Vol.19 No.1
Study Design: A Case report. Objectives: We report a case of thoracic intradural extramedullary tumor that has been misdiagnosed as the cerebral infarction. Summary of Literature Review: Spinal meningioma is one of the common spinal tumors. Clinical symptoms were characteristically progressive myelopathy, rather than radiculopathy. Materials and Methods: A 66-year-old female patient who had a history of cerebral infarction admitted as suffering from progressive lower extremities weakness for 6 months. The patient was diagnosed and has been treated as the cerebral infarction at another hospital. However, the patient showed worsening symptoms. In magnetic resonance imaging, an intradural extramedullary space occupying mass compressing the spinal cord, between T8 and T9 level, was shown. By undergoing an operation, resected the mass. In a pathologic report, mass was confirmed to be meningioma. Results: After the operation, symptoms were improved. The patient was able to walk 2 weeks after surgery. Conclusions: We report the correct diagnosis and a successful surgical treatment of myelopathy, due to thoracic myelopathy that has been misdiagnosed as the cerebral infarction in another hospital. 연구 계획: 증례보고목적: 양측 하지 약화 및 보행 장해가 진행하는 것을 뇌경색으로 오인하여 치료받다가, 종양의 척수 압박으로 인한 척수증이 원인임을 발견하고 수술적치료하였던 1예를 경험하였기에 이를 보고하고자 한다. 선행 문헌의 요약: 척추 수막종은 척추 종양중 비교적 흔한 종양으로, 신경근증보다 진행성 척수증 증상이 특징적이다. 대상 및 방법: 뇌경색의 과거력이 있던 66세 여자환자가 양측 하지 근력 약화를 주소로 타 병원에서 6개월 전부터 뇌경색이 악화된 것으로 진단받고 치료를 받았으나, 증상이 악화되어 본원으로 전원되었다. 자기 공명 영상에서 제8,9 흉추체 부위에 경막내 공간을 거의 다 점유하고 있는 타원형의 종괴가 척수를 압박하고 있는 소견이 관찰되었다. 수술적 치료로 종괴를 제거하였고, 조직검사상 수막종이었다. 결과: 수술 후 증상은 현저히 호전되어, 술후 2주째부터 보행이 가능하였다. 결론: 타 병원에서 뇌경색으로 오인하였던 척수증을, 정확한 진단과 치료를 통해 성공적인 결과를 얻을 수 있었다.
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김환정,구제윤,배경완,강종원,박건영,강성일,최원식 대한척추외과학회 2011 대한척추외과학회지 Vol.18 No.2
Study Design: A retrospective study about spinal intradural tumor. Objectives: We analyzed clinical symptom, findings of MRI, and surgical outcome of spinal intradural tumor. Summary of Literature Review: Intradural tumors are not commonly reported and they show non-specific clinical features. Materials and Methods: In this study, 18 patients who underwent surgical treatment and radiologically and pathologically diagnosed as spinal intradural tumor from 1997 to 2009 were reviewed. We evaluated pain, neurological symptoms, location of tumor as well as degrees of signal intensity and its enhancement of MRI(T1 and T2). And clinical outcomes were analyzed according to Klekamp-Samii scoring system and Visual Analogue Scale(VAS). Results: All patients were clinically suffered from back pain and radiating pain of lower extremity including 3 patients with neurological symptoms. We radiologically found single tumor in 16 cases and masses more than two lesion in 2 cases. 1 case was located on cord level(T7), 14 cases cauda equine level, and 3 cases sacral level. We performed laminectomy in 18 cases and posterior instrumentation was applied to 8 cases. In clinical features, mean Klekamp-Samii score was improved from 21.6 to 23.5(p<0.05) and VAS was recovered from 5.2 to 3.0 (p<0.05). Conclusions: Spinal intradural tumor has non-specific clinical symptoms. Therefore we should perform MRI to find intradural tumor and active management including surgical treatment should be performed due to clinically good results. Key Words: Spinal intradural tumor, MRI, Clinical symptom
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악성종양으로 오인된 흉추 경막 내-외부에 위치한 수막종: 증례 보고
배지호,송상윤,송명근,김동희 대한척추외과학회 2023 대한척추외과학회지 Vol.30 No.4
Study design: Case report. Objectives: To report a case of a 65-year-old male patient with an extra-intradural thoracic spinal meningioma mimicking a malignancy. Summary of Literature Review: In cases of extra-intradural meningioma, which could be misdiagnosed as a metastatic tumor, if it is difficult to differentiate the tumor through preoperative imaging, the diagnosis must be made through an intraoperative frozen biopsy. Materials and Methods: A 65-year-old man visited our outpatient clinic with paraparesis and paresthesia of 2 months’ duration. A radiologic evaluation at a district hospital revealed L2 and L3 spinal stenosis. He underwent L2 to L3 posterior lumbar interbody fusion and L3 laminectomy. The patient’s symptoms were not relieved after operative treatment. A repeated radiologic evaluation revealed a 1.9-cm mass with rim enhancement in the spinal canal at the T9 to T10 level, extending into the left T9-10 foramen. A routine radiologic evaluation showed a 2.3-cm incidental ground glass opacity in the right upper lobe, which mimicked malignant metastasis. Results: The patient underwent T9-10 level laminectomy and tumor removal, as well as T7-8 and T11-12 level posterior fusion. Meningioma was confirmed based on histological testing conducted using tissue obtained from the extra-intradural area. His lower limb motor power gradually improved to grade IV for both hip flexion and extension two months after surgery. Conclusions: Because it is challenging to distinguish the tumor using preoperative imaging techniques, a definitive diagnosis should be established via intraoperative frozen biopsy.
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