척수 경막내 종양의 임상적 특징 및 수술결과

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

신경성 척수종양(신경초종)에 대한 임상적 분석

염진영 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2

The author analyzed 23 cases of spinal schwannomas who had been operated at the our hospital from Mar. 1992 to Feb. 1998. The result were summerized as followings: 1) The spinal schwannomas were most common in the 6th and 7th decade of age (11 cases, 48%) and the ratio of male to female was 1.3 : 1. 2) The tumors were ocupied in intradural-extramedullary area(11 cases, 48%), dumbbell shaped intra-and extradural area(9 cases, 39%), extradural area(3 cases, 13%) in order frequency. 3) 83% of the IDEM tumors were located in the thoracolumbar area and 86% of the IDED tumors in the cervical area. All IDEM tumors(11 cases) were located in posterior or posterolateral space of the cord. 4) The size of extradural mass was larger than intradural mass in the IDED tumors(7 of 9 cases, 78%) 5) The symptome duration was average 14.5 months. Neurologic symptoms were root radiculopathic pain(18 cases, 78%), dermatomic patterned sensory deficit(12 cases, 52%),motor deficit(10 cases, 43%), sphincter weakness(2 cases, 9%) in order frequency. 6) The rate of abnormality of the plain radiologic study was 43% and the most common positive finding was the widening of the intervertebral foramen(8 cases, 35%). MRI revealed low or iso signal intensity in T1WI(19 cases, 83%), high signal intensity in T2WI(20 cases, 87%), relative homogenous well enhancement(16 cases, 70%), and peripheral rim enhancement in 5 casese of 11 IDEM tumors 7) The total removal was possible in 20 cases(87%). The ratio of postoperative improvement was 91%(21 cases).

Neurologic Complication Following Spinal Epidural Anesthesia in a Patient with Spinal Intradural Extramedullary Tumor

Kim, Sung-Hoon,Song, Geun-Sung,Son, Dong-Wuk,Lee, Sang-Won The Korean Neurosurgical Society 2010 Journal of Korean neurosurgical society Vol.48 No.6

Paraplegia following spinal epidural anesthesia is extremely rare. Various lesions for neurologic complications have been documented in the literature. We report a 66-year-old female who developed paraplegia after left knee surgery for osteoarthritis under spinal epidural anesthesia. In the recovery room, paraplegia and numbness below T4 vertebra was checked. A magnetic resonance image (MRI) scan showed a spinal thoracic intradural extramedullary (IDEM) tumor. After extirpation of the tumor, the motor weakness improved to the grade of 3/5. If a neurologic deficit following spinal epidural anesthesia does not resolve, a MRI should be performed without delay to accurately diagnose the cause of the deficit and optimal treatment should be rendered for the causative lesion.

Neurologic Complication Following Spinal Epidural Anesthesia in a Patient with Spinal Intradural Extramedullary Tumor

김성훈,손동욱,이상원,송근성 대한신경외과학회 2010 Journal of Korean neurosurgical society Vol.48 No.12

Paraplegia following spinal epidural anesthesia is extremely rare. Various lesions for neurologic complications have been documented in the literature. We report a 66-year-old female who developed paraplegia after left knee surgery for osteoarthritis under spinal epidural anesthesia. In the recovery room, paraplegia and numbness below T4 vertebra was checked. A magnetic resonance image (MRI) scan showed a spinal thoracic intradural extramedullary (IDEM) tumor. After extirpation of the tumor, the motor weakness improved to the grade of 3/5. If a neurologic deficit following spinal epidural anesthesia does not resolve, a MRI should be performed without delay to accurately diagnose the cause of the deficit and optimal treatment should be rendered for the causative lesion.

초음파 수술흡인기(CUSA)를 이용한 척수 경막내 종양 수술에 대한 임상적 연구

김은영,정환영,김남규,김광명,오석전 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.6

The cavitron ultrasonic surgical aspirator(CUSA) has been used for the surgical removal of 26 cases of spinal intradural tumors. In 26 patients, total removal was possible in 77% and there was no neurological deterioration due to surgical removal using CUSA. 21 of 26 patients(84%) showed neurological improvement at long term follow-up examination. The cavitron ultrasonic surgical aspirator had advantages in the surgical removal of spinal intradural tumors, as follows : 1) precise removal of tumor without excessive mechanical manipulation of normal tissue ; 2) rapidity of action relative to the consistency of the tissue ; 3) direct visualization of the tissue being removed and good proprioceptive feedback for the surgeon ; 4) preservation of large vessel and very little bleeding ; 5) lack of thermal injury. The limitation of CUSA was obscuring of operation field by large and straight hand piece.

척수 원위부에 발생한 경막내수막외 혈관아세포종 - 증례보고 -

박성호,조준,윤승환,장상근,Park, Sung-Ho,Cho, Joon,Youn, Seung-Whan,Chang, Sang-Keun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.11

It has been known that hemangioblastoma of spinal cord occurs about 4% of all the spinal tumors. The authors present a rare case of intradural extramedullary(IDEM) hemangioblastoma of distal spinal cord in 41-year-old male patient. This IDEM mass at the level of conus medullaris showed iso-signal intensities on T1-weighted image(T1-WI) and high-signal intensities on T2-WI, and was enhanced homogeneously on MRI. At surgery, T12- L1 total laminectomy and enbloc mass removal were performed. This IDEM hemangioblastoma was confirmed by histopathologic findings. For less postoperative complication in IDEM tumors, we suggest that precise preoperative evaluation and complete excision via proper surgical approach to distal conus should be reemphasized.

Intradural Extramedullary Ependymoma with Spinal Root Attachment: A Case Report

하승만,신동아 대한척추신경외과학회 2012 Neurospine Vol.9 No.3

A 36-year-old female patient presented with shoulder pain experienced over a period of one year and progressive weakness in both legs for one month. A magnetic resonance imaging scan revealed an intradural extramedullary (IDEM) fusiform mass about 9.8 cm in length, heterogeneously enhanced at the level of C6-T4 with spinal cord compression. At the time of surgery,the surgeon found an encapsulated IDEM tumor with spinal root attachment. The tumor was completely resected and the histologic diagnosis revealed ependymoma. The patient showed a favorable outcome with no recurrence at the 6-month follow-up. This paper reports a rare case of intradural extramedullary ependymoma with spinal root attachment.

Intradural Migration of a Sequestrated Lumbar Disc Fragment Masquerading as a Spinal Intradural Tumor

Kim, Hyeong-Suk,Eun, Jong-Pil,Park, Jung-Soo The Korean Neurosurgical Society 2012 Journal of Korean neurosurgical society Vol.52 No.2

Intervertebral intradural lumbar disc herniation (ILDH) is a quite rare pathology, and isolated intradural lumbar disc herniation is even more rare. Magnetic resonance imaging (MRI) may not be able to reveal ILDHs, especially if MRI findings show an intact lumbar disc annulus and posterior longitudinal ligament. Here, we present an exceedingly rare case of an isolated IDLH that we initially misidentified as a spinal intradural tumor, in a 54-year-old man hospitalized with a 2-month history of back pain and right sciatica. Neurologic examination revealed a positive straight leg raise test on the right side, but he presented no other sensory, motor, or sphincter disturbances. A gadolinium-enhanced MRI revealed what we believed to be an intradural extramedullary tumor compressing the cauda equina leftward in the thecal sac, at the L2 vertebral level. The patient underwent total L2 laminectomy, and we extirpated the intradural mass under microscopic guidance. Histologic examination of the mass revealed a degenerated nucleus pulposus.

경막내 척수지방종 1례

김병규,반재영,임좌혁,류태희,남방현,윤석훈 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.9

Intradural spinal lipomas are rare. primary benign tumor of the spinal canal. A case of intradural spinal lipoma with intramedullary extension is presented. Clinical feature was slowly progressing paraparesis. A subtotal excision was performed, and pathological studies confirmed the diagnosis.

Granular Cell Tumor of the Intradural Extramedullary Spinal Cord : Report of Two Cases with Respect to Radiological Differential Diagnosis

Lee, Chang-Hyun,Hyun, Seung-Jae,Lee, Joon Woo,Rhim, Seung-Chul The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.53 No.2

Granular cell tumors (GrCTs) of the spinal cord are rare benign tumors with a high rate of local recurrence. Only 6 cases of spinal GrCTs have been reported. GrCT is difficult to distinguish from other benign tumors such as schwannoma using imaging. A radiological "speckled dots" sign may be a useful differentiating feature of GrCT based upon experience with two cases and a review of the literature.