- 期刊
Spinal Schwannoma Induced Cauda Equina Syndrome and Conus Medullary Syndrome: Cases Report and Literature Review
脊椎神經髓鞘瘤引發馬尾症候群及脊髓圓錐症候群：病例報告及文獻回顧
摘要
Cauda equina syndrome(CES) and Conus medullary syndrome(CMS) were neurological disasters owing to lumbar and sacral nerve roots compression. Spinal schwannoma(SW) is implicated as an intradural extramedullary lesion to engender CES or CMS. This study aimed to verdict a therapeutic paradigm of SW patients with CES and CMS. Two cases, mean age = 56±3 years, were enrolled. Gender(1:1); one lumbar spinal intramedullary neoplasm presented paraplegia, lumbodynia and stool incontinence as well as perianal numbness; the other had monoplegia, lumbodynia and perianal numbness. Both the patients had post-operative CSF leakage, healed thru tight closure(2/2). Stool and urinary incontinence was amended later. The neurologic deficits resumed postoperatively. This study lends credence to reinforce precise diagnosis, surgical remedy ameliorates CES and CMS in SW patients. Amid the predictive elements, SW removal shortly after the commencement of CES and CMS becomes a promising factor to cure neurologic sequel in SW patients.
並列摘要
馬尾症候群及脊髓圓錐症候群為腰椎及薦椎神經過度壓迫造成的，是一種需緊急治療的神經急症。脊椎許旺腫瘤是一種生長在脊髓腔、髓鞘外的腫瘤，為造成馬尾症候群或脊髓圓錐症候群的原因之一。因為脊椎許旺腫瘤患者在引發馬尾症候群或脊髓圓錐症候群前，徵狀並不明顯；一旦發生時，往往延緩治療致效果不佳。我們希望藉此找出可治療脊椎許旺腫瘤的模式，給予脊椎許旺腫瘤患者引發馬尾症候群或脊髓圓錐症候群時，更好的治療效果。兩位患者，年齡從五十三歲跟五十九歲，男女比率1：1，一位腰椎脊髓內腫瘤並雙下肢無力、下背痛及尿失禁或大便失禁、肛門口麻木：過去病史包含代謝疾病：另一位腰椎馬尾腫瘤則有單一下肢無力者、下背痛、尿失禁或大便失禁。術後腦脊髓液外漏（2/2）接受緊密縫合手術而改善。兩位患者皆接受椎核磁共振檢查及脊椎腫瘤切除手術。治療期間從7至10天不等。尿失禁或大便失禁問題、下肢肌力改善給予藥物治療及物理療法，在七天至一個月得到改善。關於脊椎硬膜內腫瘤，一旦產生嚴重馬尾症候群或脊髓圓錐症候群，預後往往不佳。此次報告加強了對於脊椎許旺腫瘤的疾患引發馬尾症候群或脊髓圓錐症候群，須盡早進行手術治療，才能改善患者預後。