Ependmoma of the Cauda Equina

“下背痛”在復健科門診是頗為常見的主訴，腫瘤雖估其中一少部份，但卻是最為重要的一部份。倘能早期發現，必能降低神經方面的後遺症，而在臨床症狀上，有時往往不易區分椎間盤凸出與馬尾腫瘤。但隨著診斷性工具的進步，早期診斷率已大為提高，本篇報告台中榮民總醫院復健科自1986年1月至1992年5月收集的6例馬尾區室管膜瘤病人，其中3例在復健科門診診斷出。以其臨床症狀，理學檢查、結果及後遺症加以分析討論。初期臨床症狀以背痛或臀部痛居多（100%）但有一例合併頭痛、嘔吐、脖子僵硬，經檢查診斷為室管膜瘤合併蜘蛛膜下腔出血。後期則出現各種神經症狀，如感覺失常（100%），下肢無力（50%），及括約肌的問題（67%）。夜間疼痛（67%）是馬尾腫瘤的特徵，一般椎間盤凸出少有之。核磁共振造影或電腦斷層合併脊髓造影為有效的診斷工具。經手術治療或合併放射治療，大部份的症狀皆獲緩解。四例開刀前有小便困難，開刀後2例有進步。兩例在開刀後才發生此問題，經膀胱訓練於四週內復原。

關鍵字

無資料

並列摘要

Low back pain is a frequent complaint in PM&R OPD. Tumors of the cauda equina play an uncommon but nevertheless important role in the ”sciatic syndrome”. Early detection will lower the risk of neurological sequelae. However, on clinical grounds alone, it is sometimes difficult to differentiate between a cauda equina tumor and a prolapsed interver-tebral disc. Recent advances in imaging techniques had increased the diagnostic rates. This study was based on 6 cases of ependymoma of the cauda equina, collected from January 1986 to May 1992 at VGHTC. Three of them were detected at PM&R OPD. The clinical symptoms, physical examination, treatment and outcome will be discussed. The initial symptom is back or buttock pain (100%), while one case was combined with headache, vomiting and neck stiffness which proved to be subarachnoid hemorrhage later. The late symptoms include sensory deficit (100%), motor deficit (50%) and sphincter disturbance (67%). Nocturnal pain (67%), which is rare in herniated intervertebral discs, is a traditional feature of the cauda equina tumor. MRI or CT-myelogram are efficient diagnostic tools. After surgical excision with or without radiotherapy, most symptoms relieved. Two out of four cases with preexisting urination problems improved after surgery. Two cases developed difficulty in urination post-operatively. After bladder training, they regained their function within 4 weeks.

並列關鍵字

ependymoma ； cauda equina ； back pain

國際替代計量

Ependmoma of the Cauda Equina

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