第四胸椎脊髓膜瘤合併腰椎間盤凸出一病例報告

Meningioma Associated with Lumbar HIVD-Case Report

黃永賜(Yung-Szu Huang) ； 梅紹京(Sau-Chin Mei) ； 劉憶平(I-Ping Liu)

《中華民國復健醫學會雜誌》 23卷1期 (1995/06) Pp. 71-75

摘要

脊髓膜瘤(spinal menimgloma)是生長緩慢．界限清楚的良性腫瘤，約佔原發性脊髓腫瘤之25%．女性居多且大多位於胸椎。早期症狀以背痛最常見，其次是運動功能受損及感覺異常。脊髓膜瘤不易早期診斷．往往等到有明顯脊髓壓迫症候，才被診斷出來。約有三分之一的案例．診斷時已不能行走．所幸手術治療之效果良好．即使是嚴重截癱之病患．也有可能完全恢復功能。脊髓膜瘤很少鈣化．X-ray封診斷沒有幫忙．電腦斷層及磁振造彰則具有診斷性。術後復發牢比腦膜瘤更低，手術後五年內復發機率約1．3%。本文患者除了脊髓膜瘤之外．還有腰椎退化性病變．腰椎間盤凸出，右膝關節退化及攝護腺肥大。隨後之椎體症候．也僅出現在左下肢．右側則無．其原因可能是右側神經根受到椎間盤凸出壓迫所致。病患手術前已是截癱．須靠輪椅代步．小便失禁．大便須賴灌腸。脊髓已受嚴重壓迫．腫瘤已幾乎佔滿脊髓腔．然而手術後恢復之情形．仍是快速且令人滿意。
本文描述病患之臨床症狀．診斷與治療之經過反其預後．提醒臨床醫師．不要忽略詳細之理學檢查。

關鍵字

脊髓膜瘤 ； 椎間盤凸出

並列摘要

Spinal meningioma is a well circumscribed benign tumor. It grows slowly and acounts for about 25% of primary spinal cord tumors. It occurs predominantly in women and in thoracic region. Sometimes, we mistook its early symptoms for another problems such as arthritis, arachnoiditis, peripheral nerve disease, or motor neuron disease etc. Fortunately, Patient with severe motor deficit less than two months may get satisfactory improvements after surgery. The recurrent rate of spinal meningioma is much lower than that of intracranial meningioma. We reported a case of spinal meningioma at T4 level. He was diagnosed initially as lumbar disc herniation and osteoar-thritis of knees. CT scan of L-spine revealed disc herni-ation at L3-4 and L5-S1 compressing nerve root of R't side. Motor deficit, sensory dysfunction and sphincter dysfunction developed gradually. He was wheelchair dependent 3 weeks before surgery; however, he still got rapid recovery and walked independently 3 months after surgery. Here, We discussed about the symptoms, signs, diagnosis, prognosis, and recurrent rate of spinal meningiomas.

並列關鍵字

spinal meningioma ； disc herniation