PDF(Pubmed)
Abstract：
BACKGROUND: Spinal tumors comprise 15 % of all central nervous system tumors, with schwannomas accounting for 30 % of primary intraspinal neoplasms. While predominantly extramedullary-intradural, spinal schwannomas rarely manifest intramedullary occurrences (0.3 % of intraspinal tumors). This study sheds light on two rare cases of thoracic intramedullary schwannomas, emphasizing their diagnostic complexities and surgical management, alongside a literature review.
METHODS: Case 1 involves a 50-year-old female presenting with worsening back pain, right lower limb weakness, and urinary incontinence. MRI revealed an intradural intramedullary soft tissue mass, diagnosed as a schwannoma with an associated organizing hematoma. Surgical removal led to gradual improvement. Case 2 features a 25-year-old male with back pain, partial foot drop, and weakness in the right knee and hip. MRI demonstrated an intradural intramedullary lesion, later confirmed as an intradural intramedullary schwannoma. Surgery resulted in a smooth recovery without adverse effects.
CONCLUSIONS: This article presents two cases of intradural intramedullary thoracic schwannomas initially misdiagnosed as astrocytomas. Surgical resection confirmed the diagnosis, underscoring challenges in preoperative MRI diagnosis. The review of 174 reported cases reveals an equal distribution between the cervical and thoracic regions, with males affected 1.5 times more frequently than females. The average age of onset is 40, and surgical treatment demonstrates a 90 % improvement rate. The complex pathogenesis encompasses six proposed explanations. Clinical suspicion, considering pain and neurological symptoms, is paramount due to potential misdiagnosis and the imperative for histological confirmation.
CONCLUSIONS: Although rare, intramedullary schwannomas (IMS) have significant clinical implications, necessitating precise treatment. Surgical resection yields favorable outcomes, with subtotal resection considered based on adhesion factors. Pre-surgical diagnosis requires a comprehensive integration of radiological and clinical data, with intraoperative analysis ensuring optimal treatment strategies.
METHODS: Case 1 involves a 50-year-old female presenting with worsening back pain, right lower limb weakness, and urinary incontinence. MRI revealed an intradural intramedullary soft tissue mass, diagnosed as a schwannoma with an associated organizing hematoma. Surgical removal led to gradual improvement. Case 2 features a 25-year-old male with back pain, partial foot drop, and weakness in the right knee and hip. MRI demonstrated an intradural intramedullary lesion, later confirmed as an intradural intramedullary schwannoma. Surgery resulted in a smooth recovery without adverse effects.
CONCLUSIONS: This article presents two cases of intradural intramedullary thoracic schwannomas initially misdiagnosed as astrocytomas. Surgical resection confirmed the diagnosis, underscoring challenges in preoperative MRI diagnosis. The review of 174 reported cases reveals an equal distribution between the cervical and thoracic regions, with males affected 1.5 times more frequently than females. The average age of onset is 40, and surgical treatment demonstrates a 90 % improvement rate. The complex pathogenesis encompasses six proposed explanations. Clinical suspicion, considering pain and neurological symptoms, is paramount due to potential misdiagnosis and the imperative for histological confirmation.
CONCLUSIONS: Although rare, intramedullary schwannomas (IMS) have significant clinical implications, necessitating precise treatment. Surgical resection yields favorable outcomes, with subtotal resection considered based on adhesion factors. Pre-surgical diagnosis requires a comprehensive integration of radiological and clinical data, with intraoperative analysis ensuring optimal treatment strategies.
摘要：
背景：脊柱肿瘤占所有中枢神经系统肿瘤的15％，神经鞘瘤占原发性椎管内肿瘤的30%。虽然主要是髓外硬膜内，脊髓神经鞘瘤很少出现髓内病变（占椎管内肿瘤的0.3%）。这项研究揭示了两例罕见的胸髓内神经鞘瘤，强调他们的诊断复杂性和手术管理，除了文献综述。
方法：病例1涉及一名50岁女性背痛加重，右下肢无力,和尿失禁.MRI显示硬膜内髓内软组织肿块，诊断为神经鞘瘤并伴有组织性血肿。手术切除导致逐步改善。案例2以一名25岁男性背痛为特征，部分足下垂,右膝和髋部无力.MRI显示硬膜内髓内病变，后来证实为硬膜内髓内神经鞘瘤。手术恢复顺利，无不良反应。
结论：本文介绍了2例最初误诊为星形细胞瘤的胸椎髓内神经鞘瘤。手术切除证实了诊断，强调术前MRI诊断的挑战。对174例报告病例的回顾显示，颈部和胸部区域分布相等，男性受影响的频率是女性的1.5倍。平均发病年龄为40岁，手术治疗显示出90％的改善率。复杂的发病机制包括六种建议的解释。临床怀疑,考虑到疼痛和神经症状，由于潜在的误诊和组织学确认的必要性，这是至关重要的。
结论：虽然罕见，髓内神经鞘瘤（IMS）具有重要的临床意义，需要精确的治疗。手术切除产生良好的结果，根据粘连因素考虑次全切除。术前诊断需要全面整合放射学和临床资料,术中分析确保最佳治疗策略。
方法：病例1涉及一名50岁女性背痛加重，右下肢无力,和尿失禁.MRI显示硬膜内髓内软组织肿块，诊断为神经鞘瘤并伴有组织性血肿。手术切除导致逐步改善。案例2以一名25岁男性背痛为特征，部分足下垂,右膝和髋部无力.MRI显示硬膜内髓内病变，后来证实为硬膜内髓内神经鞘瘤。手术恢复顺利，无不良反应。
结论：本文介绍了2例最初误诊为星形细胞瘤的胸椎髓内神经鞘瘤。手术切除证实了诊断，强调术前MRI诊断的挑战。对174例报告病例的回顾显示，颈部和胸部区域分布相等，男性受影响的频率是女性的1.5倍。平均发病年龄为40岁，手术治疗显示出90％的改善率。复杂的发病机制包括六种建议的解释。临床怀疑,考虑到疼痛和神经症状，由于潜在的误诊和组织学确认的必要性，这是至关重要的。
结论：虽然罕见，髓内神经鞘瘤（IMS）具有重要的临床意义，需要精确的治疗。手术切除产生良好的结果，根据粘连因素考虑次全切除。术前诊断需要全面整合放射学和临床资料,术中分析确保最佳治疗策略。
