我们的目标是分享我们在骶骨区神经源性肿瘤方面的经验,一种罕见的疾病,和评估方法,术中技术,病例系列中患者的并发症和临床病程。
我们对在我们中心诊断并接受手术的19例骶骨区神经源性肿瘤患者进行了回顾性分析。其中,男性8人,女性11人。他们诊断时的平均年龄为51岁(年龄范围为25-78岁)。六名患者无症状,被诊断为偶然,而大多数(11名患者)表现为腰椎疼痛并伴有其他症状:疼痛放射到腿部,盆腔疼痛,感觉改变和腿部力量的丧失。两名患者在诊断时表现出另一种主要症状:骨盆区域和左腿疼痛。所有患者至少接受一次影像学检查(MRI/CT扫描)。9例患者肿瘤局限于骶骨或随后扩散,通过后路手术。在6个案例中,由于肿瘤的骶骨前位置,采用了专门的前入路;4例需要前后入路。
在诊断时无症状的6例患者在手术后继续无症状。在8名患者中,手术后症状缓解,出院时4岁时腰部或腿部疼痛,在随后的磋商中有所改善。一名患者的症状与右腿的运动和感觉缺陷一致,这是由于the外坐骨神经受损所致。随访时间6~178个月,平均69个月。组织学上,17例分为神经鞘瘤,一例被归类为神经纤维瘤,一个病例被归类为神经纤维肉瘤,接受了放射治疗。三名良性组织学患者因局部复发而接受了进一步手术。
选择进近时,这些肿瘤可以达到的巨大尺寸,它们与结构的关系,和他们的前或后传播应该考虑在内。尽可能多地切除肿瘤块为患者提供更大的益处,因为这降低了肿瘤复发的几率,而不会增加术中和术后并发症,同时也使用了多学科团队.
Our objective is to share our experience in neurogenic tumors of the sacral area, an uncommon disease, and assess approaches, intraoperative techniques, complications and clinical course of patients in a case series.
We conducted a retrospective analysis of 19 cases of patients with neurogenic tumors in the sacral area who were diagnosed and underwent surgery at our center. Of them, 8 were male and 11 were female. They had a mean age at diagnosis of 51 years (with an age range of 25-78 years). Six patients were asymptomatic and were diagnosed incidentally, while the majority (11 patients) presented with lumbar pain accompanied by other symptoms: pain radiating to the legs, pelvic pain, sensory alterations and loss of strength in the legs. Two patients presented with another primary symptom on diagnosis: pain in the pelvic region and in the left leg. All patients underwent a least one imaging test (MRI/CT scan). Nine patients had tumors limited to the sacrum or with subsequent spread, with surgery via the posterior route. In 6 cases, an exclusively anterior approach was employed owing to the pre-sacral location of the tumor; 4 cases required both an anterior and posterior approach.
The 6 patients who were asymptomatic at diagnosis continued to have no symptoms after surgery. In 8 patients, symptoms resolved after surgery, and at discharge 4 had pain in the lumbar region or legs, which improved in subsequent consultations. One patient had symptoms consistent with motor and sensory deficit in the right leg deriving from impairment of the external popliteal sciatic nerve. The mean follow-up period was 69 months (6-178 months). Histologically, 17 cases were classified as schwannomas, one case was classified as neurofibroma, and one case was classified as neurofibrosarcoma, which received radiotherapy. Three patients with benign histologies had further surgery for local recurrences.
When selecting the approach, the large size that these tumors can reach, their relationship with structures, and their anterior or posterior spread should be taken in to account. Resecting the tumor mass as much as possible provides greater benefit to the patient, as this decreases the odds of tumor recurrence without increasing intraoperative and postoperative complications when multidisciplinary teams are also used.