Ligation and Partial Excision of the Cauda Equina as Part of a Wide Resection of Vertebral Osteosarcoma: A Case Report and Description of Surgical Technique
Ligation and Partial Excision of the Cauda Equina as Part of a Wide Resection of Vertebral Osteosarcoma: A Case Report and Description of Surgical Technique
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马尾结扎和部分切除作为椎骨骨肉瘤广泛切除的一部分：病例报告和手术技术描述
DOI：
10.1097/01.brs.0000153396.39009.a3
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发表时间：
2005
期刊：
影响因子：
3
通讯作者：
M. Dvorak
中科院分区：
文献类型：
--
作者：
Ory Keynan;C. Fisher;Michael C. Boyd;J. O'Connell;M. Dvorak
研究设计.一份病例报告。目标.描述以硬脑膜为边缘的椎体骨肉瘤的独特挑战和新的手术方法。背景数据总结。脊椎骨肉瘤是一种罕见的恶性骨肿瘤，预后不良。目前，最好的证据支持，最佳的手术治疗需要广泛切除肿瘤。故意损害神经功能，以确保切除肿瘤与广泛的手术边缘可能会造成一个困难的困境，为外科医生和病人。我们在这里描述的第一个报告的情况下，据我们所知，广泛的手术切除脊椎骨肉瘤，包括结扎和切除部分马尾和脊髓圆锥。方法.本文报告一位L2骨肉瘤患者的临床及影像学表现。手术治疗原发性脊柱恶性肿瘤的挑战，涉及硬脑膜作为一个边缘，进行了讨论。详细描述了用于实现宽手术切缘的最终手术技术。结果4年随访显示患者情况良好，可在轮椅上行走，无活动性疾病或背部或神经性疼痛的临床或放射学证据，也无牢固的骨融合。结论目前，有足够的证据支持这一前提，即脊柱肉瘤的最佳治愈机会可以通过整块切除术提供，切缘阴性。然而，在脊柱肿瘤切除术中，神经功能的丧失通常发生在神经根水平，这是唯一一个如此戏剧性的神经功能牺牲的病例。虽然现在还为时尚早，但手术和医疗目标已经达到，但最重要的是，患者的首要生存目标已经实现。
Study Design. A case report. Objectives. To describe the unique challenges and novel surgical approach to treatment of vertebral osteosarcoma involving the dura as a margin. Summary of Background Data. Osteosarcoma of the vertebral column is a rare, malignant osseous tumor, carrying a poor prognosis. Currently, best available evidence supports that optimal surgical treatment entails wide excision of the tumor. Intentionally compromising neurologic function in order to ensure resection of the tumor with wide surgical margins can pose a difficult dilemma for the surgeon and patient. We describe here the first reported case, to our knowledge, of wide surgical resection of a vertebral osteosarcoma, including ligation and resection of part of the cauda equina and conus medullaris. Methods. The clinical and radiographic presentations of a patient with osteosarcoma of L2 are presented. The challenges of surgical treatment of a primary malignant tumor of the spine, involving the dura as a margin, are discussed. The ultimate surgical technique employed to achieve wide surgical margins is described in detail. Results. Four-year follow-up shows the patient is doing well, ambulating in a wheelchair, with no clinical or radiologic evidence of active disease or back or neuropathic pain and solid bony fusion. Conclusion. Currently, there is sufficient evidence to support the premise that the best chance for cure in sarcomas of the spine can be afforded through en bloc resection with negative margins. Neurologic forfeit in resection of spinal tumors, however, is usually at the root level, and this is the only case where such dramatic neurologic sacrifice was carried out. Although it is still early, the surgical and medical goals have been met, but most importantly, the patient’s foremost goal of survival has been accomplished.