Diagnosis and treatment of a C2-osteoblastoma encompassing the vertebral artery
Diagnosis and treatment of a C2-osteoblastoma encompassing the vertebral artery
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DOI：
10.1007/s00586-013-2875-5
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发表时间：
2013-11-01
影响因子：
2.8
通讯作者：
Kandziora, Frank
中科院分区：
文献类型：
--
作者：
Stavridis, Stavros I.;Pingel, Andreas;Kandziora, Frank
成骨细胞瘤是一种罕见的良性骨肿瘤，约占所有原发性骨肿瘤的1%和脊柱肿瘤的5%，大多数发生在生命的第二和第三十年内的脊柱后部元件内。非特异性的初始症状，主要是颈部或背部疼痛和脊柱僵硬，通常无法诊断，肿瘤扩张的破坏性性质甚至可以导致神经功能缺损。CT和MRI扫描构成了诊断和术前计划的基本成像方式，前者描绘了肿块的位置和骨质受累，后者提供了对软组织和神经元素的影响的评价。在我们的病例中，一位23岁的男性在一个月前的一次汽车碰撞后出现了持续的头颈部疼痛。尽管最初的诊断影像学检查（包括X线平片和MRI扫描）未能显示任何病理学结果，但症状的持续存在导致重复影像学检查（CT和MRI）显示存在C2椎板良性骨肿瘤，该肿瘤破坏周围的骨结构并包围右侧椎动脉。怀疑为成骨细胞瘤，决定手术切除肿瘤，以治疗持续症状并预防可能的神经功能缺损或血管病变。通过后路进行边缘肿瘤切除，然后进行前路内固定融合。组织学检查证实了骨母细胞瘤的诊断。患者恢复顺利，术后症状明显减轻。手术后18个月，病人仍然没有疼痛，没有任何迹象表明肿瘤复发。本病例描述了诊断这种肿瘤的困难，以及在手术治疗中遇到的挑战和问题，以及适当治疗时的良好预后。
Osteoblastoma is a rare, benign bone tumor that accounts for approximately 1 % of all primary bone tumors and 5 % of spinal tumors, mostly arising within the posterior elements of the spine within the second and third decades of life. Nonspecific initial symptoms mainly neck or back pain and stiffness of the spine remain often undiagnosed and the destructive nature of the expanding tumor can cause even neurological deficits. CT and MRI scans constitute the basic imaging modalities employed in diagnosis and preoperative planning with the former delineating the location and osseous involvement of the mass and the latter providing appreciation of the effect on soft tissues and neural elements.In our case a 23-year-old male presented with persisting head and neck pain, after being involved in a car collision a month ago. Although the initial diagnostic imaging, including plain X-rays and MRI scan failed to reveal any pathological findings, the persistence of the symptoms led to repeating imaging (CT and MRI) that showed the existence of a benign osseous tumor of the C2 lamina that was destructing the surrounding osseous structures and encompassing the right vertebral artery. The suspicion of an osteoblastoma was raised and the decision for surgical removal of the tumor was made for treating the persistent symptoms and preventing a possible neurological deficit or vascular lesion. A marginal tumor resection was performed through a posterior approach, followed by an anterior instrumented fusion. Histological examination confirmed the diagnosis of an osteoblastoma.The recovery of the patient was uneventful and a significant symptom subsidence was reported following surgery. Eighteen months postoperatively the patient remains pain free without any indications for tumor recurrence.This case delineates the difficulties in diagnosing this tumor, as well as the challenges and problems encountered in its surgical management, and also the favorable prognosis when adequately treated.