SPINAL RADIOSURGICAL TREATMENT FOR THORACIC EPIDURAL CAVERNOUS HEMANGIOMA PRESENTING AS RADICULOMYELOPATHY: TECHNICAL CASE REPORT
SPINAL RADIOSURGICAL TREATMENT FOR THORACIC EPIDURAL CAVERNOUS HEMANGIOMA PRESENTING AS RADICULOMYELOPATHY: TECHNICAL CASE REPORT
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DOI：
10.1227/01.neu.0000345940.21674.ae
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发表时间：
2009-06-01
期刊：
影响因子：
4.8
通讯作者：
Khang, Shin Kwang
中科院分区：
文献类型：
--
作者：
Sohn, Moon-Jun;Lee, Dong-Joon;Khang, Shin Kwang
目的：应用影像引导立体定向放射外科（SRS）治疗1例胸椎硬膜外海绵状血管瘤。本报告证明了脊髓SRS在治疗以前需要广泛侵入性手术的疾病方面的潜力。临床表现：一位27岁的女性步态障碍和肩部疼痛放射到右臂和背部提出临床评估。磁共振成像显示椎间孔外膜外肿块压迫椎间孔T1-T2和T2-T3水平的脊髓。患者曾接受减压椎板切除术和开放性活检。手术后几个月，她的神经根性脊髓病没有改善，而且似乎在进展。干预：对病变进行调强低分割放射手术。患者的神经根性疼痛在几天内得到显著改善，相关神经症状在几个月内基本消失。随访12个月和36个月的磁共振成像显示肿瘤肿块大大缩小。没有任何与辐照相关的并发症的明显证据，患者继续表现出积极的预后。结论：经病理证实的胸椎硬膜外海绵状血管瘤采用最先进的脊柱图像引导SRS成功治疗。根据我们对其他类型肿瘤的治疗经验，我们确定这种病理的有效治疗方式是将32 Gy的低分割剂量分成4次。该治疗方案提供了快速的临床效益和长期的肿瘤控制，证明了SRS在治疗这种困难和罕见的疾病中的可行性。
OBJECTIVE: Image-guided stereotactic radiosurgery (SRS) was applied to a case of spinal epidural cavernous hemangioma in the thoracic spine. This report demonstrates the potential for spinal SRS in treating diseases that have previously required extensive invasive surgery.CLINICAL PRESENTATION: A 27-year-old woman with gait disturbance and shoulder pain radiating into the right upper arm and back presented for clinical evaluation. Magnetic resonance imaging revealed an extraforaminal epiclural mass compressing the spinal cord at the T1-T2 and T2-T3 levels of the intervertebral foramen. The patient had previously undergone a decompressive laminectomy and open biopsy. Several months after this surgery, her radiculomyelopathy had not improved and appeared to be progressing.INTERVENTION: Intensity-modulated hypofractionated radiosurgery was performed on the lesion. The patient's radicular pain was remarkably improved within days, and associated neurological symptoms had largely disappeared within a few months. Subsequent follow-up magnetic resonance imaging at 12 and 36 months showed that the tumor mass was greatly reduced. No evidence of any complications associated with irradiation was apparent, and the patient continued to demonstrate a positive prognosis.CONCLUSION: A thoracic epidural cavernous hemangioma of proven pathology was successfully treated using state-of-the-art, spinal image-guided SRS. Based on our experience with other types of tumors, we determined that an effective treatment modality for this pathology would be a hypofractionated dose of 32 Gy in 4 fractions. This treatment protocol delivered rapid clinical benefits and long-term tumor control demonstrating the viability of SRS in the treatment-of this difficult and rare condition.