Posterior mediasten yerleşimli nörojenik tümörlerde spinal kanal invazyon insidansı ve cerrahi yaklaşımı
Öz
Amaç: Posterior mediastinal nörojenik tümörlerin yaklaşık %10’u spinal kanala
invazedir. İnvaze tümörlerin tek seansta güvenli bir şekilde spinal ve torasik
komponentinin birlikte çıkarılması gerekir. Bu lokalizasyondaki tümörlerin
spinal kanal invazyonunun olup olmadığının direkt ve indirekt bulguları,
ameliyat öncesi çektirilen bilgisayarlı tomografi (BT) ve manyetik rezonans
görüntülemesi (MRI) ile detaylı olarak değerlendirilmelidir. Çalışmamızda,
kliniğimizde opere ettiğimiz bu tür tümörlerdeki tanı ve yaklaşımımızın
sunulması amaçlanmıştır.
Gereç ve Yöntem: Nörojenik tümör nedeni
ile opere ettiğimiz tüm hastaların klinik bilgileri retrospektif olarak analiz
edildi.
Bulgular: Çalışmaya aldığımız 35 hastanın
19’u erkek 16’sı kadındı ve yaş ortalaması 40 yıldı (dağılım: 19-71). Hastaların
sadece 5’inde (%14) operasyon öncesi semptom mevcuttu. Tümör boyutları 2,1 cm ile 17 cm arasında (ortanca 6,2)
idi. Hastaların 7’sinde (%20) radyolojik olarak spinal kanal invazyonu olduğu
belirtildi. Laminektomi gerektiren dumbbell
tipteki 6 hasta ile birlikte hepsi komplet olarak rezeke edildi. İnvazyon
gösteren vakalardaki lezyonlar beyin ve sinir cerrahi uzmanı ile birlikte
yapıldı. Ortalama takip süresi 48 ay (3 ila 72 ay) idi. Bir hastada ameliyat
sırasında tamir edilen serebrospinal sıvı kaçağı ile postoperatif kalıcı
olmayan spinal hasar meydana geldi ve 4 ayda düzeldi. Mortalite gözlenmedi.
Sonuç: Ameliyat öncesinde, nörojenik dumbbell tümör teşhis edilmezse, sadece
intratorasik kısmının çıkarılması, kalıcı spinal hasara neden olabilir. Spinal kanalı
incelemek için MRI kritik öneme sahiptir. Preoperatif invazyon tespit
edildiğinde tek seansta sinir cerrahisi ekibi ile birlikte tümörün daha güvenli
rezeksiyonu mümkündür.
Anahtar Kelimeler
Schwannoma dumbbell tümör mediastinal nörojenik tümör manyetik rezonans görüntüleme.
Kaynakça
- Whooley BP, Urschel JD, Antkowiak JG, Takita H. Primary tumors of the mediastinum. J Surg Oncol 1999;70:95–9.
- Silverman NA, Sabiston DC Jr. Mediastinal masses. Surg Clin North Am 1980;60(4):757–77.
- Bobbio A, Hamelin-Canny E, Roche N, et al. Abducens nerve palsy after schwannoma resection. Ann Thorac Surg 2015;99(2):694-5.
- Akwari OE, Payne WS, Onofrio BM, Dines DE, Muhm JR. Dumbbell neurogenic tumors of the mediastinum. Mayo Clin Proc 1978;53(6):353-8.
- Kocatürk C. Mediastinal nörojenik tümörler. Toraks Cerrahisi Bulteni 2011;2(2):106-16.
- Grillo HC, Ojemann RG, Scannell JG, Zervas NT. Combined approach to “dumbbell” intrathoracic and intraspinal neurogenic tumors. Ann Thorac Surg 1983;36(4):402-7.
- Kieffer E, Fukui S, Chiras J, Koskas F, Bahnini A, Cormier E. Spinal cord arteriography: A safe adjunct before descending thoracic or thoracoabdominal aortic aneurysmectomy. J Vasc Surg 2002;35(2):262-8.
- Davidson KG, Walbaum PR, McCormac RJM. Intrathoracic neural tumours. Thorax 1978;33(3):359-67.
- Ricci C, Rendina EA, Venuta F, Pescarmona EO, Gagliardi F. Diagnostic imaging and surgical treatment of dumbbell tumors of the mediastinum. Ann Thorac Surg 1990;50(4):586-9.
- Konno S, Yabuki S, Kinoshita T, Kikuchi S. Combined laminectomy and thoracoscopic resection of dumbbell-type thoracic cord tumor. Spine 2001;26(6):E130-4.
- Reeder LB. Neurogenic tumors of the mediastinum. Semin Thorac Cardiovasc Surg 2000;12(4):261-7.
- Hazelrigg SR, Boley TM, Krasna MJ, Landreneau RJ, Yim AP. Thoracoscopic resection of posterior neurogenic tumors. Am Surg 1999;65(12):1129-33.
- Bousamra M. Neurogenic Tumors of the Mediastinum. In: Pearson FG, Cooper JD, Deslaruiers JD, Ginsberg RJ, Hiebert CA, Urschell HC (eds). Thoracic Surgery, 2nd ed. Philadelphia: Churchill Livingstone;2002;1732-8.
- Reynolds M, Shields TW. Benign and Malignant Neurogenic Tumours of Mediastinum in Children and Adults. In Shields TW, Locicero J, Reed CE, Feins RH (eds). General Thoracic Surgery, Vol. 2, 7th ed. Philadelphia: Lippincott Williams Wilkins;2009:2415-39.
- Strollo DC, Rosado-de-Christenson ML, Jett JR. Primary mediastinal tumors: Part II. Tumors of the middle and posterior mediastinum. Chest 1997;112(5):1344-57.
- Yamaguchi M, Yoshino I, Fukuyama S, et al. Surgical treatment of neurogenic tumors of the chest. Ann Thorac Cardiovasc Surg 2004;10(3):148-51.
- Landreneau RJ, Dowling RD, Ferson PF. Thoracoscopic resection of a posterior mediastinal neurogenic tumor. Chest 1992;102(4):1288-90.
Spinal canal invasion incidence and surgical approach to the neurogenic tumors of the posterior mediastinum
Öz
Aim: Approximately 10% of posterior mediastinal neurogenic tumors invade the
spinal canal. Safe removal of these tumors requires single-stage combined
neurosurgical and thoracic operations. Meticulous radiological preoperative
examination with computed tomography (CT) and magnetic resonance imaging (MRI)
is obligatory for assessing direct or indirect signs of spinal canal
involvement. Hereby, we reviewed our clinical experience of preoperative
diagnostic and therapeutic approaches in these types of tumors.
Materials and Methods: Clinical files of all patients undergoing surgical
resection at our institution for a neurogenic tumor located at the posterior
mediastinum were reviewed retrospectively.
Results: The mean age of the 35 patients was 40 years (range 19-71), including 19
males and 16 females. Preoperative
symptoms were present in five patients (14%). Tumor
size was ranging from 2.5 to 17 cm (median 6.2). Preoperative radiological
examination revealed spinal canal involvement in seven (20%) patients. All
patients were performed complete resection, including an additional laminectomy
in six cases of dumbbell-type. Intraforaminal portion was resected by the
neurosurgeon. Mean follow-up period was 48 (range 3-72) months. Major
complication of postoperative cerebrospinal fluid leakage, detected and treated
intraoperatively, with non-permanent spinal cord injury was seen in 1 patient,
fully recovered in 4 months postoperatively. No mortality occurred.
Conclusion: If a dumbbell neurogenic tumor is not recognized and only the
intrathoracic portion is resected, it may cause permanent spinal cord injury
and neurological problems. Spinal MRI is crucial to examine the spinal canal. If
spinal canal invasion is detected preoperatively, a single-stage and safe
resection with neurosurgical team may be possible.
Anahtar Kelimeler
Schwannoma dumbbell tumor mediastinal neurogenic tumor magnetic resonance imaging.
Kaynakça
- Whooley BP, Urschel JD, Antkowiak JG, Takita H. Primary tumors of the mediastinum. J Surg Oncol 1999;70:95–9.
- Silverman NA, Sabiston DC Jr. Mediastinal masses. Surg Clin North Am 1980;60(4):757–77.
- Bobbio A, Hamelin-Canny E, Roche N, et al. Abducens nerve palsy after schwannoma resection. Ann Thorac Surg 2015;99(2):694-5.
- Akwari OE, Payne WS, Onofrio BM, Dines DE, Muhm JR. Dumbbell neurogenic tumors of the mediastinum. Mayo Clin Proc 1978;53(6):353-8.
- Kocatürk C. Mediastinal nörojenik tümörler. Toraks Cerrahisi Bulteni 2011;2(2):106-16.
- Grillo HC, Ojemann RG, Scannell JG, Zervas NT. Combined approach to “dumbbell” intrathoracic and intraspinal neurogenic tumors. Ann Thorac Surg 1983;36(4):402-7.
- Kieffer E, Fukui S, Chiras J, Koskas F, Bahnini A, Cormier E. Spinal cord arteriography: A safe adjunct before descending thoracic or thoracoabdominal aortic aneurysmectomy. J Vasc Surg 2002;35(2):262-8.
- Davidson KG, Walbaum PR, McCormac RJM. Intrathoracic neural tumours. Thorax 1978;33(3):359-67.
- Ricci C, Rendina EA, Venuta F, Pescarmona EO, Gagliardi F. Diagnostic imaging and surgical treatment of dumbbell tumors of the mediastinum. Ann Thorac Surg 1990;50(4):586-9.
- Konno S, Yabuki S, Kinoshita T, Kikuchi S. Combined laminectomy and thoracoscopic resection of dumbbell-type thoracic cord tumor. Spine 2001;26(6):E130-4.
- Reeder LB. Neurogenic tumors of the mediastinum. Semin Thorac Cardiovasc Surg 2000;12(4):261-7.
- Hazelrigg SR, Boley TM, Krasna MJ, Landreneau RJ, Yim AP. Thoracoscopic resection of posterior neurogenic tumors. Am Surg 1999;65(12):1129-33.
- Bousamra M. Neurogenic Tumors of the Mediastinum. In: Pearson FG, Cooper JD, Deslaruiers JD, Ginsberg RJ, Hiebert CA, Urschell HC (eds). Thoracic Surgery, 2nd ed. Philadelphia: Churchill Livingstone;2002;1732-8.
- Reynolds M, Shields TW. Benign and Malignant Neurogenic Tumours of Mediastinum in Children and Adults. In Shields TW, Locicero J, Reed CE, Feins RH (eds). General Thoracic Surgery, Vol. 2, 7th ed. Philadelphia: Lippincott Williams Wilkins;2009:2415-39.
- Strollo DC, Rosado-de-Christenson ML, Jett JR. Primary mediastinal tumors: Part II. Tumors of the middle and posterior mediastinum. Chest 1997;112(5):1344-57.
- Yamaguchi M, Yoshino I, Fukuyama S, et al. Surgical treatment of neurogenic tumors of the chest. Ann Thorac Cardiovasc Surg 2004;10(3):148-51.
- Landreneau RJ, Dowling RD, Ferson PF. Thoracoscopic resection of a posterior mediastinal neurogenic tumor. Chest 1992;102(4):1288-90.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Haziran 2019 |
| Gönderilme Tarihi | 27 Nisan 2018 |
| Yayımlandığı Sayı | Yıl 2019 |
Cited By
Posterior Mediastinal Schwannoma: İki Olgu Sunumu İle
Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi
https://doi.org/10.47572/muskutd.1113136