척수 신경섬유종의 임상적 관찰

Abstract

[한글]

Clinical Study of the Spinal Neurinomas

Shim, Jae Hong

Dept. of Medical Science, The Graduate School, Yonsei University

(Directed by Prof. Lee, Hun Jae)

Although there are exhaustive studies of Rausmussen, Kernohan and Adson(1940),

Broager(1953) and Gautier-Smith(1967) on the spinal neurinomes dealt with the

clinical features, distribution, results of investigations and surgical treatment,

the surgical judgement on the tumor seemed to be quite different in each cases.

the author has attempted to analyze the clinical records of 35 verified spinal

neurinomas treated in the Department of Neurosurgery, Yonsei University, Medical

Center, over 10 years period.

The spinal neurinomas comprised 28% of 125 cases of the spinal cord compression,

excluding prolapsed intervertebral disc, tuberculous spondylitis, and

arachnoiditis.

The incidence of neurinomas in our series is higher than that of Broager's(1953),

but it corresponds to those reported by Rasmussen et al(1940) and Kernohan and

Sayre(1952). In contrast meningiomas and gliomas are much less frequent in our

series compared to previous reports.

The spinal neurinomas occured predominantly in 3rd to 6th decade of age and

males(22) were more affected than females(13). All the 5 cases of dumb-bell

neurinomas in our series occured in female.

The clinical courses was chronic and progressive, ranging from 2 months to 6

years.

No particular location of the spinal cord level was predilected in this series,

but the tumor was most commonly located intradurally(31) and dorsal(30) to the

spinal cord. Two cases of upper cervical tumor were grown intracranially through

the foramen magnum.

The clinical symptoms and signs of neurinomas were not different from those of

other benign spinal cord tumors, but sensory cord or root symptoms seemed to be

preceded the motor deficits in the majority of cases.

An enlargement of the intervertebral foramen and a shadow of the extravertebral

part of the dumb-bell neurinoma on plain x-ray studies were the most significant

finding in the diagnosis of spinal dumb-bell neurinomas.

Pantopsque myelography was confirmatory diagnostic aid, and for the removal of

contrast dye in cases with complete subarachnoid blockage a new irrigation

technique was designed.

The higher level of spinal fluid protein was suggestive intraduaral tumors or

tumors located in the lower level of the spinal canal.

The choice of surgery is principally complet removal of the tumor but in cases

when the tumor is too large and has dangers to separate from the spinal cord milieu

a decompression only was better attempted.

31 cases(88.5%) out of 35 were improved by surgical treatment in our series.

[영문]

Although there are exhaustive studies of Rausmussen, Kernohan and Adson(1940), Broager(1953) and Gautier-Smith(1967) on the spinal neurinomes dealt with the clinical features, distribution, results of investigations and surgical treatment, the surgical judgement on the tumor seemed to be quite different in each cases.

the author has attempted to analyze the clinical records of 35 verified spinal neurinomas treated in the Department of Neurosurgery, Yonsei University, Medical Center, over 10 years period.

The spinal neurinomas comprised 28% of 125 cases of the spinal cord compression, excluding prolapsed intervertebral disc, tuberculous spondylitis, and arachnoiditis.

The incidence of neurinomas in our series is higher than that of Broager's(1953), but it corresponds to those reported by Rasmussen et al(1940) and Kernohan and Sayre(1952). In contrast meningiomas and gliomas are much less frequent in our series compared to previous reports.

The spinal neurinomas occured predominantly in 3rd to 6th decade of age and males(22) were more affected than females(13). All the 5 cases of dumb-bell neurinomas in our series occured in female.

The clinical courses was chronic and progressive, ranging from 2 months to 6 years.

No particular location of the spinal cord level was predilected in this series, but the tumor was most commonly located intradurally(31) and dorsal(30) to the spinal cord. Two cases of upper cervical tumor were grown intracranially through the foramen magnum.

The clinical symptoms and signs of neurinomas were not different from those of other benign spinal cord tumors, but sensory cord or root symptoms seemed to be preceded the motor deficits in the majority of cases.

An enlargement of the intervertebral foramen and a shadow of the extravertebral part of the dumb-bell neurinoma on plain x-ray studies were the most significant finding in the diagnosis of spinal dumb-bell neurinomas.

Pantopsque myelography was confirmatory diagnostic aid, and for the removal of contrast dye in cases with complete subarachnoid blockage a new irrigation technique was designed.

The higher level of spinal fluid protein was suggestive intraduaral tumors or tumors located in the lower level of the spinal canal.

The choice of surgery is principally complet removal of the tumor but in cases when the tumor is too large and has dangers to separate from the spinal cord milieu a decompression only was better attempted.

31 cases(88.5%) out of 35 were improved by surgical treatment in our series.