长节段胸椎管内硬膜外血管脂肪瘤一例报告

袁振超; 黄保华

doi:10.3969/j.issn.2095-252X.2016.02.018

摘要：Objective To report a case with long segmental thoracic intra-spinal canal epidural angiolipoma. Methods Retrospective analysis was done on the data of a case with long segmental thoracic intra-spinal canal epidural angiolipoma treated in our hospital in Feburary. 2012. Results The patient was male, 46 years old. More than 10 years ago, the patient developed left lower extremity weakness without remarkable precipitating factors. Numbness was not obvious, walking became more difficult, often accompanied of left shoulder and lower back pain, left lower extremity weakness was gradually worsened. In the past 3 months, left lower limb weakness and difficulty in walking exacerbated, and were accompanied by the numbness on the left side of the body from the nipple. Examination showed tottering gait. He could walk with crutches, and his longest walking distance on the flat ground was 50 m. He could not climb up and walk down the stairs, and had reduced sensation on the left side of the body from the nipple downward. Left lower limb muscle atrophy existed. His left iliopsoas muscle strength was grade 3, left femoral quadriceps muscle strength was grade 3, extensor digitorum longus had a grade 4 strength. He had left knee tendon hyperreflexia. Babinski sign was ( + ) on the left and was ( - ) on the right, Hoffmann’s sign was ( - ) on the left andright. Thoracic and enhanced MRI examination revealed T1-9 long segment spinal canal space-occupying lesions. T1, T2-weighted images showed internal high signal mixed uneven images, while T2-weighted images had high signal intensity. There was left thoracic spinal cord compression, which was more dramatic at T4-5 levels. It was found intraoperatively that there was an epidural band-like mass at thoracic spinal canal at T1 to T9 levels, which was about 20 cm, dark red color, elastic, with clear boundary and rich blood supply, loose dural adhesions, easy to isolate. The dura and spinal cord at the corresponding section was obviously compressed and beating was poor. Pathological diagnosis: angiolipoma. Postoperative recovery was good: the left limb numbness remitted, left shoulder, lower back pain no longer existed, the left lower limb muscle strength was improved compared with preoperative improvement. Re-examination with MRI 2 weeks after the surgery showed that the tumor in the thoracic spinal canal was completely removed. In 2 years follow-up, the patient’s left shoulder and lower back pain disappeared, left lower limb muscle strength recovered to grade 5, limb sensory functional recovered. The patient could walk independently, climb up stairs, and bear some weight. The thoracic MRI re-checking showed that thoracic spinal canal was patent and there was no recurrence of the tumor. Conclusions The effect of early surgical treatment of long-segment spinal canal epidural angiolipoma was good and therefore early surgery is recommended.