Desmoid tümörlerde nörovasküler invazyondan korunma

Öz

Desmoid tümör veya agresif fibromatozis, derin muskülo-aponevrotik yapılardan köken alan, nadir görülen, kapsülsüz, infiltratif ve lokal agresif karakterde bir tümördür. Desmoid tümörlerde tercih edilen geleneksel tedavi yöntemi geniş lokal eksizyondur. Tümörün lokal nüks oranları, yerleşim yeri ve rezeksiyon tipine bağlı olarak %15-77 arasında değişmektedir. Benzer şekilde, kurumumuzda, desmoid tümör tanısı ile opere edilen hastalarda %24 ile anlamlı bir nüks oranı görülmüştür. Birkaç kez nüks görülen desmoid tümörlerde, tekrarlayan damar ve sinir rekonstrüksiyonunu takiben amputasyon kaçınılmaz olabilmektedir. Damar ve sinir gibi canlı yapıları diğer canlı bir yapı olan tümörün invazyonundan korumak amacı ile de cansız sentetik bariyerlerin kullanılması gereksinimi doğmuştur. Bu gereksinim doğrultusunda burada sentetik damar grefti kullandığımız iki olgumuzu sunuyoruz. Tedavide sadece radyoterapinin tercih edilmediği veya lokal nüks riskinin yüksek olduğu hastalarda nörovasküler yapıların korunması sentetik damar greftlerinin kullanılması ile sağlanabilmektedir.

Anahtar Kelimeler

• Desmoid tümör; nörovasküler invazyon; greft

Preventing neurovascular invasion in desmoid tumors

Abstract

Desmoid tumors or aggressive fibromatoses are rare, non-encapsulated, infiltrative and locally aggressive tumors originating from deep musculo-aponeurotic structures. Traditionally, preferred treatment method for desmoid tumors is wide local excision. Depending on the side and type of resection, the reported local recurrence rates range from 15 to 77%. Similarly, in our institution there is a significant recurrence rate (24%) in patients who underwent surgery for desmoid tumor. After several recurrences, amputation may be inevitable following repeating vascular and nerve reconstructions. There is a need for a nonviable barrier in order to prevent the invasion of the viable tumor to the neurovascular structures which are also viable tissues. Depending on this need, we present two cases that we used synthetic vascular graft in their operations to cover neurovascular structures in order to prevent tumor invasion. For patients who are not suitable for radiotherapy and the neurovascular structures need to be secured because of the risk of local recurrence, this method can prevent possible future invasion of vessels and nerves.

Keywords

• Desmoid tumor
• graft
• neurovascular invasion

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