Konus Seviyesinde Gelișen 5 Schwannoma Olgusunda Total Rezeksiyon ve Nörolojik Defisitin Önlemesinde Nöromonitarizayonun Yeri

Year 2014, Volume: 67 Issue: 1, 37 - 41, 18.03.2015

Hakan Özalp , Onur Özgüral , İhsan Doğan , Melih Bozkurt

Abstract

Aim: Nerve sheath tumors are the most common tumors among the spinal tumors and mostly seen as schwannom and neurofibroma. They may cause serious morbidity by the localization and total excision provides cure. In this article, we present the cases who have conus medullary tumors, to emphasize the total excision of tumor and to discuss the benefits of neuromonitorization.

Material and Method: 5 patients who had conus medullary tumors admitted to department of Neurosurgery Ankara University Faculty of Medicine was operated by adjunct of neuromonitorization between 2012-2014.

Case: All the patients have conus medullary tumors. Three of them had lumbalgia and limb pain. Two of were recurrent tumors that had neurological deficit. One of these two patients had cauda equina syndrome. Three of them was operated by the anterolateral and rest of cases were operated by the posterior approach. Electroneuromonitorization was used for all cases. Postoperatively, there was no additional neurological deficit. Four of patients achieved totally and 1 was subtotally excision.

Discussion-Result: To choose for optimal approach and microsurgical tecniques and apply to neuromonitorization provides totally excision and prevent neurological impairment even in recurrent cases. Thus, in conus medullary schwannomas, to apply essential microsurgical methods with neuromonitorization can reduce postoperatively morbidity and totally removal of mass may provide cure.

Keywords

Schwannoma , medullary conus , electromonitorization

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Konus Seviyesinde Geli􀄹en 5 Schwannoma Olgusunda Total Rezeksiyon ve Nörolojik Defisitin Önlemesinde Nöromonitarizayonun Yeri

Abstract

Amaç: Sinir k􀃖l􀃖f􀃖 tümörleri spinal tümörler içinde en s􀃖k rastlan􀃖lan tümörlendendir ve bunlar içinde en çok schwannomlar ve nörofibrom görülmektedir. Bulunduklar􀃖 lokalizasyona göre ciddi morbidite yapabilirler ve total ç􀃖kar􀃖lmalar􀃖 kür sa􀃾lar. Biz bu yaz􀃖m􀃖zda konus medullaris seviyesinde yerle􀄹en olgular􀃖m􀃖z􀃖 ve operasyonlarda total eksizyonun önemi ve bunda nöromonitarizasyonun faydalar􀃖n􀃖 tart􀃖􀄹t􀃖k.

Materyal Metod: 2012-2014 y􀃖llar􀃖 aras􀃖nda Ankara Üniversitesi T􀃖p Fakültesi Hastanesi Beyin ve Sinir Cerrahisine ba􀄹vuran toplam 5 konus medullaris kitlesi bulunan hasta nöromonitorizasyon kullan􀃖larak opere edildi.

Olgu: 5 hasta da konus medullaris tümörü mevcuttu. Hastalar􀃖n üçünde bel ve bacak a􀃾r􀃖s􀃖 mevcuttu. Hastalardan ikisinde, bu iki olguda nüks-rezidü vakalard􀃖, nörolojik defisit mevcuttu. Bunlardan birinde de couda equina sendromu geli􀄹mi􀄹ti. Bu olgular􀃖n ikisi anterolateral üçü posterior yolla opere edildi. Ameliyatlar􀃖n tümünde elektromonitörizayon yap􀃖ld􀃖. Postoperatif hiçbir hastada nörolojik kötüle􀄹me izlenmedi. 4 hasta da total rezeksiyon, 1 hastada subtotal rezeksiyon sa􀃾land􀃖.

Tart􀃖􀄹ma-Sonuç: Uygun cerrahi yöntemin seçilmesi, uygun mikrocerrahi yöntemler ve nöromonitarizasyonun kullan􀃖lmas􀃖 nüks-rezidü vakalarda bile total rezeksiyona imkan sa􀃾lam􀃖􀄹 ve nörolojik defisit geli􀄹mesini önlemi􀄹tir. Böylece, konus medullaris shwannomlar􀃖nda temel mikrocerrahi prensiplerin yan􀃖s􀃖ra nöromonitorizasyon kullan􀃖lmas􀃖 postoperatif morbiditeyi azaltmakta ve total eksizyon kursa􀃾layabilmektedir.

Keywords

Schwannom , konu􀄹 medullaris , elektromonitörizasyon

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