En-bloc Excision of Neurofibroma in Thoracic Vertebral Region  

Oleh:

Sudiharto, P

Jenis: Article from Journal - ilmiah nasional
Dalam koleksi: Berkala Kesehatan Klinik vol. 11 no. 02 (Dec. 2005), page 126.
Topik: neurofibroma - thoracic region - laminectomy - thoracotomy - en-bloc excision

Ketersediaan

Perpustakaan FK Nomor Panggil: B25.K.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Background: Neurofibroma is a benign peripheral nerve tumor and, to some extent, on spinal nerve roots. Commonly it has correlation with neurofibromatosis. Neurofibromas are the hallmark of neurofibromatosis type 1 and usually appear during childhood or adolescence. Spinal changes in individuals with vertebral Neurofibromas type 1 are usually divided into cervical, thoracic, lumbosacral and spinal canal pathologies. The regionally symptoms of the vertebral tumors are caused by pressure on the spinal cord and nerve roots. The pressure tumors effects are based upon the site and involvement the certain level of neural elements. Method: To report a 12 year old boy with clinical presentations were lower parapharesis central type, the strength of the limbs was 3. General condition was neurofibromatosis type 1. Local signs of the tumor were in thoracic vertebral area with 15 cm in diameter, brownish (cafe au lait spots) of skin surface, soft rubbery in consistence, fixed to the vertebral bones and the border was not obvious. The chest x-ray showed erosion and pathological fractures of right 8th and 9th ribs. Scoliosis was appeared (angulations 40° at the level between T6th and T10th vertebrae). Preoperative MRI demonstrated a 15 cm in diameter mass lesion occupying around thoracic vertebral. Erosion of T7th - T9th vertebral bodies, tumor extensions into the thoracic cavity and through the intervertebral foraminas into the spinal canal. The surgery was undertaken in left recumbent position, V-shape incision, laminectomy of T8th and T9th vertebrae, the neurofibroma extended into the intracranial but the meninges was intact. The procedure was followed by thoracotomy right SIC 7th. The border of the mass was clearly identified. Bluntly dissection had succeeded separating the mass from the outer pleura. The front surface and right pedicle of the T8th and T9th vertebral bodies were invaded by the tumor. Radical excision was performed by partial corpectomy, resected the 9th rib pars posterior and T9th vertebral pedicle. Result: The mass could be removed in one piece and en-block excision was achieved. Chest tube was inserted and posterior fixation was devised. The chest X-ray was performed for radiological postoperative evaluation. Pathological finding was neurofibroma. Postoperative, there was improvement in muscles strength of the legs clinically. The patient could stand and walk with a cane. Conclusion: Excision of neurofibroma in thoracic region could be performed by laminectomy and thoracotomy. The result was satisfactory.

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