Author/Editor		Bunc, Gorazd; Čižmarevič, Bogdan; Košir, Gorazd
Title		Interdisciplinarno zdravljenje kraniospinalnih tumorjev z ekspanzijo v vratno regijo
Translated title		Interdisciplinary management of craniospinal tumors with expansion into cervical region
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 69, št. 3
Publication year		2000
Volume		str. 149-52
Language		slo
Abstract		Background. Dumb-bell shaped neurinomas growing transdurally are rare. We present two such tumors growing intradurally and expanding extradurally into the cervical region, stressing the safety and effectiveness of two-stage interdisciplinary approach. Methods. The intradural and intracondylar part of hypoglossal neurinoma was removed by transcondylar access. The tumor part expanding into the paravertebral region was excised by adapted vascular approach for the upper internal carotid artery. For the intradural part of neurinoma at CGC7 level, classical laminectomy was applied. Its extradural larger part was removed via neck dissection. Results. Our hypoglossal neurinoma is, the 63rd of such tumors known in the literature and only the 16th dumb-bell shaped tumor. Postoperatively no significant additional neurologic deficits occured. There was no radiologic evidence of tumor recurrence. After removal of the cervical neurinoma i.e. its intradural part, the right cervicobrachialgia and spastic right lower monoparesis improved. Although asymptomatic, the extradural cervical part of the tumor was removed after several months. Both tumors were neurilemmomas. Conclusions. We wish to stress the possibility of safe and radical excision practically without postoperative deficits using two separate interdisciplinary approaches for intra- and extra dural cervical parts of tumors.
Summary		Izhodišča. Na primeru dveh redkih bisagastih nevrinomov, lokaliziranih delno intraduralno, delno pa ekstraduralno v vratni regiji, želimo predstaviti varno in učinkovito operativno odstranitev tumorjev v dveh sejah ob sodelovanju kirurgov različnih strok. Metode. lntraduralni in intrakondilični del hipoglosnega nevrinoma odstranimo transkondilično, ekstraduralnega pa s pomočjo vaskularno kirurškega pristopa za zgornji del interne karotide. Intraduralni del neurinoma C6-C7 odstranimo prek laminektomije, ekstraduralni del pa prek ORL pristopa za neck-dissection. Rezultati. Hipoglosni nevrinom je 63. izmed takšnih tumorjev objavljenih v literaturi, in le 16. izmed bisagastih. Pooperativno ni bilo nobenih dodatnih nevroloških izpadov. Tudi vratni bisagasti nevrinom je redek tumor. Po odstranitvi intraduralnega dela izgineta tako desna cervikobrahialgija kot tudi spastična ataktična spodnja monopareza. Navkljub asimptomatičnosti odstranimo po nekaj mesecih ekstraduralni vratni del tumorja. Oba tumorja sta histološko neurinoma. Tri leta po posegih ni radioloških niti kliničnih znakov za preostanek ali recidiv tumorjev. Zaključki. Poudariti želimo možnost varne in radikalne ekscizije bisagastih tumorjev, ki iz različnih predelov CŽS prodirajo v vratno regijo, v dveh sejah ob sodelovanju kirurgov različnih strok.
Descriptors		NEURILEMMOMA SPINAL NEOPLASMS NECK ADULT MIDDLE AGE HEAD AND NECK NEOPLASMS PATIENT CARE TEAM