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患者女,57岁,腰痛、左下肢麻痛1年10个月,半月前出现左股外侧夜间出现剧痛,需肌注强痛定方能入睡,于1995年10月30日入院。检查:腰_(4～5)压痛,椎旁左侧压痛向左下肢放散,双下肢肌力正常,左膝腱反射弱,左直腿抬高试验阳性,无病理征。CT示腰_(4～5)椎间盘膨出,肌电图示腰_(4～5)神经根性病损。在局麻下行腰椎管探查术,见腰_(4～5)椎间盘膨出,无压迫神经征象。探查硬膜囊,腰_(3、4)椎体水平有移动性硬物,触痛,随患者喊叫上下移动。切开硬膜,见左侧一根马尾神经上有4个串珠样肿瘤,从近端至远端分别为黄豆、蚕豆、黄豆及米粒样,呈肉红色、质硬,串珠长6cm。切除载瘤神经。病理:多发性神经鞘瘤。术后有短暂双下肢不适感,无运动与尿便异常。 讨论:神经鞘瘤在一根马尾神经上呈串珠样生
Patients, 57 years old, low back pain, left lower extremity numbness 1 year and 10 months, a half months ago appeared in the left side of the left side of the night appeared severe pain, need to be intramuscular injection of strong pain to fall asleep, on October 30, 1995 admission. Check: lumbar (4 ~ 5) tenderness, left lateral vertebral tenderness to the left lower extremity excretion, normal muscle strength of both lower extremities, tendon reflex left knee, left straight leg raising test was positive, no pathological signs. CT showed lumbar _ (4 ~ 5) disc bulging, EMG showed waist _ (4 ~ 5) nerve root lesions. Lumbar lumbar spinal exploration under local anesthesia, see the waist _ (4 ~ 5) disc bulge, no compression of neurological signs. Explore the dural sac, lumbar (3,4) vertebral level of mobility of hard objects, tenderness, shouting with the patient to move up and down. Cut the dura mater, see a cauda equina nerve on the left there are four beaded tumors, from the proximal to the distal, respectively, soybeans, beans, soybeans and rice-like, was red meat, hard, beaded 6cm long. Excision of tumor-bearing nerves. Pathology: Multiple schwannoma. Short postoperative discomfort of both lower extremities, no movement and abnormal urination. Discussion: Schwannomas are beaded on a cauda equina