title: [A case of a large thoracic epidural hourglass neurinoma, incidentally detected on routine chest roentgenogram--with respect to the surgical approach].
abstract: In case of the advanced extension into the thoracic cavity, it has been difficult to remove a large thoracic spinal hourglass tumor by conventional laminectomy, even adding costotransversectomy, due to high risk of injuring diverse important vessels and other organs by blind manipulation. A case of a large thoracic spinal hourglass neurinoma with advanced extension into the mediastinum is presented. A 49-year-old female was admitted for the further examination of the left mediastinal tumor, incidentally detected on routine chest roentgenogram, which was suspected as the part of spinal hourglass tumor. Her neurological examination was normal except hyperreflexia of bilateral lower extremities. Plain chest roentgenogram showed a left mediastinal mass behind the aortic arch and the descending aorta, which slightly enlarged in size, compared with its previous size in the chest film taken 3 years ago. Thoracic spine tomogram showed the destruction of the left pedicle of T4, the absorption of posterior aspect of the T4 vertebral body and the dilatation of the left intervertebral foramen between T4-T5. Myelogram showed the complete block of dye column at T4. Metrizamide CT scan revealed the large extradural hourglass tumor, which compressed the dural theca anterolaterally and extended through the dilated left T4-T5 intervertebral foramen into the left mediastinum and attached to the descending aorta. Two stage operation, the first for the removal of the left mediastinal tumor by transthoracic approach and the second for intraspinal canal tumor by posterior approach, was performed with success for this large thoracic spinal hourglass tumor.(ABSTRACT TRUNCATED AT 250 WORDS)
mesh_terms: D005260:Female; D006801:Humans; D007796:Laminectomy; D008400:Mass Chest X-Ray; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D008722:Methods; D008793:Metrizamide; D008875:Middle Aged; D009192:Myelography; D009442:Neurilemmoma / Q000000981:diagnostic imaging / Q000601:surgery*; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae; D014057:Tomography, X-Ray Computed
chemical_list: D008793:Metrizamide