Tumor of a horse tail
Tumor of a horse tail — primary or metastatic new growth which is localized in terminal department of the vertebral channel. It is clinically shown by a unilateral, then bilateral radicular syndrome, sluggish paresis of the lower extremities, mosaic violations of sensitivity, difficulty of an urination and defecation in the beginning. The basis for diagnosis are results of neurologic survey, a lyumbalny puncture, MRT, a histologic research. The main method of treatment — radical removal of education, if necessary is in addition carried out radiation therapy
Tumor of a horse tail
Horse tail in neurology is called the bunch of nerves including terminal thread of a spinal cord, four lumbar, all sacral and coccygeal spinal backs. The horse tail is surrounded with a firm brain cover and lower than the level of the 2nd lumbar vertebra settles down in the vertebral channel. The main function — an innervation of pelvic bodies and the lower extremities. The tumor of a horse tail meets in 11-15% of cases of neoplaziya of a spinal cord. Meningioma, nevrinoma, ependimoma, lipomas, teratoma of this localization are more often observed. Despite mainly good-quality character of new growths, their radical removal it is difficult owing to dense accretion with nervous backs.
Reasons of a tumor of a horse tail
The majority of tumors of terminal department of a spinal cord are primary, ependima of the spinal channel, spinal covers, fatty cellulose are formed of fabrics of nervous backs. The Etiologichesky factors starting tumoral transformation of healthy cells are studied insufficiently. Assume multifactorial influence. All etiofaktor are divided into three main groups:
- Physical. The leader in this group of factors is radioactive radiation. Influence of radiation is possible in connection with professional activity, passing of a course of radiation therapy. Ionizing radiation provokes the cellular mutations which are the cornerstone of tumoral process.
- Chemical. Various chemicals have cancerogenic properties: benzidinovy and aniline dyes, nitroconnections, nitrosamines, separate metals (nickel, lead, cobalt). Influencing organism cages, harmful chemical compounds cause change of their basic properties. As a result of cellular transformation the tumor of a horse tail is formed.
- Biological. Include various infections, persistiruyushchy viruses in an organism which are formed owing to violation of exchange processes onkogenny metabolites. Impact of the specified factors on a cellular genome leads to its change, activation of division and growth with emergence of a new growth.
The etiofaktor stated above lead to pathological changes of genetic intracellular material, atypical, mutant cages are formed. Why tumoral transformation affects cages of a certain fabric accessory and localization – remains unclear. Normal the immune system of the person exercises antineoplastic control and destroys all changed cages. This mechanism does not work when easing antineoplastic immunity, mass character of mutations. As a result mutant cages continue to breed, forming a tumor. Further development of process depends on new growth malignization degree. The malignant neoplasia sprouts fabrics. A benign tumor, reaching certain sizes, begins to squeeze spinal backs, causing symptoms of loss of their functions. The compression of vessels leads to an atrophy of brain covers, nearby bone tissues of a sacrum and a tailbone with destruction of the last.
Traditionally allocate primary and secondary (metastatic) new growths. Most often metastasises are formed at a breast cancer, malignant tumors of lungs, a prostate cancer. New growths of a horse tail classify Patomorfologicheski on:
- The good-quality which — were more differentiated, which are not sprouting the surrounding structures which often have the capsule. The benign tumor does not give metastasises, however during incomplete removal is capable to recur.
- The malignant which — are poorly differentiated, having invasive growth inclined to metastasis. Developing of malignancies is possible as a result of transformation of good-quality neoplaziya or against the background of earlier not changed fabrics. All secondary tumors are malignant.
In clinical practice experts in the sphere of neurosurgery and neurology apply the classification based on criterion of germination of a new growth in spinal backs. This approach allows to define possibilities of surgical treatment and the further forecast. According to it a neoplasia of a horse tail are classified on the following two look:
- Infiltrative tumor. The malignant new growths sprouting structures of a horse tail are truly infiltrative. Also the good-quality neoplasia which is densely soldered by the capsule to spinal backs is considered infiltrative.
- The encapsulated tumor. It is accurately separated by the capsule from surrounding structures. Thanks to this property education can be considerably removed without damage of nervous trunks of a horse tail.
Symptoms of a tumor of a horse tail
In a classical case the symptomatology demonstrates the pains of lumbar and sacral localization taken for radiculitis. If the new growth settles down at the level of the 2nd and 3rd lumbar vertebras, pain irradiates on the forward surface of the corresponding hip if below — in an inguinal zone and a crotch. Strengthening of a pain syndrome at kashlevy pushes, sneezing is characteristic. Intensity of pain increases in horizontal position, weakens in a vertical or semi-sedentary pose.
Further sensitive violations — feeling of a sleep in a buttock, a hip, genitalia join. The patient complains of the weakness in a leg more expressed in foot. Muscular weakness amplifies in the course of walking that forces the patient to stop for rest. Emergence of similar symptoms on other party is the guarding sign confirming progressing of a tumor. Touch frustration differ in the mosaic asymmetric character demonstrating multiple defeat of spinal backs.
Classical manifestations of a radicular syndrome are supplemented with difficulties at an urination, defecation. The Dizurichesky phenomena are presented by the complicated beginning of the act of an urination, lack of feeling of fullness of a bladder, loss of sensitivity to desires on an urination. From a rectum loss of desires to defecation, a lock is noted. Sexual function suffers, at men violation of an erection is observed, women have an anorgazmiya. The tumor increasing in sizes causes progressing of process to the expressed peripheral paresis of disteel departments of the lower extremities, a full delay of an urination.
The progressing paresis of the lower extremities deprives of the patient of an opportunity to move independently. Complications of frustration of an urination are formation of a diverticulum of a bladder, , infectious diseases of an urinary path (uretrit, cystitis). The sharp delay of urine demanding an urgent kateterization or a tsistostomiya is considered the Urgentny complication. As a result of a long lock the kalovy blockage is formed, there is kalovy intoxication of an organism. Metastasis, development of a cancer kakheksiya act as the heaviest complications of malignant new growths.
Clinically it is extremely difficult to assume a tumor of a horse tail at an early stage. In most cases primary diagnosis sounds as "lumbar and sacral radiculitis", "a neuropathy of a femoral nerve", "a neuropathy of a sciatic nerve". Suspicion of a tumor arises at a persistent retsidivirovaniye of symptoms after treatment, bilateral character of symptomatology, emergence of dysfunction of pelvic bodies. For the purpose of verification of the diagnosis the next researches are conducted:
- Neurologic survey. During inspection the neurologist reveals decrease in force and a tone of muscles of the lower extremities, loss of Achilles and knee tendinous reflexes. Over time there are muscular atrophies, local vegetative and trophic violations. Sensitive frustration are presented by mosaic zones of a gipesteziya.
- Backbone X-ray analysis. Maloinformativna in initial stages of a disease. On the roentgenogram at the level of a new growth Elsberga-Dayk's symptom — deformation of handles of vertebras, increase in distance between them can be found. In the started cases define destructive focuses in a sacrum.
- Lyumbalny puncture. The big tumor filling subarakhnoidalny space is the reason of a dry puncture — it is not possible to receive a likvor (tserebrospinalny liquid). At the same time the doctor who is carrying out manipulation after a puncture of a firm cover feels hit of a needle in a certain weight, but not in the space filled with liquid.
- Research of tserebrospinalny liquid. Reveals a stagnant ksantokhromiya (yellow coloring of a likvor), the expressed proteinaceous and cellular dissociation. Protein content is so big that turning of tserebrospinalny liquid is often observed. Tumor cells are defined extremely seldom.
- MRT of lumbar and sacral department. The research is conducted for visualization of a tumor, specification of its sizes, prevalence, the nature of growth, existence of the capsule. At impossibility of carrying out MRT backbone KT with contrasting is carried out.
- Histologic research. Allows to verify precisely type and degree of a zlokachestvennost of a new growth. The intake of tumoral fabrics is intraoperatsionno made for a research, results influence tactics of further maintaining the patient.
It is necessary to differentiate a tumor from a spinal arakhnoidit, a hernia nuclei pulposi of lumbar department, tumors of a cone and an epikonus. At an arakhnoidita the lyumbalny puncture never happens dry, protein content in a likvor is increased slightly. The hernia nuclei pulposi of the big sizes is capable to create the block of likvorny space, the dry puncture turns out to be consequence of what. It is possible to differentiate hernia and a tumor in similar cases only by means of neurovisualization. The new growth of an epikonus differs in the dissociated type of touch frustration, existence of a-foot symptom of Babinsky, an urine incontience. The tumor of a cone proceeds with symmetric sensitive violations, a true incontience of urine.
Treatment of a tumor of a horse tail
The only effective way of treatment is surgical removal. At most of patients radical excision of a tumor is impossible because of dense cohesion with spinal backs. Use of the microsurgical equipment significantly improved results of surgeries, however completely it was not succeeded to exclude need of crossing of nervous trunks that in some cases leads to formation of resistant neurologic deficiency. For the purpose of the most expedient ratio of radicalism of removal and risk of neurologic deficiency intraoperative monitoring of the caused potentials of motor and touch fibers is carried out.
In the postoperative period under observation of a reabilitolog recovery treatment is performed. The physiotherapy exercises are applied. Physiotherapy is contraindicated. After a subtotal resection and at a high probability of a recurrence consultation of the radiologist is necessary for the solution of a question of radiation therapy. At development of the recurrence which is not followed by clinical manifestations, stereotaksichesky radiation acts as method of the choice. If the recurrence proceeds with the accruing clinical symptomatology, repeated neurosurgical removal is recommended. Concerning malignant tumors application of chemotherapeutic courses is possible.
Forecast and prevention
The tumor of a horse tail can have a long latent current what destructive changes of bones at certain patients testify to. The forecast of a disease depends on histologic type and the nature of growth of education. Because of impossibility of full removal of tumoral fabrics the retsidivirovaniye is often observed. The forecast at malignant neoplaziya is most adverse. Primary prevention comes down to the prevention of onkogenny impacts on an organism, observance of safety measures during the work with chemicals, X-ray installations, etc. Secondary prevention is directed to early identification of a tumoral recurrence, includes long observation at the neurosurgeon, passing of MRT-control in 3,12,36 and 60 months from the operation moment.