Abstract
BACKGROUND: Intraspinal Ewing’s sarcoma lesions are rare occurrences. Limited clinical research exists regarding the surgical treatment options and prognosis of these tumors. We report a case of thoracic extradural Ewing’s sarcoma in a 14-year-old-girl, where we performed the double door laminoplasty technique for the removal of the tumor. MATERIAL AND METHODS: The 14-year-old patient had a progressive neck and shoulder pain of a duration of one month. Her body examination showed a rapidly progressive severe paraparesis and hypoesthesia from Th6 in both legs. Her MRI revealed a sizable paravertebral mass located at the Th3 level on the right side, displaying extension along the rib and into the spinal canal through the neuroforamen. The portion from Th2 to Th4 (intraspinal extradural) exhibited a conspicuous space-occupying effect, leading to substantial compression of the spinal cord and signaling myelopathy. Due to the clinical and imaging findings, we opted for an immediate spinal decompression and tumor resection. To maintain the stability after operation, we performed a double door laminoplasty from Th2 to Th4. The block comprising the three laminae was gradually separated from the underlying tumor and extracted en bloc. Residual tumor fragments from the extracted laminae were carefully removed with the intention of reinsertion. Since the three removed laminae did not exhibit osseous infiltration or destruction, we reinserted them. The diagnosis was confirmed histologically. The patient had a significant reduction of the pain and improvement in her neurological deficits. The adjuvant therapy was started 3 weeks after the operation. RESULTS: The open door laminoplasty technique has been previously used to treat cervical spondylotic myelopathy. We adapted it successfully for this thoracic case. Neither spinal malalignment nor displacement of bone flap (laminoplasty flap) were observed on postoperative examinations. No complications were encountered. CONCLUSION: Ewing’s sarcoma typically affects children and young adults. However, the exact prevalence of extradural thoracic Ewing sarcoma remains unknown due to its rarity. It is impossible to definitively conclude which surgical modality is the best for these cases, but our case shows that a tumor resection with double door laminoplasty can be an optimal mode of treatment.