脊髓髓内室管膜瘤的显微外科治疗——附173例临床总结

Microneurosurgical Management of Intramedullary Spinal Cord Ependymomas:Report of 173 Cases

背景与目的:随着神经影像技术,显微外科技术和术中监测手段的发展,大多数脊髓髓内肿瘤的早期诊断和治疗已成为现实。本研究旨在探讨显微外科手术治疗脊髓室管膜瘤的经验。方法:回顾性研究北京天坛医院神经外科脊柱脊髓组从2000年1月至2005年4月经显微外科手术治疗的髓内室管膜瘤173例,并分析其预后影响因素。结果:肿瘤全切除163例(94.2%),近全切除8例(4.6%),大部分切除2例(1.2%),出院3￣6个月门诊随访好转142例(76.3%),余随访不全。结论:积极的显微外科治疗,争取全切是髓内室管膜瘤治疗的最佳选择,术前神经功能状况、肿瘤的性质与部位、手术技巧与切除程度等都是影响预后的重要因素。

BACKGROUND ＆ OBJECTIVE： Ependymoma is the most common intramedullary spinal tumor. This study is to investigate strategies, techniques and other factors in the microneurosurgcial management of intramedullary spinal ependymomas. METHODS： One hundred and seventy-three patients with intramedullary spinal ependymoma treated with microneurosurgical management at Beijing Tiantan Hospital, from January of 2000 to April of 2005 were retrospectively analyzed. RESULTS： Total removal was achieved in 163 cases （94.2%）, subtotal removal in 8 cases（4.6%）, and partial resection in 2 cases（1.2%）. Post-operative neurological function was improved in 142 patients （76.3%）. CONCLUSIONS： Radical resection is the best choice for the treatment of intramedullary spinal cord ependymoma. Prognosis is related primarily with preoperative neurological conditions of the patients,the location and histological grade of the tumor, and the degree of removal.