髓外硬膜内肿瘤诊断与手术治疗分析

Clinical analysis of diagnosis and surgical treatment of extramedullary intradural tumors

目的探讨髓外硬膜内肿瘤的诊断及手术治疗效果。方法回顾分析我院1996年6月～2009年12月期间治疗的23例髓外硬膜内肿瘤。肿瘤位于颈段2例,胸段16例,腰段5例。神经鞘瘤14例,脊膜瘤8例,神经纤维瘤1例。出现症状至确诊时间1月～6年。采用CTM诊断4例,用MRI诊断19例。术前JOA评分4～15分,平均8.7分。全部病例均以后路手术切除肿瘤。结果手术均完全切除肿瘤。随访6个月～13年,平均1年6个月。所有患者神经功能障碍均有明显改善或缓解,其中2例未完全恢复。术后半年时JOA评分12.7分(10～17分)。全部病例均未见复发,且脊柱稳定性良好。结论髓外硬膜内肿瘤易于误诊漏诊,临床可疑者,MRI或CTM检查可帮助确诊;后路全椎板切除或椎管后中央扩大开窗均可充分显露并彻底切除肿瘤。

Objective To explore the clinical effect of diagnosis and surgical treatment of extramedullary intradural tumors.Methods The surgical results of 23 cases of extramedullary intradural tumor during the periods from 1996 to 2009 were analyzed.The tumors were located at the cervical area in 2 cases,at the thoracic region in 16 cases and at the lumbar region in 5cases.There were neurinoma in 14 patients,meningioma in 8 cases and neurofibroma in 1 case.Mean duration of symptoms prior to diagnosis were 24 months（1 to 84 months）.MRI was used in 19 cases and CT-myelography were used in 4 cases for diagnosis.JOA score of all patients were recorded preoperative.there were 4 to 15 cores（mean 8.7 cores）.Laminectomy and tumor resection in 7 cases,posterocentral enlarged fenestration of spinal canal and tumor resection in 16 cases.Internal fixation with pedicle screw in 2 cases.Results A gross total resection were achieved in all patients at the time of surgery.The patients were followed up from 6 to 156 months with an average of 18 months.The postoperative recovery of neurological function were measured with JOA score at 6 months after the operation.there were 10 to 17 cores（mean 12.7 cores）.The patients showed no tumor recurrence and no spinal instability.Conclusion Extramedullary intradural tumors are easily misdiagnosed.MRI or CT-myelography may be helpful in the exact diagnosis of extramedullary intradural tumors.The tumors that can be removed safely and completely by a laminectomy or posterocentral enlarged fenestration of spinal canal.