颈髓髓内血管网织细胞瘤的诊断及显微外科治疗

Diagnosis and microsurgical treatment of intramedullary hemangioblastoma in cervical spinal cord

目的探讨颈髓髓内血管网织细胞瘤的诊断及显微外科治疗。方法分析26例患者的MRI表现及其显微外科手术治疗的效果。其中男19例,女7例,年龄17～55岁。结果根据肿瘤在MRI上的表现可分为囊肿型12例,实体型14例,均行肿瘤全切除术。术后患者神经系统症状好转者17例,7例无改善,2例加重。结论颈髓MRI能对颈髓髓内血管母细胞瘤作出定位诊断,并可将其分型,以利选择不同的手术方法。颈髓髓内、即使累及延髓的血管母细胞瘤宜行积极手术治疗；根据肿瘤类型不同选择不同手术方法,在手术显微镜下沿正确的界面进行分离,先离断动脉后处理静脉,避免分块切除而力争全切,是减少术中出血和避免神经功能损害的关键。

Objective To investigate the diagnosis and the microsurgical treatment of intramedullary hemangioblastoma in cervical spinal cord. Methods The signs of MRI, and the results of operations were analysed in 26 patients with the tumors. Rusults The tumors can be classified into two types： Solid type （14 cases）and cystic type（ 12 cases）. All the tumors underwent total removal and were all hemangioblastoma confirmed by histopathologic examinations. Postoperatively, neurological status were improved in 17 patients, remained in 7 cases and worse in 2 cases. Conclusion For intramedullary hemangioblastoma of cervical spinal cord MRI is of significant importance in the diagnosis of localization and the nature of the tumors which is conductive to selecting appropriate operative methods. There is high risk in operating at cervical section, but microsurgical total resection is the optimal method to stop the development of the clinical presentation. Opera- L tive methods varied with the different typer of the tumor. It is the most important principal that dissection is performed along the correct interface and the tumor should be removed en bloc after it is devascularized.