髓外硬膜下型枕大孔区肿瘤31例的诊断与治疗

Diagnosis and treatment of intradural extramedullary tumors in foramen magnum： analysis of 31 cases

目的探讨髓外硬膜下型枕大孔区肿瘤的诊断和治疗。方法对31例髓外硬膜下型枕大孔区肿瘤患者的临床资料进行了回顾性分析，包括其临床表现、影像学、病理学及手术入路的分析。结果脑膜瘤最多见，占54．8％（17／31），其中颅脊型多位于枕大孔前方和前外侧（9／11），脊颅型多位于枕大孔侧方和后方（4／6）。31例均接受手术治疗，全切除26例，大部切除5例，肿瘤位于枕大孔后方、后外侧者采用枕后正中入路（8／31），位于前方、前外侧者采用枕下外侧入路（13／31）或远外侧经髁入路（10／31），并依据术中肿瘤与后组颅神经的位置关系分为后组颅神经前型（Ⅰ型）、跨后组颅神经型（Ⅱ型）和后组颅神经后型（Ⅲ型）。结论髓外硬膜下型枕大孔区肿瘤多属良性，手术切除可取得满意疗效。

Objective To discuss the diagnosis and treatment of intradural extramedullary tumors. Methods The clinical data, including manifestations, images, pathological features, and operative approaches of 31 intradural extramedullary tumors admitted from 2000 to 2006 were analyzed retrospectively. Results Seventeen cases （54.8%） suffered from meningioma. Eleven of the 17 cases were located with craniospinal meningioma, 9 of which were located in the ventral and ventrolateral sides of foramen magnum ; and 6 of the 17 cases were with spinocranial meningioma, 4 of which were located in the lateral and dorsal sides. All 31 cases underwent operation under microscope, and of tumor, total removal and major removal were achieved in 26 and 5 cases respectively. Lateral suboccipital approach, far lateral transcondyle approach, and median suboccipital approach were applied according to the location and size of tumors, and the approaches were divided into three categories based on their position relationship with the underlying cranial nerves. Conclusion Intradural extramedullary tumors are benign mostly, and the therapeutic effect of surgical removal is ideal.