脊髓海绵状血管畸形的显微外科治疗

Microsurgicai treatment of spinal cavernous malformation

目的探讨脊髓海绵状血管畸形的临床、影像学、病理学特点和显微手术方法。方法对28例脊髓海绵状血管畸形患者进行了MRI检查，其中1例术前未能明确诊断，术后证实为海绵状血管畸形。全组患者均经后背正中直切口显微手术治疗，其中22例行全脊髓血管造影，均无染色。结果28例均为单发，8例位于颈段，12例位于颈胸段，4例位于胸段，2例位于腰段，2例位于圆锥马尾部位。MRI检查显示团块状短T1长T2信号，中间由点条状长T1短T2信号分隔而形成桑葚状混杂信号团，周边绕以低信号团，尤以T2WI显著。随访3个月～6年，全组均未见复发，16例术后功能明显恢复。结论MRI是脊髓海绵状血管畸形术前最可靠的诊断方法。显微手术切除是脊髓海绵状血管畸形的优选治疗方法，术中精细的显微操作是手术成功的关键。全脊髓血管造影可以排除其他脊髓血管畸形。

Objective To investigate the characteristics of clinical manifestations, diagnostic imaging,pathology, and microsurgical treatment of spinal cavernous malformation. Methods The clinical data of 28 patients with spinal cavernous malformation undergoing total resection through posterior approach during 1991 -2006, all receiving MRI examination and 22 also receiving spinal DSA examination, were analyzed. Results Among the 28 cases, 8 lesions were located in the cervical segment of the spinal cord; 12 lesions in the cervical-thoracic segment; 4 lesions in the thoracic segment; 2 in the lumbar segment, and 2 in the thoraco-lumbar segment. The MRI images looked like mulberry; a black ring around the cavemoma was indicated. The spinal cord tissues around the lesion were obviously stained by the deposited hemosiderin. Follow-up of 3 months to 6 year showed no recurrence. Conclusion MRI is the most reliable method for diagnosis of spinal cavernous malformation and surgical resection is the best treatment method. The key of success is meticulous surgical techniques. DSA helps differentiate spinal cavernous malformation from other arterio-venous malformations.