脊髓髓内病变的显微外科治疗

Microsurgerical treatment of the intramedullary spinal cord lesions

目的分析脊髓髓内占位性病变的手术特点,探讨手术时机、手术方式及预后。方法回顾性分析2002年7月～2008年4月经手术和病理证实的25例脊髓髓内占位性病变,随访患者术后神经功能状态。结果病变全切20例,次全切除3例,大部切除2例。术后病理证实室管膜瘤15例,星形细胞瘤2例,海绵状血管瘤2例,脂肪瘤2例,神经鞘瘤1例,血管畸形1例,结核瘤1例,炎性肉芽肿1例。术后神经功能好转20例,无变化3例,加重2例。结论对脊髓髓内病变应早期诊断,应在发生明显神经功能障碍之前实施手术。沿着确切的瘤-髓界面分离、切除病变,是肿瘤一级切除的基本保证,重建蛛网膜下腔能有效防止脊髓粘连;采用椎板成型解剖学复位技术可提高术后脊柱稳定性。

Objective To analyze the characteristic of techniques of microsurgerical treatment of the intramedullary spinal cord lesions and to study the operative time, the manner of operation and prognosis. Method Retrospective analyse of 25 case of the intramedullary spinal cord lesions resected by microsurgerical techniques since July 2002. The lesions were all confirmed by pathological examination. The post operative neural function were followed up Results Totally tumor resection was achieved in 20 patients , subtotal resection in 3 patients, partial resection in 2 patients. The pathology of the lesions were confirmed by post operative pathologic examination including 15 ependymomas , 2 astrocytoma , 2 cavernous angioma ,2 lipoma , 1 neurilemoma, 1 tuberculoma , 1 Vascular malformation and 1 infective granuloma. The neurological condition improved in 20 cases and stabled in 3 cases and deteriorated in 2 cases compared with pre-operative condition. Conclusion Intramedullary spinal cord lesions need to be operated as earlier as possible. It is better to be operated before neural deficits happening. Premature diagnose and operative treatment should be taken for the intramedullary lesions of spinal cord. Taking microsurgery technique and resecting the tumor along the correct boundary layer of tumor-medulla are the fundamental guarantee of total resection for the lesions Reconstruction of subarachnoid membrane can protect spinal cord from adhesion. Laminaplasty can improve the spinal column Is stability.