脊髓内海绵状血管瘤的诊断和显微外科手术体会

Diagnosis and Microsurgical Treatment of Spinal Intramedullary Cavernous Hemangiomas

目的:提高脊髓海绵状血管瘤(CA)的诊断水平与显微外科治疗效果。方法:回顾性分析11例资料完整的脊髓CA病例,所有患者均经MRI确诊并行显微外科手术治疗。结果:11例病灶全切10例,次全切1例。术后脊髓功能改善9例,无变化1例,加重1例,无手术死亡。结论:MRI是脊髓海绵状血管瘤术前最可靠的诊断方法。全脊髓血管造影可以排除其它脊髓血管畸形。显微手术切除是脊髓海绵状血管瘤的首选治疗方法,术前脊髓功能受损程度是影响预后的主要因素,抓住合适的手术时机和术前精确定位病灶十分必要,精细"无血"的显微外科操作是手术成功的关键。

Objective： To raise the diagnostic level of spinal intrarnedullary cavernous hemangiomas （CA） and the curative elect of the microsurgery on them.Method： The clinical and imaging data of 11 patients with spinal intramedullary cavernous hemangiomas underwent microsurgery in our department from 2003 to 2008 were analyzed retrospectively, The definite diagnosis was made by MRI examination in all patients. Results： Ten patients received total resection and 1 subtotal in the 11 patients with spinal intmmedullarycavernous hemangiomas.The post - operative neurological function of the spinal cord was improved in 9 patients, unchanged in 1, and deteriorated in 1 .No patients died from the operation.Conclusion： MRI is a reliable method in the diagnosis of spinal intrameduaUy cavernous hemangiomas.DSA can diferentiate other spinal AVM. Microanrgery is the best method in the treatment of spinal cavernous hemangiomas. The outcome depends on the severity of preoperative neurological dysfunction. Precise diagnosis of the CA and timely treatment are mandatory. Meticulous nonbleeding surgery and experience are the keys to success.