改良椎管扩大成形术治疗颈胸交界区髓内室管膜瘤

Microneurosurgery Combined wi1th Modified Canal-expansive Laminoplasty for Multisegmental Intramedullary Ependymomas of Spinal Cord in Cervicothoracic Junctions

目的探讨利用微型钛板-钛钉内固定行改良椎管扩大成形术治疗颈胸交界区髓内室管膜瘤的可行性。方法回顾性分析2000年至2008年收治的14例颈胸交界区多节段髓内室管膜瘤患者的临床资料。结果肿瘤全切除13例,近全切除1例。14例患者均以微型钛板-钛钉行椎板复位,恢复脊柱的正常解剖结构。术后肌力改善10例,无变化3例,1例患者术前McCormick分级Ⅳ级,术后略有加重。术后随访未发现脊柱不稳病例。结论采用显微外科手术全切肿瘤是髓内室管膜瘤治疗的最佳选择;利用微型钛板-钛钉固定,行改良椎管扩大成形术,是一种简单、安全、有效的方法;在抬起的椎板获得稳定的同时,可以恢复椎管的完整性。

Objectives To explore the feasibility of canal-expansive laminoplasty with titanium miniplate-screw fixation, and the curative effect of the microneurosurgery combined with modified canal-expansive laminoplasty on the multisegmental intramedullary ependymomas of spinal cord in the cervicothoracic junctions. Methods The clinical data of 14 patients with multisegmental intrame- dullary ependymoma of spinal cord in the cervicothoracic junctions, who underwent microneurosurgery combined with modified canal-expansive laminoplasty from 2000 to 2008 in our hospital, were analyzed retrospectively. Results Of patients with multisegmental intramedullary ependymoma of spinal cord in the cervicothoracic junction, 13 received total resection of the tumors and 1 subtotal. The vertebral laminae were reduced and fixed with titanium miniplate-screws, and the normal structures of spinal columns were restored in all the patients. After the operation, the neurological function was improved in 10 patients, unchanged in 3, and aggravated in 1 with McCormick grade Ⅳ before the operation. Conclusions The microsurgery combined with modified canal-expansive laminoplasty with titanium miniplate-screw fixation is a simple, safe and effective method to treat the intramedullary ependymoma of spinal cord in the cervicothoracic junction. While the stability of the elevated laminae is achieved, the integrity of spinal canal may be recovered.