诱发电位监护下显微神经外科手术治疗脊髓髓内脂肪瘤

Microneurosurgical therapy for spinal intramedullary lipoma with intraoperative evoked potentials monitoring

目的探讨脊髓髓内脂肪瘤的临床特点及其诱发电位监护下显微神经外科手术治疗方法。方法对重庆医科大学附属第一医院神经外科2003年3月至2009年1月收治的4例脊髓髓内脂肪瘤患者进行回顾性分析,对其临床表现、诊断方法、治疗与结果作出评价。结果本组4例患者均在显微镜下行肿瘤分块次全或大部切除术,同时行硬膜减张、椎板切除减压术。术中全程进行诱发电位监护。3例患者出院时症状明显好转,1例出院时症状较术前略有好转。结论MRI检查是目前诊断脊髓髓内脂肪瘤最有效的影像学手段。为避免术中加重脊髓损伤而出现严重并发症,主张在显微镜下行肿瘤分块次全或大部切除术。术中应用诱发电位监护有助于避免损伤肿瘤周围正常脊髓组织。

Objective To explore the clinical characteristics and the microneurosurgical treatment for spinal intramedullary lipoma under the monitoring of intraoperative evoked potentials. Methods The clinical data of 4 patients with spinal intramedullary lipoma from March 2003 to January 2009 hospitalized in the First Affiliated Hospital of Chongqing Medical University were collected and analyzed retrospectively. The clinical presenta- tion, diagnostic method, treatment and outcome were evaluated. Results Under intraoperative evoked potentials monitoring, all 4 patients were treated microneurosurgically with tumor subtotal or partial resection operation, lumbar decompressive laminectomy and duraplasty to relieve tension. Three out of them were improved in nervous system function. Conclusion MRI scan is by far the best option to diagnose spinal intramedullary lipoma. Intraoperative evoked potentials can help to enhane the accuracy of microsurgery for spinal intramedullary lipoma and decrease surgical complications.