脊髓髓内海绵状血管瘤的显微外科治疗及预后

The microsurgical treatment and prognosis of intramedullary spinal cord cavernoma

目的探讨脊髓髓内海绵状血管瘤（ISCC）的临床过程、影像学特点、治疗策略。方法对宣武医院神经外科1993年5月至2007年11月手术治疗的81例ISCC资料进行回顾性分析。结果ISCC占同期脊髓血管病的8．7％；男：女=1．6：1；平均发病年龄为35．7岁；病灶位于胸段56例（69％），颈段23例（28％），腰段2例（3％）；64例患者获得长期随访，平均随访48个月，神经功能改善23例，未变化35例，恶化6例。术后复发4例。结论（1）ISCC好发于青壮年，胸段多见，颈段次之；（2）大部分ISCC在MRI有特征性的表现；（3）对症状明显、病灶位于脊髓背侧、非出血急性期的ISCC提倡显微手术治疗。

Objective To investigate the clinical course, radiological characteristics and long term outcome of patients with intramedullary spinal cord cavernoma （ISCC）. Method Clinical data on 81 patients who accepted microsurgical treatment in our hospital from 1993 to 2007 were retrospectively analyzed. The function of the spinal cord in pre, post - operation and long term follow - up was assessed by Aminoff ＆ Logue disability scale. Results ISCC constituted 8.7% of all spinal cord vascular disease. The mean age at onset of symptoms was 35.7 - year - old. The mean duration of symptom was 22.5 months. The lesions of ISCC located in thoracic, cervical and lumbar segment was 69% ,28% and 3% respectively. All patients underwent microsurgical resection of ISCC. The long term follow - up data was obtained in 64 patients. At the end of the follow up, the neurological function improved in 23 cases, unchanged in 35 cases and got worse in 6 cases. Incomplete resection was detected in 4 patients with neurological condition decline due to rebleeding of residual. Conclusions （ 1 ） Thoracic segment of spinal cord is the most common site for ISCC and the symptoms usually be onset during the third to fourth decade. （2） MRI is specific for the diagnosis of ISCC and the spinal angiography is necessary for some patients for differential diagnosis. （ 3 ） Total resection of lesions is the best way to avoid symptom recurrence due to rebleeding of the residue.