脊髓海绵状血管瘤的显微外科治疗

Microneurosurgery of intramedullary spinal cord cavernous angioma

目的总结脊髓海绵状血管瘤的手术经验。方法回顾性分析39例海绵状血管瘤病人的临床表现、术前MRI表现、术中所见、手术切除情况、术后MRI表现及随访结果。均在显微镜下行手术治疗,根据肿瘤与脊髓有无明确边界,决定肿瘤切除的程度。手术前后采用McCormick分级评价脊髓功能。结果镜下见肿瘤有明确边界者行手术全切除,共34例;肿瘤有相对边界但不明确者仅行近全切除,共4例;肿瘤无边界且病人术前功能较差者行部分切除,计1例。病理证实均为海绵状血管瘤。术后McCormick分级改善30例,无变化5例,加重4例。结论MRI是脊髓海绵状血管瘤术前诊断最有效的方法;手术全切除病变是最主要的治疗方法,有症状者应积极行手术治疗。

Objective To summarize the therapeutic strategies of spinal cord cavernous angioma. Methods Data of clinical manifestation, pre- and postoperative MRI appearance, intraoperative findings, tumor resection rate and follow up outcomes in 39 patients with intramedually cavernous angioma were analyzed retrospectively. All patients underwent microsurgical resection, the tumor resection extent was determined by the clarity of boundary between tumor and spinal cord. The function of the spinal cord was evaluated before and after operation by McCormick scale. Results Total tumor removal was achieved in 34 patients who had a clear boundary, subtotal removal in 4 who had a relatively clear boundary, and partial removal in 1 who had no boundary and the spinal function was worse. All the tumors were confirmed as cavernous angioma by pathological diagnosis. The postoperative McCormick scale was improved in 30 cases, no changes occurred in 5 and aggravated in 4. Conclusions MRI is one of the most effective ways in preoperative diagnosis for intramedually cavernous angioma. Total removal of the tumor is the main treatment method; patients with symptoms should be operated on actively.