脊椎管内神经鞘瘤的手术治疗

Operative Treatment for Schwannoma in the Spinal Canal

目的:回顾分析了66例脊椎管内神经鞘瘤的诊断和手术治疗特点。材料与方法:本组包括1983～1996年收治的66例脊椎管内神经鞘瘤,其中颈段27例,胸段13例和腰骶段26例。分别叙述临床表现及类型,影像学检查结果(脊柱X线片、脊髓造影、CT扫描和MRI),手术治疗。结果:66例均得到及时、准确的诊断和手术治疗。60例获全切除,6例大部分切除。平均随访2年11个月,优良率为90.9%,有效率为97.0%。结论:(1)椎管内神经鞘瘤并不少见,本组4例有恶变或恶变倾向。(2)此种肿瘤形态呈多样性。(3)详细的神经系统检查,可确定损害的大致部位,结合影隊学检查、手术探查和病理识别及病理切片检查才能确定诊断。(4)彻底切除肿瘤才能获得良好效果,尽管有时相当困难和危险。

Purpose: To retrospectively analyse the characteristics of diagnosis and operative treatment of 66 cases of scwannoma in the spinal canal. Methods: Sixty-six cases, 27 of the cervical region, 13 the thoracic and 26 of the lumbar and sacral regions were treated from 1983 to 1996. Clinical manifestation and types, and results of spinal radiography, myelography, CT scannig, MR imaging, operative treatment were separately described. Results: All of the 66 cases obtained timely and accurate diagnosis and treatment. The tumors in 60 patients were completely resected; and in remaining 6 patients subtotal excision was performed. The duration of follow-up averaged two years and eleven months and excellent and good results were achieved in 90.9% of the patients. Conclusions: 1) Schwannoma in the spinal canal is not uncommon; four in this series are malignant or with malignant tendency. 2) The forms of the tumor are with lots of variations. 3)An approximate position of the lesion can be determined by clinical neurological examination. Accurate diagnosis can be made by a procedure combining clinical and imaging examinations, operative exploration and pathological examination. 4) Total resection of the tumor may result in good restoration although it is sometimes difficult and risky.