脑干脊髓腹侧肠源性囊肿的显微手术治疗

Microsurgical resection of neurenteric cysts situated ventral to spinal cord and brain stem

目的 探讨位于脑干及脊髓腹侧肠源性囊肿的诊断及显微手术方法.方法 回顾位于脑干脊髓腹侧肠源性囊肿8例,其中4例颅颈交界部囊肿采用远外侧手术入路,3例颈段采用后正中入路,1例胸段采用胸椎侧前方入路进行手术切除.结果 MRI是早期诊断肠源性囊肿的有效手段.7例囊肿获得全切除,1例大部切除;所有患者术后神经功能恢复良好.结论 肠源性囊肿虽然是先天性良性肿瘤,但多位于脑干、脊髓腹侧,手术易造成脑干、脊髓损伤,全切除难度大;采用枕下远外侧经髁入路或胸椎侧前方入路,通过显微外科操作可在对脑干、脊髓最小干扰下获得全切除.

Objective To discuss the clinical diagnosis and operative approach to neurenteric cycsts （NC） situated ventral to spinal cord and brain stem. Materials From January 2005 to Febuary 2007 the clinical data of 8 patients（5 male and 3 female） with NC situtated ventral to brain stem and spinal cord were reviewed. 4 tumors located in brain stem and upper cervical spinal cord received operation through extremely lateral transcondlar approach, 3 tumors in cervical segment through cervical posterior approach and 1 tumor in thoracic segment through thoracic lateral - anterior approach. Results Total resection of NC was achieved in 7 patients and subtotal resection in 1 patient. All patients recovered well postoperatively. The followed - up MRI imaging revealed no evidence of tumor recurrence. Conclusions Neurenteric cysts are rare congenital benign cysts of endodermal origin and usually locate ventral to brain stem and spinal cord.The extreme lateral transcondlar approach or thoracic lateral - anterior approach could provide an effective exposure and get satisfied therapy outcome for NC located ventral to brain stem and spinal cord.