椎管内脊膜瘤的诊断与显微手术治疗

Diagnosis and microsurgical treatment of intraspinal meningioma

目的总结椎管内脊膜瘤的影像学特征及显微外科手术操作技巧,提高其临床诊治效果。方法回顾性分析69例椎管内脊膜瘤病人的临床资料,本组均采用后正中入路,采取全椎板或半椎板切除,行显微外科手术切除肿瘤。结果肿瘤全切除64例,大部分切除4例,部分切除1例。术后症状好转28例,无变化36例,加重4例,死亡1例。术后并发椎管内感染1例。57例获0.5～5.5年随访,肌力正常恢复55例,未恢复正常2例。结论 MRI是椎管内脊膜瘤的最佳影像学检查方法;后正中入路切除椎板适用于大多数病例,显微外科技术能提高肿瘤全切除率,减少脊髓和神经损伤。

Objective To summarize the imaging feature and microsurgical technique of intraspinal meningioma for improving diagnostic accuracy and therapeutic efficacy.Methods Clinical data of 69 patients with intraspinal meningioma were analyzed retrospectively.Posterior median approach was adopted for microsurgical resection of tumors with total or half laminectomy in all the cases.Results Total resection was achieved in 64 cases,subtotal resection in 4 and partial resection in 1.The symptoms were improved in 28 cases,unchanged in 36,aggravated in 4 and 1 patient died after operation.Intraspinal infection occurred in 1 patient postoperatively.Fifty-seven patients were followed up from 0.5 to 5.5 years,muscle strength recovered completely in 55 patients and partially recovered in 2.Conclusions MRI is the best imaging method for intraspinal meningioma.Posterior median approach with laminectomy is appropriate formost meningiomas,and microsurgical technique can increase total resection rate and decrease injury of the spine cord and nerve.