椎管内髓外硬膜下转移瘤的诊治:附病例分析

Diagnosis and Treatment of Subdural Extramedullary Spinal Metastases:A Case Study

目的总结椎管内髓外硬膜下转移瘤的临床特点及诊治经验。方法回顾性分析3例(孤立性转移腺瘤2例,星形细胞瘤1例)经手术及病理证实的椎管内髓外硬膜下转移瘤患者的临床资料。3例患者行椎管内肿瘤切除术及椎板减压术,在显微镜下将脊神经根或马尾神经与肿瘤粘连紧密的部分予以切断,术后给予激素治疗及放化疗等综合治疗。结果椎管内髓外硬膜下转移瘤灶MRI T1、T2像的信号特点,均匀程度,与周围正常组织的分界及强化后的影像学特征均与脊膜瘤或神经鞘瘤类似。经显微外科手术治疗,患者术后疼痛基本消失,脊髓功能较术前明显改善。结论诊断椎管内髓外硬膜下转移瘤时应仔细询问病史,并做全面的相关检查。确诊后早期手术治疗可取得良好的治疗效果。

Objective To summarize the clinical features and therapeutic experiences of the subdural extramedullary spinal metastases. Methods The clinical data of 3 cases（2 cases of solitary metastatic adenocarcinoma,1 case of astrocytoma） confirmed by surgery and pathology as subdural extramedullary spinal metastases and treated in our department were respectively reviewed.Patients underwent tumor resection and spinal laminectomy surgery.Under the microscope,we cut off the part where the spinal nerve root or cauda equina had close adhesion with the tumor.After the operation,hormone therapy and chemoradiation were given to the patients in order to have a comprehensive treatment. Results The signal and uniformity of MRI T1 and T2 of subdural extramedullary spinal metastases and its dividing line with peripheral normal tissues as well as the imaging features were similar to those of meningioma and neurinoma.After microsurgical treatments,the pain of all patients disappeared and spinal cord function was improved significantly compared with that before. Conclusion Through the surgical treatment at early stage,patients with subdural extramedullary spinal metastases can achieve favorable treatment effectiveness.