脊髓内室管膜瘤的诊断与显微外科治疗(附36例报告)

Diagnosis and Microsurgical Management of Intramedullary Spinal Cord Ependymomas(Report of 36 Cases)

目的探讨脊髓内室管膜瘤的诊断方法、手术技巧及手术疗效。方法回顾性分析了1999年至2009年10年间武汉协和医院神经外科收治的36例脊髓内室管膜瘤的临床资料。结果 36例脊髓内室管膜瘤患者,有32例获得手术全切,全切率为88.9%,3例次全切除,1例部分切除。术后临床症状改善者24例（66.7%）,无明显改善者7例（19.4%）,加重5例（13.9%）;随访0.5年至9.5年,术前McCormick临床功能分级在Ⅰ-Ⅲ级的24例患者中,有19例患者完全恢复正常生活和工作,3例患者未见明显好转,2例肌力障碍程度加重;术前McCormick临床功能分级Ⅳ级的12例患者中,有5例好转,3例症状有加重。肿瘤复发有3例。结论采用显微外科技术可以达到脊髓内室管膜瘤的镜下全切,患者术后症状大多数可以得到改善。

Objective To discuss the diagnosis and microneurosurgery techniques in the treatment of intramedullary spinal cord ependymomas.Methods The clinical data of 36 cases of intramedullary spinal cord ependymomas between 1999 and 2009 were retrospectively analyzed.Results Of the 36 patients with intramedullary spinal cord ependymomas,complete tumor removal was achieved in 32 patients（88.9%）,subtotal resection in 3 cases,and partial removal in 1 case.Postoperative neurological function was improved in 24 patients（66.7%）,unchanged in 7 cases（19.4%）,and worsened in 5 cases（13.9%）.During a follow-up period of 0.5-9.5 years,of the 24 preoperative patients between Ⅰand Ⅲ according to McCormick clinical classification,postoperative neurological function was significantly improved in 19 patients,and unchanged in 3 patients.In the remaining 12 patients at Ⅳ according to McCormick clinical classification,postoperative neurological function was improved in 5 cases,and worsened in 3 cases.Recurrence occurred in 3 patients.Conclusion Microneurosurgery techniques for intramedullary spinal cord ependymomas can achieve complete removal of the tumor,and most clinical symptoms can be relieved.