单纯椎管内海绵状血管瘤的诊断与外科治疗

Diagnosis and surgical management of single intraspinal cavernous hemangioma

目的：探讨单纯椎管内海绵状血管瘤（cavernous hemangioma,CH）的诊断与外科治疗效果。方法：回顾性分析2002年1月2010年11月18例行手术治疗并经病理检查证实的单纯椎管内CH患者的临床资料,并依据Aminoff-Logue评分标准对手术前后患者脊髓功能进行评价。结果：18例患者术前均有相应神经系统损害表现。术前均行脊柱MRI检查,其中6例术前MRI检查有典型的CH表现,其MRI诊断与术后病理检查结果相符,17例为单发,1例L2L3和S1节段各1个肿瘤,10例肿瘤累及23个节段。手术均经后正中入路,3例急性发病患者在出血急性期急诊行手术治疗,其余患者均在发现肿瘤早期（1周内）行肿瘤切除术,17例单发病例均行肿瘤全切除,另1例患者仅切除引起症状的L2L3节段肿瘤,无症状的较小的S1节段肿瘤未行手术切除;手术时间170±20min,术中出血量280±40ml,术中均未出现相关并发症。术后均经病理检查证实为CH。术前Aminoff-Logue评分311分,平均6.0±2.8分;术后011分,平均4.2±3.8分,术后评分与术前比较有显著性差异（P〈0.05）。术后脊髓功能Aminoff-Logue分级12例较术前改善,4例无明显变化,2例恶化,无死亡病例。随访2个月5年,平均30个月,8例门诊随访患者影像学检查均未见肿瘤复发;其余患者电话随访,症状较术前改善7例,无明显变化3例。结论：MRI检查有典型的CH表现时对椎管内CH有诊断价值;对于有相应神经系统症状的椎管内CH患者,应积极、早期行肿瘤切除术,可获得良好效果。

Objective：To investigate the diagnosis and surgical management of single intraspinal cavernous hemangioma（CH）.Method：From January 2002 to November 2010,18 patients with single intraspinal CH determined pathologically and undergoing surgery were reviewed retrospectively.The function of the spinal cord was evaluated before and after surgery by using the Aminoff-Logue scale.Result：All 18 patients presented with preoperative neurological deficit.All underwent preoperative MRI,and six cases have typical imaging manifestation,which were consistent with pathological diagnosis.17 cases had single defect;while 1 case had multiple defects（L2,L3,and S1）;10 cases had 2 or 3 vertebrae involved.Posterior midline approach was performed in all cases.All patients were scheduled for surgery（within 1 week after determination） except for 3 cases at acute onset.17 patients with solitary lesion underwent total tumor resection,while 1 case only resected the tumor of L2-L3 that caused clinical symptoms and didn′t resect S1 that has no symptom.No surgery-associated complication occurred during the operation.The operation time was 170±20min,and the blood loss was 280±40ml.Cavernous hemangioma was determined pathologically in all patients.The preoperative Aminoff-Logue score was 3 to 11,with the average score of 6.0±2.8,while the postoperative one was 0 to 11,with the average score of 4.2±3.8,which showed significant difference（P〈0.05）.12 patients had spinal cord function improved,4 unchanged,and 2 deteriorated.No surgery related death was noted.All patients were followed up from 2 months to 5 years,averaging 30 months.8 patients followed up by out-patient had no recurrence of tumor,while of the rest 10 patients followed up by telephone,7 had symptoms improved,and 3 remained unchanged.Conclusion：When the patients have the typical MRI manifestation of the intraspinal cavernous hemangioma,MRI has diagnosis value.Patients with definite neurological symptoms should actively and early undergo tumor resection,and can obtain good operation result.