脊髓髓内神经鞘瘤的临床诊断和治疗

The clinical diagnosis and treatment of intramedullary spinal schwannomas

目的探讨脊髓髓内神经鞘瘤的临床特点和外科治疗方法。方法回顾分析8例髓内神经鞘瘤的临床特点、影像学表现及其手术治疗效果。结果8例患者肿瘤均获手术全切除，术后均进行临床随访，随访时间3-108个月。术前有肌力下降的5例患者，术后3个月肌力较术前明显改善，有6例患者术后出现不同程度感觉异常；所有患者MRI复查未见肿瘤复发。结论脊髓背外侧生长且边界清楚，均匀强化的脊髓髓内肿瘤伴有明显神经根症状，应考虑髓内神经鞘瘤诊断，手术全切肿瘤是该病的最佳治疗选择，手术入路和手术技巧与预后密切相关。

Objective To investigate the clinical features and surgical treatment of intramedullary spinal schwannomas. Methods 8 cases of intramedullary spinal schwannomas were respectively reviewed and related clinical data, including manifestations, imaging features, operative outcomes was analyzed. Results Tumors were totally removed in all the 8 patients. During follow - up period from 3 months to 9 years, muscle strength significantly improved in 5 patients with limb weakness before operation. 6 cases complained of abnormal sensitivity. No tumor recurrence was found in the rechecking MRI of the 8 patients. Conclusions Intramedullary spinal tumors,locating at dorsalateral side, with clear boundary, homogenous enhancement and neuralgic pain, should be highly suspected intramedullary shwannomas. Once diagnosed, surgical resection is the best choice. Clinical outcome is closely related to the surgical approach and skill.