椎管内硬脊膜外海绵状血管瘤的影像学特点及治疗

The Radiology Imaging Characteristics and Treatment of Spinal Epidural Cavernous Angiomata

目的探讨单纯椎管内硬脊膜外海绵状血管瘤(SECA)的影像学诊断和治疗经验。方法回顾性分析2004～2011年经手术病理确诊的4例SECA患者的临床表现、治疗方式、影像学及预后情况;4例患者术前均行脊柱X线片、CT轴位平扫及磁共振成像(MRI)平扫检查,手术方式被采用后正中入路在显微镜辅助下完整剥离瘤体,对所有患者术后随访3～36个月观察手术治疗效果。结果本组4例SECA患者的主要临床表现为肢体感觉、运动障碍及神经根症状;病变位于C7～T1节段1例,胸椎节段3例;术前X线平片未检出病灶,CT检出1例,MRI全部检出病灶。所有患者均借助显微镜完整切除病变,除1例术后出现了延髓缺血、呼吸和运动障碍,治疗2年后基本康复;余3例术后恢复良好,随访未见复发。结论 SECA为少见病,临床主要表现为脊髓及神经根慢性受压而出现神经功能障碍及相应体征。X线及CT检查对术前诊断帮助不大,而MRI检查可明确病变位置、形状和大小,并指导临床制订手术方式;SECA一旦发现宜尽早手术切除,据瘤体的大小及与周围组织的关系不同术中采用不同的操作方式,借助显微镜可完整切除肿瘤,术中避免损伤脊髓是避免并发症发生最有效的办法。

Objective To summarize the experiences of radiology diagnosis and treatment of the simplex spinal epidural cavernous angioma（SECA）.Methods According to the analysis of 4 patients′ clinical documents（from 2004 to 2011） who had been made definite diagnosis by radiology and pathology,and received surgical treatment,the experiences of the radiology imaging characteristics and treatment of this disease were summarized.These 4 cases of samples had received the examination of CT,X-ray and MRI before surgical operation,and all the samples had been conducted posterior midline surgical approach,and 4 angiomas had been taken off completely under the microscope in the operations,at last,all cases had a follow-up period for about 3-36 months after discharge from hospital.Results The clinical manifestations of the 4 SECA cases mainly were the sensory and movement disorders of bodies as well as the symptoms of nerve root.1 space-occupying lesions located at C7-T1 spinal,another 3 at vertebra thoracalis.The 4 cases had nothing found by the X-ray examination,1 case had been detected by CT,and 4 had been detected by MRI.All 4 SECA cases had received micrurgy.One of the samples had arisen the impediments of breath and locomote after surgical treatment.The other 3 patients had recovered successfully after treatment.No relapse was seen during the follow up.Conclusion SECA is a rare disease.The primary clinical symptoms are progressive impediments of spinal cord and nerve roots.There are rarely positive symptoms can be found in X-ray and CT examination.However MRI can greatly help clinical staff to find and make an optimal decision for treatment of this disease.Once SECA is found,the best way is conducting micrurgy as soon as possilbe.According to the size of the tumor and connection closeness with the surrounding tissues suitable surgical options can be selected and complete removal of the tumors can be realized with the help of the microscope.Effective protection of the spinal cord in operation is the most effective way of avoiding the complications.