电生理监测辅助显微手术治疗圆锥、终丝起源室管膜瘤

Microsurgery assisted with electrophysiological monitoring for treating ependymoma originating from the conus and filum terminale

目的探讨圆锥、终丝起源室管膜瘤的显微手术技巧及疗效。方法回顾性分析15例圆锥、终丝起源室管膜瘤病人的临床资料,均在神经电生理监测下行显微手术切除肿瘤。结果肿瘤全切除13例,次全切除2例。术后病理证实为室管膜瘤Ⅰ-Ⅲ级。术后发生脑脊液漏1例,皮下积液1例,均经对症治疗后痊愈;无手术相关神经功能障碍;无死亡病例。所有病人术后随访3个月-6年,平均2年;病人神经功能改善11例,改善不明显3例,加重1例。肿瘤复发3例,均再次行显微手术治疗,并行放射治疗。结论圆锥、终丝起源的室管膜瘤与脊髓、马尾神经黏连紧密,肿瘤切除程度及术中是否有脊髓神经损伤是决定病人预后的重要因素。神经电生理监测配合显微手术可有效提高肿瘤全切率,并防止术中神经损伤。

Objective To explore the technique and therapeutic effect of microsurgery for ependymoma originated from the conus and ilium terminale. Methods Clinical data of 15 patients with ependymoma originating from the conus and ilium terminale were analyzed retrospectively. The lesions were removed under the microscope with intraoperative neurophysiological monitoring. Results Total tumor resection was achieved in 13 patients and subtotal resection in 2. The pathological examinations confirmed the tumor as ependymoma （Grade Ⅰ - Ⅲ）. Postoperative cerebrospinal fluid leakage occurred in 1 patient and subcutaneous effusion in 1, and the two patients were cured. No procedure-related neurological disorders were found and no patient died. All the patients were followed up for the mean period of 2 years, ranged from 3 months to 6 years. The neurologic function improved in 11 patients, unchanged in 3 and aggravated in 1. The tumor reoccurred in 3 patients, which all underwent microsurgical treatment again and got radiation therapy. Conclusion The ependymoma originating from the conus and ilium terminale always adhere tightly to spinal cord and cauda equina. The important factors determining the patient＇s prognosis are the extent of tumor resection and if there is intraoperative spinal nerve injury. A combination of microsurgical treatment with neurophysiological monitoring can effectively improve the total resection rate, and prevent intraoperative nerve injury.