手术治疗延颈交界区病变30例分析

Neurosurgery for intramedullary cord tumors involved in medulla oblongata and cervical spinal cord (report of 30 cases)

目的探讨各种不同延颈交界区病变的临床特征、影像学诊断及手术时机和技巧。方法回顾性分析2002年6月至2012年6月经手术治疗的30例延颈交界区病变患者的临床资料,包括病理类型、临床表现、辅助检查、手术切除程度及疗效。结果 30例延颈交界区病变中全切除29例(96.7%),1例黑色素瘤脑内转移近全切除,无手术死亡病例。术后6个月随访,所有患者临床症状改善,未见病变复发。结论延颈交界区病变可通过MRI作出正确诊断,对绝大多数肿瘤可用显微外科手术切除,对恶性肿瘤术后应辅以放射治疗。

Objective To discuss the clinical and imaging features of the intramedullary tumors involved in the medulla oblongata and cervical spinal cord （ITIMOCSC） and the opportunity and skills of neurosurgery for them. Methods The clinical data of 30 patients with ITIMOCSC, who underwent neurosurgery through the posterior midline approach, were analyzed retrospectively, including the clinical manifestations, imaging examinations, the extent of tumor resection, therapeutic outcomes and pathological findings. Results Of 30 patients with ITIMOCS, 29 received the total removal of the tumors and 1, who had the metastasis from melanoma, subtotal. No patients die of the surgery. The clinical manifestations were improved in all the patients and no lesions recurred 6 months after the surgery. Conclusions ITIMOCS may be definitely diagnosed by MRI, and most of them may be totally resected by micosurgery. The postoperative radiotherapy should be performed in the patients with malignant ITIMOCS.