硬脊膜内外多发性神经鞘膜瘤7例诊治分析

Diagnosis and Treatment about Seven Cases of the Multiple Nerve Sheath Tumor Inside and Outside of Spinal Dural

目的:回顾分析硬脊膜内外多发性的神经鞘膜瘤的手术治疗疗效及注意事项。方法:我院2001-2011年间脊柱病区收治的椎管内肿瘤患者中,共发现7例硬脊膜内外多发性的神经鞘膜瘤。肿瘤发生部位:胸段3例,腰段2例,2例为胸段肿瘤位于硬膜内,腰段肿瘤位于硬膜外呈哑铃型向椎管外生长。临床表现为隐袭性、进行性双下肢麻木、无力、僵硬和不灵活,行走不稳等症状。治疗方法:全部手术肿瘤摘除,5例一期行硬膜内外同时摘除肿瘤,2例不同节段的肿瘤采取分期手术。结果:全部病例经1-9年随访,肿瘤未见复发。病理报告:均为神经鞘膜瘤。结论:临床上硬脊膜内外多发性的神经鞘膜瘤较少见,容易漏诊漏治。术前应注意详细查体,仔细阅片,术中注意切除硬膜外的肿瘤后,观察硬膜有无异常表现,手术是治疗该病的有效方法。

Objective： A retrospective analysis was made on the therapy effect and the points for attention about surgical treatment of the multiple nerve sheath tumor inside and outside of Spinal Dural. Methods： Between 2001 and 2011, there are seven cases of the multiple nerve sheath tumor inside and outside of Spinal Dural among all the patients with intraspinal neoplasm in spinal ward in my hospital. Among the tumor locations, three eases are located in thoracic, two eases are located in lumbar and two eases of thoracic tumors are located inside the dura mater. Lumbar tumor was located outside the dura mater, which was dumbbell-shaped growth outside the spinal canal. The main clinical manifestations included insidious, progressive lower extremity numbness, weakness, stiff and inflexible, unsteady gait and other symptoms. Treatment： surgical tumor removal, five eases of a line subduml inside and outside at the same time to remove the tumor, two eases of tumors of different segments to take installments surgery. Rosul~： All patients were followed up between one and nine years, the tumor had no recurrence. The pathology report shows that all the tumors are nerve sheath tumor. Conclusion： It was rarely seen the multiple nerve sheath tumor inside and outside of Spinal Dural in clinical practice, so it was easily missed diagnosis and treatment. Surgery is an effective method for the treatment of the disease. You should pay attention to the detailed physical examination in preoperative examination and reading the data of images earefully. During operation, you should observe whether there are abnormal features in dum mater atter reseeting the tumor, which outside the epidural.