延颈部髓外肿瘤的诊断与治疗

Diagnosis and microsurgical treatment of extramedullary tumors in the medullocervical junction:report of 14 cases

目的 进一步认识延颈部髓外肿瘤病程特点 ,提高早期诊断率和手术治愈率 ,缩短病程、病痛时间 ,减少并发症。方法 回顾分析 14例延颈部髓外肿瘤的临床及影像学表现、鉴别诊断、显微手术和随访结果。结果 神经鞘瘤 9例 ,神经纤维瘤 2例 ,脊膜瘤 2例 ,脊索瘤 1例 ,病程平均 2 5a ,除 1例复发脊索瘤外均作肿瘤显微镜下全切 ,随访 0 5～8a(平均 3 6a) ,仅脊索瘤 1例复发 ,其余各例短期恢复工作或生活自理。结论 认真询获病史 ,仔细查取体征 ,以减少误诊、漏诊 ,缩短病程 ;MRI检查对该区段肿瘤的定性、定位诊断及手术设计有帮助 ;积极显微手术是全切肿瘤。

Objective To study the characteristics of extramedullary tumors in the medullocervical junction, for improvement in diagnosis, treatment and prognosis.Methods Fourteen patients with extramedullary tumors of medullocervical junction were treated in our department. Their clinical manifestations and neuro-images, differential diagnosis, results of microsurgery and follow-up were analyzed.Results There were 9 cases of neurinoma, 2 cases of neurofibroma,2 cases of meningioma and 1 cases of chordoma. All were completely removed by microsurgery except 1 relapsed chordam. The average course was 2 5 years, during 0 5～8 years( average 3.6 years) followed-up, all patients gone back to work or became life-independent, except only 1 case of choradm relapsed one year after operation.Conclusion The history and sign should be carefully caught to that reduce mis-diagnosis, MR examination is decisive in the differential diagnosis and operative design. An aggressive surgical treatment and minimally invasive technique is crucial for reducing the operative complications, achieving good results, removing tumor completely, and preventing tumor relapse.