假瘤样脱髓鞘病变—脊髓手术的误区

Tumefactive demyelinating lesions:a pitfall of inspinal cord surgery

目的脊髓的假瘤样脱髓鞘病变(TDLs)与肿瘤之间的鉴别非常困难。由于两种疾病的治疗方法不同,对于脊髓TDLs的误诊往往导致了严重的后果。方法对5例收治的脊髓TDLs的患者进行了总结,从临床资料、影像学表现、治疗方法及预后进行归纳分析。结果患者的平均年龄为50.4岁;主要临床表现包括:肢体肌力下降、疼痛及麻木等;脊柱所有节段均可能受累及;影像学表现包括:占位效应、病灶周边水肿、不规则环形强化等;1例接受病灶活检,另外4例接受病灶手术切除;术中冰冻病理无法正确判断病理类型;在病理结果证实为TDLs后,所有患者均接受了激素治疗;所有患者对激素治疗反应良好,随访中未见病灶复发及症状加重。结论由于不同的诊断会直接导致不同的治疗手段,因此对于脊髓内占位性病变的诊断及治疗需要谨慎处理:术前应尽量完善各种辅助检查;术中以保留正常脊髓功能为主,不追求病灶全切除,并可进行活检;在病理分析遇到困难时应寻求神经病理学帮助;对于术前高度怀疑为脊髓TDLs的患者可考虑给予诊断性激素治疗,但需从临床及影像学方面密切动态观察。

Objective Differential diagnosis between tumefactive demyelinating lesions （TDLs） and neoplasms in the spinal cord is digicult. Misdiagnosis usually worsens the outcome because of different treatments. The clinical and radiological data, treatment and prognosis of 5 cases of TDLs in the spinal cord were investigated. Results The mean age of onset in these patients was 50. 4 years, and the main clinical symptoms included limb weakness, pain, and numbness, suggesting that the lesions may affect all the segments. Radiological examinations showed mass effect, perifocal edema, and enhancement. One patient received a biopsy, followed by and homaone therapies. Surgery was performed in the other 4 patients who received hormone therapy after pathological diagnosis. Although intra-operative frozen section analysis failed to confirm the diagnosis of TDLs, these patients responded well to hormone and immunosuppressive therapies. No relapse was found in the follow-up. Conclusion Since different diagnoses lead to different outcomes, spinal cord lesions should be carefully diagnosed. Preoperative examination should be consummate, and functions should be reserved during intraoperative resection; a diagnostic hormonal therapy could be used but strict observation should be performed in both clinical and imaging.