颈髓髓内血管母细胞瘤的诊断与治疗

Diagnosis and treatment of intramedullary hemangioblastoma of cervical spinal cord

目的 探讨颈髓髓内血管母细胞瘤的诊断与治疗。方法 分析 19例患者的MRI表现 ,及其手术治疗的效果。结果 这类肿瘤在MRI上可分为三型 :A 空洞型 ,肿瘤大小不等 ,且继发延、脊髓空洞 ;B 囊肿型 ,为囊内小的附壁结节 ;C 实体型 ,为巨大的实体性肿瘤。所有患者均经手术全切除肿瘤 ,并经病理证实为血管母细胞瘤。术后患者神经系统状态好转者 18例 ,加重 1例。结论 颈髓MRI能对颈髓髓内血管母细胞瘤作出定位、定性诊断 ,并可将其分型 ,以利选择不同的手术方法 ;诊断时 ,还需与胸廓出口综合征和颈椎病相鉴别。认为颈髓髓内、即使累及延髓的血管母细胞瘤宜行积极手术治疗 ;手术方法随肿瘤类型不同而各异 ,最为重要是 :需沿正确的界面分离 ,并应在离断供血动脉后切除肿瘤。

Objective To probe into the diagnosis and the treatment of intramedullary hemangioblastoma of cervical spinal cord.Methods The signs of MR imagings, and the methods and the results of operations were analysed in 19 patients with the tumor.Results On MRI, the tumors can be divided into three types: A.Syringeal type, the tumor varied in size and accompanied by syringobulbia and syringomyelia; B.Cystic type, the tumor presdented a cyst with small mural nodule; C.Solid type, the tumor revealed a huge solid tumor. All the patients underwent total tumor removal. Resected tumors were hemangioblastomas that were all confirmed by histological examinations. After operation, neurological status was improved in 18 patients and aggravated in 1.Conclusions For intramedullary hemangioblastoma of cervical spinal cord, cervical MR imagings can make out the diagnosis of localization and the nature, and classification. The classficationn is conductive to selecting appropriate operative method. When it is diagnosed, intramedullary hemangioblastoma of cervical spinal cord needs to be distinguished from thoracic outlet syndrome and cervical spondylopathy. Intramedullary hemangioblastoma of cervical spinal cord ,even invloving medulla oblongata,is amenable to aggressive surgery. Operative methods varied with the different type of the tumor. It is the most important that dissection is performed along the innterface and the tumor is removed after it is devascularized.