脊髓髓内肿瘤显微外科治疗

Experience of Microsurgical Treatment for Intramedullary Spinal Cord Tumors

目的 总结并探讨脊髓髓内肿瘤显微外科手术的治疗经验。方法 统计近3年来显微外科手术治疗18例髓内肿瘤的临床资料、手术方式及术后转归。结果 手术全切17例,大部分切除1例;病理学诊断室管膜瘤8例,星形细胞瘤6例,血管母细胞瘤3例,血管畸形1例;术后运动及感觉障碍改善14例,不明显3例,加重1例;随访共16例,未见1例复发。结论 髓内肿瘤一旦诊断应早期手术治疗。脊髓髓内肿瘤应强调显微手术镜下操作,这不仅使病变与正常脊髓更易辨清,同时使操作更为细致轻柔。仔细辨认肿瘤与脊髓界限,对全切肿瘤和保护脊髓是有帮助的。对于肿瘤与脊髓有较清楚界限时应争取显微镜下全切,但当肿瘤侵蚀已至软膜下区时,此时不能盲目追求全切,以避免永久性功能障碍。

Objective To summarize the microsurgical experience for treatment of intramedullary spinal cord tumors. Methods The clinical data, surgical procedures and outcomes of 18 cases with intramedullary spinal cord tumors treated within 3 years were reviewed. Results Of 18 tumors 17 were radically resected and 1 partially resected. The pathological diagnosis was as follows: ependymoma (8 cases); astrocytomas (6); hemangioblastoma (3) and vascular malformation (1). Postoperative functional assessment showed that the function of motion and sensation had improved in 14 patients, less changed in 3 and deteriorated in 1. The follow-up was carried in 16 patients and showed no recurrence. Conclusions The intramedullary spinal cord tumors should be treated as soon as the diagnosis was confirmed. The microsurgical operation not only can clearly identify the interface between the tumor and spinal cord, but also make the operation more easy and smooth. When the tumor has invaded the pia mater, total resection should be cautiously considered because the diffifcult total resection probably produces a permanet sequela.