脊髓髓内血管母细胞瘤的显微外科治疗

Microsurgery through postero-medial approach for intramedullary spinal cord hemangioblastoma(report of 16 cases)

目的总结脊髓髓内血管母细胞瘤的显微外科手术治疗经验。方法回顾性分析2005年1月至2013年11月显微手术治疗的16例脊髓髓内血管母细胞瘤患者的临床资料。结果肿瘤全切除15例（18个肿瘤,2例多发）,部分切除1例;术后病理学检查证实为血管母细胞瘤。术后11例随访3月∽5年,无复发,病情恢复良好。结论对于脊髓髓内血管母细胞瘤,显微镜下严格沿正确的界面进行分离,先离断动脉后处理静脉,避免分块切除而力争全切,是减轻术中出血和神经功能损害的关键。虽然手术风险高,但对临床表现明显的患者,宜应行积极的显微外科手术治疗,防止症状发展。

Objective To explore the microsurgical technique to treat the intramedullary spinal cord hemangioblastoma （IMSCH）. Methods The clinical data of 16 patients with IMSCH treated in our department from January, 2005 to November, 2013 were analyzed retrospectively, including clinical manifestations and curative effect of microsurgery on IMSCH. Results Of 16 patients with 18 IMSCH, 15 with 17 IMSCH underwent total resection of the tumors and 1 part. All IMSCH were pathologically confirmed. Of 16 patients, 15 were recovered well and 1 undergoing part resection of the tumor was in worse condition. No patients died. No tumors recurred in 11 patients followed up from 3 months to 5 years, who were recovered very well. Conclusions The keys to decrease in the intraoperative bleeding and damage to the neurological function include strict separation of the tumors along the interface between the tumors and normal tissues, cutting off the artery feeding blood to the tumor followed by treating the veins from the tumors and intaet resection of the tumors as possible. The curative effect of microsurgery on IMSCH is good, and IMSCH patients with obvious clinical manifestations should be positively treated by microsurgery.