圆锥髓内病变的显微外科治疗

Microsurgery for intramedullary lesions of the conus medullaris

目的评价圆锥髓内病变的手术疗效。方法回顾性分析122例圆锥髓内病变的治疗情况。最常见症状为腰背部及下肢疼痛,术前Mc Cormick脊髓功能分级Ⅰ级55例,Ⅱ级32例,Ⅲ级20例,Ⅳ级15例。结果肿瘤全切除90例(73.8%),近全切除32例(26.2%),最常见病理学类型是室管膜瘤和畸胎瘤。术后症状好转91例。结论应该在保留病人圆锥功能的前提下进行手术治疗,最佳的手术时机、完善的术前检查、完备的术中电生理学监测及精良的手术器械对保留病人神经功能的同时达到治疗目的至关重要。

Objective To evaluate the surgical outcome of the intramedullary lesion in the conus medullaris. Methods The clinical data of 122 patients with intramedullary lesion in conus medullaris ~were analyzed retrospectively. The most common presenting symptom was low back and lower limb pain. Preoperative spinal cord function was graded using McCormick classification： Grade Ⅰ in 55 cases, Grade Ⅱ in 32, Grade Ⅲ in 20 and Grade V in 15. Results Total resection was achieved in 90 patients （73.8%）, subtotal in 32 （26.2%）. The most common type of pathology was ependymoma and teratoma. The symptoms were improved postoperatively in 91 patients. Conclusions The function of the conus medullaris should be emphasized in resection of the lesion. The optimal operative time, perfect preoperative examination, complete intraoperative electrophysiological monitoring and precise surgical instruments are very important for the function of the conus medullaris after surgery.