侵及硬膜、脊椎的巨大黏液乳头型室管膜瘤一例报告

Large myxopapillary ependymomas invading the dura mater and the vertebra: 1 case report

张某，女，47岁，因“腰背部疼痛6年，双下肢麻木疼痛3年，加重半年”入院。患者6年前无明显诱因出现腰背部疼痛，于当地医院检查并对症治疗，具体不详，3年前逐渐出现双下肢麻木疼痛，伴尿频、尿急，无反射痛，无神经性间歇性跛行，无腹胀腹痛、胸部束带感，口服止痛药疼痛可缓解，近半年腰背部及双下肢疼痛加重，难以忍受，严重影响日常生活。查体：L1～S1棘突及椎旁压痛、叩击痛（＋），腰椎前屈后伸活动受限，双侧臀部及腹股沟以下皮肤痛觉减退，马鞍区皮肤痛觉减退，左下肢肌力 IV 级，右侧膝腱反射（＋），双侧跟腱反射未引出。影像学检查：腰椎MRI示T12椎体下缘至S2水平椎管内占位，长T1混杂长T2信号，边界清楚，L1及L2椎体后缘骨质呈压迫性吸收，考虑室管膜瘤的可能性大（图1a～d ）；腰椎CT示L1～3水平椎管内占位性病变，L1、L2椎体骨质破坏（图2a～f ）。

Spinal ependymomas occupy 60% of primary spinal cord tumors and have the features of intramedullary tumors. The tumors most commonly ariginate from the central canal of the spinal cord, the conus medullaris or the filum terminale and their pathological features are usually benign. A rare case with large spinal ependymomas invading the dura mater and the vertebra from T12 to L5 underwent a successful operation in our hospital. Postoperatively the tumors turned out to be myxopapillary ependymomas （ MPE ）.