终丝室管膜肿瘤13例临床病例分析

A clinical report of 13 patients with filum terminale ependymal neoplasm

目的探讨脊髓终丝室管膜肿瘤的临床特点、手术策略及预后分析。方法回顾性分析了北京积水潭医院神经外科2009--2014年手术治疗的脊髓终丝室管膜肿瘤的临床特征、影像学资料、病理特征、手术资料及预后等。结果13例患者病变最常见节段为T12～L3，长度1．5～11．0cm，平均4．1cm，有7例（54％）病理回报为黏液乳头型室管膜瘤（WHOⅠ级），6例（46％）为室管膜瘤（WHO1I级）。本组患者10例肿瘤全切除，3例大部切除。长期随访有2例复发，复发患者肿瘤均为分块大部切除，病理均为室管膜瘤（WHOⅡ级），术后常规放疗。长期随访2例复发患者改良的Mccormick评级较术前分别下降1级和2级，余未复发患者有5例较术前提高1级或2级，余6例患者维持术前的1级或2级水平。结论手术全切是终丝室管膜肿瘤最有效的治疗方法。

Objective To evaluate the clinical features, strategy of surgery and prognosis of the patients with ilium terminale ependymal neoplasm. Methods The clinical features, imaging findings, pathologic manifestation, oper- ative details and prognosis of 13 patients with ilium terminale ependymal neoplasm operated in the department of neurosurgery between 2009 and 2014 were retrospectively reviewed. Results The most common location of the tumor was in T12-L3, with the length between 1.5 cm and 11 cm （average 4. 1 cm）. Seven of 13 patients （54%） were reported as WHO grade I myxopapillary ependymoma, the other 6 patients （46%） were reported as WHO grade l] ependymoma. Surgically gross total resection （GTR） was obtained in 10 patients without any recurrence in the follow up period. The subtotal resection （STR） was obtained in the other 3 patients, in which 2 patients with WHO grade Ⅱ ependymoma relapsed in the follow up period although adjuvant radiotherapy was adopted post-oper- atively. Except these 2 relapsed patients, the modified Mccormick scale of the other Ⅱ patients improved at least 1 level or remained at the pre-operative levels. Condusions Gross total resection （GTR） is the most efficient meth- od for the treatment of ependymal neoplasms of filum terminale.