高颈段椎管内肿瘤显微手术治疗效果及轴性症状相关因素分析

The curative effect of microsurgery for tumors in the superior cervical spinal cord and analysis of the related factors on axial symptom

目的评价高颈段椎管内肿瘤显微手术治疗效果及轴性症状相关因素分析。方法回顾性分析武汉协和医院神经外科2007年1月至2011年2月收治含C4及以上高颈段椎管内肿瘤显微手术病例共计41例。高颈段髓内肿瘤与脊髓平均宽度比为1.08>0.80;高颈段髓外肿瘤与脊髓平均宽度比为2.18。经后正中入路行半椎板切除25例,经椎板成形术行肿瘤切除16例。结果术中切除组织病理报告结果显示:室管膜瘤4例,间变型室管膜瘤1例,星形细胞瘤4例,血管网状细胞瘤、海绵状血管瘤各1例;神经鞘瘤22例,神经纤维瘤1例,脊膜瘤5例,非典型脊膜瘤1例,合体细胞脑膜瘤1例。全切39例,部分切除2例。出院时运动功能障碍改善率为89.30%(25/28),感觉功能障碍改善率为63.30%(19/30),括约肌功能障碍改善率为100%(3/3),自发性疼痛94.10%(16/17)的患者缓解或消失。随访37例,平均随访时间5年,81.1%(30/37)的患者神经功能美国脊髓损伤协会(ASIA)分级E级,复发1例。术后颈托固定平均时间34.5 d,随访有颈背部疼痛僵硬,肌肉痉挛4例,颈椎日本骨科学会(JOA)评分改善明显(P<0.005)。结论显微手术治疗高颈段椎管内肿瘤技术日益完善,全切率提高,即使髓内肿瘤周径较大,总体疗效满意,预后与术前神经功能状态密切相关。适当减少佩戴颈托固定时间,并予以合理的肌肉功能锻炼可有效减少轴性症状发生率。

Objective To evaluate the curative effect of microsurgery for tumors in the superior cervical spinal cord and analyze the related factors on axial symptom. Methods A series of 41 patients with tumors in the superior cervical spinal cord of C4 or above who were treated in Neurosurgery Department of Wuhan Union from January 2007 to February.2011 were retrospectively analyzed. The ration of the average width between intramedullary tumor in the superior cervical spinal cord and spinal cord was 1.08 〉 0. 80. The ration of the average width between the extramedullary tumor in the superior cervical spinal cord and spinal cord was 2. 18. Surgical operations were performed for resection, including posterior central unilateral laminectomy approach in 25 cases and laminoplasty in 16 cases. Results Pathology reports in the surgical operation showed ：4 cases were ependymoma, 1 case was variant ependymoma, 2 cases were astrocytomas ,28 cases were sehwannomas, 4 cases were eningiomas, 1 case was untypical-eningiomas, 1 case was syneytial meningioma. There were 39 cases of total resection and 2 cases of partial resection. The motor and sensory functions were found to be improved after operation in 89. 30% （ 25/28 ） and 63.30% （ 19/30 ） respectively. The sphincter function was 100% （3/3）. The rate of pain relief was 94. 10% （16/17）. The average follow-up periods were 5 years in 37 patients. 81.1% （30/37）of patients were graded to E level according to neural function American Spinal Injury Association（ASIA） and 1 ease with recurrence was found. The average time of fixing the neck-collar after operation was 34. 5 days. After four years of follow-up, there were 4 patients suffering pain and stiffness on the neck and back. And the scores of cervical vertebra Japanese Orthopaedic Association （ JOA ） were improved obviously （ P 〈 0. 005 ）. Conclusion The radical microneurosurgery treatment for intradullary tumor in the superior cervical spinal cord has been increasingly improved and the ration of tall resection has been heightened. Even if the diameter in the intramedullary tumor is relatively big and the whole results are satisfactory, prognosis and neurological status before surgical operation are closely related. Reduction of wearing the fixed neck-collar and doing proper muscle functional exercise can reduce the occurrence of axial symptoms.