脊髓终丝黏液乳头状室管膜瘤的显微手术治疗

Microsurgical treatment of myxopapillary ependymomas in the spinal cord terminal filaments

目的探讨脊髓终丝黏液乳头状室管膜瘤(MPE)的手术方法及疗效。方法回顾性分析显微手术治疗的16例脊髓终丝MPE的临床资料。结果 16例肿瘤均全切除。出院时临床症状全部得到明显改善。16例随访10~70个月,平均45个月,未见复发,未出现脊髓栓系综合征和脊柱畸形;McCormick脊髓功能评分均达到Ⅰ级。结论显微手术是脊髓终丝MPE的有效治疗方法。

Objective To analyze the clinical characteristics and microsurgical treatment principles of the myxopapillary ependymomas in the spinal cord terminal filaments. Methods The clinical data of 16 patients with spinal cord terminal filaments myxopapillary ependymomas who underwent surgery from January, 2010 to January, 2018 were analyzed retrospectively, including the clinical manifestations, diagnosis and treatment. Results The first symptom was numbness or weakness in the lower extremities in 8 patients, pain in 1 and fecal and urinary incontinence in 4. The ependymomas were found out on physical examination in 3 patients.Preoperative McCormick spinal cord function score was grade Ⅰ in 11 patients and grade Ⅱ in 5. Preoperative MRI showed that the tumors were in the lumbar spines in 13 patients and in the lumbosacral spines in 3. The Tumors were totally removed in all the patients.Symptoms were significantly improved on discharge from hospital in all the patients. The recurrence of the tumors, tethered cord syndrome and spinal deformity were not observed in all the patients during following-up from 10 to 70 months. Conclusions Microsurgical removal of the lesion should be selected first in the patients with myxopapillary ependymoma in the spinal cord terminal filaments, in whom the prognoses are mainly affected by degree of preoperative neurological deficits and surgical methods.