术中超声联合神经电生理监测辅助高位颈段脊髓髓内肿瘤显微手术治疗

Application of intraoperative ultrasound and neuromonitoring in microsurgical treatment of intramedullary tumor in the superior cervical spinal cord

目的探讨术中超声技术联合神经电生理监测辅助高位颈段脊髓髓内肿瘤的显微手术治疗.方法回顾性分析2014年1月至2018年1月收治的15例高颈段(C1~C4)脊髓髓内肿瘤患者的临床资料,所有患者经椎板切开显微手术切除肿瘤,术中辅助超声及神经电生理监测,随访资料来自门诊复诊及电话随访.结果15例均在联合神经电生理监测和超声技术下实施显微肿瘤切除术,术后病理诊断8例为室管膜瘤,7例为星形细胞瘤.肿瘤全切除13例,大部分切除2例.术后Mc-Cormick评分,Ⅰ级10例,Ⅱ级3例,Ⅲ级和Ⅳ级各1例.13例患者平均随访(19.2±7.6)个月,2例随访1年后失访.随访结果:神经功能恢复10例(66.6%)、好转3例(20.0%)、症状同治疗前1例(6.7%)、恶化1例(6.7%).结论显微手术切除是治疗高位颈段脊髓髓内肿瘤的有效方式;术中联合神经电生理监测和超声技术对手术操作具有指导意义,减少脊髓神经功能损伤.

Objective To analyze the effect of clinical application of ultrasound in microsurgical treatment of intramedullary tumors in the superior cervical spinal cord.Methods Retrospective study the clinical data of 15 patients with intramedullary tumors in the superior cervical spinal cord,which were underwent a laminectomy for microsurgical tumor resection during January,2014 and January,2018.Intraoperative ultrasound and neuromonitoring was accompanied by the whole surgical procedure for each case.The follow-up data was collected by outpatient department visits and telephone interviews.Results All the described patients were performed with microscopic tumor resection by using intraoperative neurophysiological monitoring and ultrasound.The pathological diagnosis was ependymocytoma (n=8) and astrocytoma (n=7).Gross total resections comprised 86.7% of cases (n=13),and subtotal resections 13.3%(n=2).The neurological outcome was as follows:Mc-Cormick scale grade Ⅰ,10 patients;grade Ⅱ,3 patients;grade Ⅲ,1 patient;and grade Ⅳ 1 patient;Follow-up was applied for (19.2±7.6) months in 13 cases and 12.0 months in 2 cases.Compared to the preoperative period,66.6% of patients recovered postoperatively,20.0% improved,6.7% remained without deficit and deterioration persisted in 6.7%.Conclusion The microscopic resection of tumors is the effective way to cure this disease.By using intraoperative neurophysiological monitoring and ultrasound,the complete tumor resection and the minimal spinal cord injury were certainly achieved.