椎管髓外硬膜下毛细血管瘤的临床特征和治疗效果(附七例报告)

Clinical features and surgical outcomes of intradural extramedullary capillary hemangiomas:A report of 7 cases

目的探讨椎管髓外硬膜下毛细血管瘤的临床特征和手术治疗效果。方法回顾性分析2006年7月至2017年1月于解放军总医院第一医学中心神经外科行显微手术治疗的7例髓外硬膜下毛细血管瘤患者的临床资料。其中男6例,女1例;发病年龄为(44.4±12.8)岁(23~62岁)。病变位于腰段5例,脊髓圆椎节段2例。临床表现主要为腰腿痛、下肢力弱及大小便功能障碍。术前脊髓MRI显示病变多呈等T1、高T2信号,增强扫描多可见病变呈明显均匀强化。术前5例诊断为神经鞘瘤,1例为血管瘤,1例为海绵状血管畸形。7例患者均采取后正中入路切除肿瘤。术后定期行临床随访,以改良McCormick分级系统进行神经功能评估。行影像学随访评估病变有无复发。结果7例患者中,6例达到肿瘤全切除,1例脊髓圆锥部肿瘤予部分切除。1例患者术后出现鞍区麻木,其余患者无手术相关并发症发生。7例患者术后随访(113.0±49.9)个月(34~160个月),患者的疼痛及大小便功能障碍均得到改善。末次随访时McCormick分级:Ⅰ级6例,Ⅱ级1例。影像学复查显示未见肿瘤复发。结论椎管髓外硬膜下毛细血管瘤罕见,多发生于40~60岁男性患者,病变多位于胸腰段,术前易于误诊,行显微外科手术效果良好,复发率低。

Objective To investigate the clinical features and surgical outcomes of patients with intradural extramedullary capillary hemangiomas(CH).Methods Seven patients with intradural extramedullary CH were admitted to Department of Neurosurgery,First Medical Center of Chinese PLA General Hospital from July 2006 to January 2017 and underwent microsurgery whose clinical data were retrospectively analyzed in this study.Those patients included 6 males and 1 female,with a mean age of 44.4±12.8 years old(range:23-62 years old).At admission,the lumbar segment was most commonly affected(5 cases),followed by conus medullaries(2 cases).Their clinical symptoms included low-back pain and leg pain,limb weakness,urination and defecation dysfunctions.The lesion usually demonstrated isointense on T1-weighted imaging,hyperintense on T2-weighted imaging,and homogeneously enhanced after injection of contrast materials.Five patients were preoperatively diagnosed as schwannoma,1 as hemangioma and 1 as cavernous malformation.Seven cases underwent tumor resection via posterior midline approach.Clinical follow-up was routinely carried out after surgery.Functional status was evaluated based on the modified McCormick′s classification(MMS)system.Imaging follow-up was conducted to explore the recurrence.Results Among the 7 patients,complete excision of the tumor was achieved in 6 and tumor in the area of conus medullaris was partially removed in 1 case.One patient developed numbness in the saddle area after surgery,and the rest of the patients had no surgical complications.The average follow-up period was 113.0±49.9 months(range:34-160 months).At the last follow-up,MMS gradeⅠwas achieved in 6 cases andⅡin 1 case.Pain,urination and defecation dysfunctions improved in patients.An imaging review showed no recurrence of the tumor.Conclusions Intradural extramedullary CH seems rare,which usually occurs in lumbar and thoracic segments,affects male patients of 40-50 years old and tends to be misdiagnosed prior to operation.Microsurgery could lead to relatively good outcome with low recurrence rate.