多节段髓内室管膜瘤的显微外科治疗

Microneurosurgery for multisegmental intramedullary ependymomas

目的探讨多节段(≥3节)髓内室管膜瘤的显微外科治疗效果。方法回顾性分析46例多节段髓内室管膜瘤的临床资料,行后正中入路显微手术切除肿瘤。采用McCormick分级评估手术前后病人脊髓功能状态。结果肿瘤全切除37例(80.4%),次全切除7例(15.2%),部分切除2例(4.3%)。术后3 d病人症状体征无明显改变26例(56.5%),改善8例(17.4%),加重12例(26.1%)。术后1周根据McCormick分级,肿瘤全切除病人的脊髓功能损害加重率(32.4%)高于未全切除病人(22.2%),但差异无统计学意义(P>0.05)。与术前McCormick分级比较,术后6个月、12个月显著改善(P<0.05),而术后1个月无明显改善(P>0.05)。结论应用微创理念及操作技巧显微手术切除多节段髓内室管膜瘤可取得较好效果,显著改善远期脊髓神经功能。

Objective To investigate the microsurgical effects for multisegmental(greater than or equal to 3)intramedullary ependymomas.Methods Clinical data of 46 patients with multisegmental intramedullary ependymomas undergoing microsurgery via posterior midline approach were analyzed retrospectively.The function of the spinal cord was evaluated by McCormick grade.Results Total tumor resection was achieved in 37 patients(80.4%),subtotal resection in 7(15.2%)and partial resection in 2(4.3%).The postoperative symptoms and signs had no significant change in 26 patients(56.5%),improved in 8(17.4%)and aggravated in 12(26.1%).According to McCormick grade at 1 week after the operation,the aggravation rate of spinal cord function in patients with total tumor resection(32.4%)was higher than that in patients without total tumor resection(22.2%),but the difference was not statistically significant(P>0.05).Compared with McCormick grades before surgery,there was a significant improvement in 6 and 12 months after the surgery(P<0.05),but no significant improvement 1 month after surgery(P>0.05).Conclusion Using minimally invasive concept and skills for resection of multisegmental intramedullary ependymomas can get good therapeutic effects and significantly improve the long-term spinal nerve function.