延髓血管母细胞瘤的显微手术切除体会(附17例临床分析)

Experience of microsurgical resection of medulla oblongata hemangioblastoma(A clinical analysis of 17 Cases)

目的探讨延髓内血管母细胞瘤的显微手术切除要点及疗效,分析其并发症发生的原因并探讨其预防方法,提高手术安全性。方法回顾性分析2016年1月~2021年1月17例延髓内血管母细胞瘤病例临床资料,包括肿瘤实体部分大小、位置、术前及术后早期改良Ranki量表(modified Ranki scale score,mRS)评分等指标。根据影像学表现分为囊实性肿瘤14例,实性3例,采用枕部后路正中入路显微手术切除肿瘤。术后根据mRS评分将其分为预后良好(mRS≤2分)及预后不佳(mRS>2分)。结果17例患者囊实性全切14例,实性全切2例,部分切除1例。术后神经系统症状如呼吸费力、麻木及枕颈部疼痛等症状完全缓解12例,好转2例,无明显改善或加重3例(其中1例术后气管切开后康复)。术后切口脑脊液漏2例,对症治疗后痊愈。无感染、颅内出血及死亡病例。出院前mRS评分示预后良好14例(82.4%),预后不佳3例(17.6%)。结论显微手术切除延髓血管母细胞瘤疗效确切,术中肿瘤全切手术难度大,风险较高,囊实性肿瘤切除率较高,实性肿瘤术后并发症几率较高。术前完善影像学检查、术中显微操作技巧及严密的硬脑膜缝合有利于提高手术效果并降低手术并发症。

Objective To investigate the main points and effect of microsurgical resection of medulla oblongata hemangioblastoma.To analyze the causes of its complications and to explore its prevention methods to improve surgical safety.Methods A total of 17 cases of medulla oblongata hemangioblastoma were reviewed in our department from 2016 to 2021.We reviewed tumor size,location,preoperative and early postoperative Modified Ranki Scale score(mRS),etc in this research.According to the imaging manifestations of the tumor,14 cases were cystic and solid,and 3 cases were solid.Microsurgical resection of the tumor was performed with a posterior median approach to the occipital region.According to the postoperative MRS score,the patients were divided into good prognosis(mRS≤2)and poor prognosis(mRS>2).Results There were 14 cases of complete resection of the cystic solid cases,2 cases of complete resection and 1 case of partial resection of solid cases.Neurological symptoms such as breathlessness,numbness and occipital and neck pain were completely relieved in 12 cases,improved in 2 cases,and did not significantly improve or worsen in 3 cases(one of them recovered after tracheotomy).Two cases of cerebrospinal fluid leakage were cured after symptomatic treatment.There were no cases of infection,intracranial hemorrhage or death in the following-up period.Before discharge,14 cases(82.4%)had good prognosis and 3 cases(17.6%)had poor prognosis.Conclusion Microsurgical resection of medulla oblongata hemangioblastoma has a definite curative effect.It is difficult and risky to complete intraoperative resection of tumor,and the rate of cystic and solid tumor resection is higher while the postoperative complications of solid tumor is more usual.Perfecting preoperative imaging examination,intraoperative micromanipulation techniques and tight dura mater suture are beneficial to improve the operative effect and reduce the complications.