目的:对比性分析少节段和多节段髓内原发性肿瘤患者神经功能和预后的差异。方法:选择北京大学第三医院2010年1月至2015年12月显微神经外科手术治疗髓内肿瘤患者进行回顾性分析,共收集病例135例,用IJOA(improved Japanese orthopaedic as...目的:对比性分析少节段和多节段髓内原发性肿瘤患者神经功能和预后的差异。方法:选择北京大学第三医院2010年1月至2015年12月显微神经外科手术治疗髓内肿瘤患者进行回顾性分析,共收集病例135例,用IJOA(improved Japanese orthopaedic association)评分评估手术前后的神经功能状况。结果:在少节段和多节段髓内肿瘤患者中,术前IJOA评分(P=0.02)和术后早期IJOA评分(P=0.004)差异均有统计学意义,不论术前还是术后早期,少节段髓内肿瘤患者神经功能都较好一些,大部分多节段髓内肿瘤患者都有不同程度的肢体无力,但是,对于术后长期的神经功能,多节段和少节段髓内肿瘤患者的差异无统计学意义(P=0.12),经过积极的功能锻炼,多节段髓内肿瘤患者的神经功能状况得以充分改善。结论:相比多节段髓内原发肿瘤患者,少节段髓内原发肿瘤患者围手术期的神经功能状况要好一些,尤其在肢体肌力方面,经积极功能锻炼,多节段髓内肿瘤患者的远期神经功能状况得以充分改善。展开更多
Background About 50%--70% of patients with Chiad malformation I （CMI） presented with syringomyelia （SM）, which is supposed to be related to abnormal cerebrospinal fluid （CSF） flow around the foramen magnum. The ...Background About 50%--70% of patients with Chiad malformation I （CMI） presented with syringomyelia （SM）, which is supposed to be related to abnormal cerebrospinal fluid （CSF） flow around the foramen magnum. The aim of this study was to investigate the cerebrospinal fluid dynamics at levels of the aqueduct and upper cervical spine in patients with CMI associated with SM, and to discuss the possible mechanism of formation of SM. Methods From January to Apdl 2004, we examined 10 adult patients with symptomatic CMI associated with SM and 10 healthy volunteers by phase-contrast MRI. CSF flow patterns were evaluated at seven regions of interest （ROI）： the aqueduct and ventral and dorsal subarachnoid spaces of the spine at levels of the cerebellar tonsil, C2-3, and C5-6. The CSF flow waveforms were analyzed by measuring CSF circulation time, durations and maximum velocities of cranial- and caudal-directed flows, and the ratio between the two maximum velocities. Data were analyzed by ttest using SPSS 11.5. Results We found no definite communication between the fourth ventricle and syringomyelia by MRI in the 10 patients. In both the groups, we observed cranial-directed flow of CSF in the early cardiac systolic phase, which changed the direction from cranial to caudal from the middle systolic phase to the early diastolic phase, and then turned back in cranial direction in the late diastolic phase. The CSF flow disappeared at the dorsal ROI at the level of C2-3 in 3 patients and 1 volunteer, and at the level of C5-6 in 6 patients and 3 volunteers. The durations of CSF circulation at all the ROIs were significantly shorter in the patients than those in the healthy volunteers （P=-0.014 at the midbrain aqueduct, P=-0.019 at the inferior margin of the cerebellar tonsil, P=-0.014 at the level of C2-3, and P=-0.022 at the level of C5-6）. No significant difference existed between the two groups in the initial point and duration of the caudal-directed CSF flow during a cardiac cycle at all the ROIs. The maximum velocities of both cranial- and caudal-directed CSF flows were significantly higher in the patients than those in the volunteers at the aqueduct （P=-0.018 and P=-0.007） and ventral ROI at the inferior margin of the cerebellar tonsil （P〈0.001 and P=-0.002）, as so did the maximum velocities of the caudal-directed flow in the ventral and dorsal ROIs at the level of C2-3 （P=-0.004; P=-0.007）. Conclusions The direction of CSF flow changes in accordance with cardiac cycle. The syringomyelia in patients with CMI may be due to the decreased circulation time and abnormal dynamics of the CSF in the upper cervical segment. The decompression of the foramen magnum with dural plasty is an alternative for patients with CMI associated with SM.展开更多
文摘目的:对比性分析少节段和多节段髓内原发性肿瘤患者神经功能和预后的差异。方法:选择北京大学第三医院2010年1月至2015年12月显微神经外科手术治疗髓内肿瘤患者进行回顾性分析,共收集病例135例,用IJOA(improved Japanese orthopaedic association)评分评估手术前后的神经功能状况。结果:在少节段和多节段髓内肿瘤患者中,术前IJOA评分(P=0.02)和术后早期IJOA评分(P=0.004)差异均有统计学意义,不论术前还是术后早期,少节段髓内肿瘤患者神经功能都较好一些,大部分多节段髓内肿瘤患者都有不同程度的肢体无力,但是,对于术后长期的神经功能,多节段和少节段髓内肿瘤患者的差异无统计学意义(P=0.12),经过积极的功能锻炼,多节段髓内肿瘤患者的神经功能状况得以充分改善。结论:相比多节段髓内原发肿瘤患者,少节段髓内原发肿瘤患者围手术期的神经功能状况要好一些,尤其在肢体肌力方面,经积极功能锻炼,多节段髓内肿瘤患者的远期神经功能状况得以充分改善。
基金the Foundation of Peking University Third Hospital(YZZ05-17-07)
文摘Background About 50%--70% of patients with Chiad malformation I （CMI） presented with syringomyelia （SM）, which is supposed to be related to abnormal cerebrospinal fluid （CSF） flow around the foramen magnum. The aim of this study was to investigate the cerebrospinal fluid dynamics at levels of the aqueduct and upper cervical spine in patients with CMI associated with SM, and to discuss the possible mechanism of formation of SM. Methods From January to Apdl 2004, we examined 10 adult patients with symptomatic CMI associated with SM and 10 healthy volunteers by phase-contrast MRI. CSF flow patterns were evaluated at seven regions of interest （ROI）： the aqueduct and ventral and dorsal subarachnoid spaces of the spine at levels of the cerebellar tonsil, C2-3, and C5-6. The CSF flow waveforms were analyzed by measuring CSF circulation time, durations and maximum velocities of cranial- and caudal-directed flows, and the ratio between the two maximum velocities. Data were analyzed by ttest using SPSS 11.5. Results We found no definite communication between the fourth ventricle and syringomyelia by MRI in the 10 patients. In both the groups, we observed cranial-directed flow of CSF in the early cardiac systolic phase, which changed the direction from cranial to caudal from the middle systolic phase to the early diastolic phase, and then turned back in cranial direction in the late diastolic phase. The CSF flow disappeared at the dorsal ROI at the level of C2-3 in 3 patients and 1 volunteer, and at the level of C5-6 in 6 patients and 3 volunteers. The durations of CSF circulation at all the ROIs were significantly shorter in the patients than those in the healthy volunteers （P=-0.014 at the midbrain aqueduct, P=-0.019 at the inferior margin of the cerebellar tonsil, P=-0.014 at the level of C2-3, and P=-0.022 at the level of C5-6）. No significant difference existed between the two groups in the initial point and duration of the caudal-directed CSF flow during a cardiac cycle at all the ROIs. The maximum velocities of both cranial- and caudal-directed CSF flows were significantly higher in the patients than those in the volunteers at the aqueduct （P=-0.018 and P=-0.007） and ventral ROI at the inferior margin of the cerebellar tonsil （P〈0.001 and P=-0.002）, as so did the maximum velocities of the caudal-directed flow in the ventral and dorsal ROIs at the level of C2-3 （P=-0.004; P=-0.007）. Conclusions The direction of CSF flow changes in accordance with cardiac cycle. The syringomyelia in patients with CMI may be due to the decreased circulation time and abnormal dynamics of the CSF in the upper cervical segment. The decompression of the foramen magnum with dural plasty is an alternative for patients with CMI associated with SM.
