颈髓髓内肿瘤显微手术治疗32例

目的 总结颈髓髓内肿瘤显微外科手术治疗的临床经验.方法 回顾性分析应用显微外科手术切除的32例颈髓髓内肿瘤的临床资料.显微镜下分离蛛网膜,于脊髓最薄弱处或后正中沟锐性切开,肿瘤与脊髓之间有可区分界面者,从肿瘤上、下极锐性分离,整块切除肿瘤;肿瘤与脊髓之间无可区分界面者,瘤内分块部分切除病变.结果 32例颈髓髓内肿瘤中,星形细胞瘤18例,肿瘤全切除3例,次全切除11例,部分切除或活检4例;髓内室管膜瘤13例,肿瘤全切除9例,次全切除4例;血管网织细胞瘤1例,仅行减压.术后无并发症发生.结论 应用显微外科手术切除可提高颈髓髓内肿瘤治疗效果和降低并发症的发生.     

脊髓室管膜瘤的诊断与治疗

目的：探讨脊髓髓内室管膜瘤的诊断和治疗方法。方法：总结分析16例脊髓髓内室管膜瘤患者的MRI表现特点,应用显微外科手术治疗,评价手术前,后神经功能状态。结果：肿瘤位于颈髓（包括颈延髓）7例,颈胸髓5例,胸髓1例,圆锥3例,肿瘤长度2．5－18cm,肿瘤一端或两端有囊肿者14例,11例合并脊髓空洞,手术全切除15次,次全切除1例,无手术死亡,随访6－38个月未见肿瘤复发,2例术前McComick分级IV级者术后神经功能无恢复。结论：MRI是诊断脊髓室管膜瘤的可靠方法,早期显微外科全切除是治疗髓内室管膜瘤有效的措施,术前神经功能状态与预后有密切关系。     

脊髓髓内肿瘤的外科思考和手术技术

目的：总结脊髓髓内肿瘤显微外科手术切除的经验。方法：回顾性分析37例髓内肿瘤病例资料，其中星形细胞瘤19例，室管膜瘤17例，血管母细胞瘤1例。所有患者均行后正中入路肿瘤切除术。结果：除5例星形细胞瘤行次全切或活检外，其余肿瘤均在显微镜下全切。术后随访3个月，症状改善者24例，无变化者8例，加重者5例。结论：外科手术是多数髓内肿瘤最有效的单一治疗。几乎所有的室管膜瘤和多数星形细胞瘤均可单用显微外科于术切除获得远期控制或治愈。应强调早期诊断和积极的初次全切手术。手术成功的最关键技术是辨清和拓展肿瘤与脊髓之间的界面。     

脊髓血管母细胞瘤的诊断与手术治疗

目的总结脊髓血管母细胞瘤的诊断和手术治疗经验，探讨其诊断治疗方法。方法回顾性分析近10年来显微外科手术治疗12例脊髓血管母细胞瘤的临床资料。结果12例脊髓血管母细胞瘤MRI均表现为边界清楚的、增强后明显均匀强化的脊髓内占位。DSA表现为富血供肿瘤染色影。12例患者均经手术全切除病变，病理学诊断为血管母细胞瘤；术后运动及感觉障碍改善7例，无变化3例，即刻加重1个月内恢复2例；无手术死亡病例。随访6—60个月，无一例复发。结论脊髓血管母细胞瘤手术治疗效果好，有症状者应早期手术治疗。     

脊髓髓内血管母细胞瘤的显微手术治疗

目的 探讨脊髓髓内血管母细胞瘤的临床特点和显微手术体会. 方法 回顾性分析2000年1月至2011年7月经显微外科手术切除的脊髓髓内血管母细胞瘤16例,占同期脊髓内肿瘤(184例)的8.7％,占中枢神经系统血管母细胞瘤(99例)的16.2％.手术均在手术显微镜下进行,所有手术病例均获目的肿瘤全切除,并均经病理确诊为血管母细胞瘤.术前、术后及随访均采用McCormick分级评估脊髓功能和完善MRI检查进行评价. 结果 本组16例,术后神经功能改善11例(68.7％)、无明显变化4例(25.0％)、恶化1例(6.3％),无手术死亡病例.随访6个月～10年,脊髓功能继续改善13例(81.3％),无明显变化3例(18.7％),未见肿瘤复发. 结论 脊髓髓内血管母细胞瘤好发于中年男性,男女比例约3∶1,颈段脊髓多见,首发症状麻木、疼痛多见;显微外科手术切除是最有效的治疗方法.     

显微手术治疗脊髓髓内肿瘤22例

目的 报道应用显微外科手术切除脊髓髓内肿瘤的临床疗效。方法 对22例脊髓髓内肿瘤施行显微手术治疗。采用McCormick临床神经功能分级方法及MRI检查，对患者术前、术后神经功能改变，以及肿瘤切除情况进行评估分析。结果 肿瘤全切除16例，次全切除切除5例，部分切除1例。术后临床神经功能改善8例，保留术前神经功能9例，术后神经功能变差5例。结论 显微外科能提高手术切除脊髓髓内肿瘤的临床疗效，改善患者症状；对髓内室管膜瘤及良性肿瘤全切除效果良好。     

高位颈段椎管内肿瘤的手术治疗

目的总结治疗高位颈段椎管内肿瘤的经验。方法回顾性分析16例经手术治疗的高位颈段椎管内肿瘤的临床症状和体征、病理类型及手术治疗的方法和疗效。结果本组病例髓外硬膜下肿瘤占75％,髓内肿瘤占25％。肿瘤全切除率87．5％,其中髓外肿瘤全切除率达100％,髓内肿瘤全切除率50％。术后症状改善、恢复满意14例,Frankel分级提升1～2级,1例症状无变化,1例症状加重,本组无死亡病例。结论高位颈段椎管内肿瘤手术全切除后预后良好,MRI检查是椎管内肿瘤的首选检查方法,枕颈结合部内固定器有效地重建脊柱稳定性,显微外科技术的应用提高了高位颈段椎管内肿瘤的全切除率,减少了神经损伤并发症。     

儿童髓母细胞瘤的显微外科手术治疗42例临床分析

目的 报道儿童髓母细胞瘤的临床特点及显微外科手术治疗的临床疗效. 方法 回顾性分析儿童髓母细胞瘤经显微手术治疗42例的临床和随访资料,对显微外科手术技巧进行总结,并对临床疗效进行分析. 结果 肿瘤全切除34例,近全切除7例,部分切除1例,无手术死亡.术后随访时间3～84个月,平均随访时间为26个月.术后2年内肿瘤复发14例,中枢神经系统种植转移5例,术后2年生存率61.9%,术后5年生存率42.9%. 结论 对儿童髓母细胞瘤应用显微外科手术进行肿瘤全切除和术后全中枢轴放疗可获较好的临床疗效.     

脊髓血管母细胞瘤的MRI特点

【摘要】〓目的〓分析探讨脊髓血管母细胞瘤的MRI表现特征。方法〓回顾性分析经手术病理证实的7例脊髓血管母细胞瘤的临床及MRI表现。全部患者均行MRI平扫及增强扫描。结果〓单发6例,多发1例,共有脊髓血管母细胞瘤病灶8个,所有病灶均位于髓内。其中,延髓1个,颈段4个,胸段2个,腰段1个。肿瘤多呈点状、结节状、香肠状或不规则形状,肿瘤在MRI T1WI呈等或稍低信号,T2WI呈稍高信号,增强扫描上下径<20 mm的病灶呈明显、均匀强化,上下径>20 mm的病灶呈明显不均匀强化,其内可见多发流空的血管影;7例患者均伴有不同程度脊髓空洞或水肿。结论〓脊髓血管母细胞在MRI中具有特征性的影像表现,MRI对诊断脊髓血管母细胞瘤具有重要价值。     

显微手术治疗枕骨大孔区肿瘤28例

目的 探讨枕骨大孔区肿瘤的显微外科手术治疗的临床疗效.方法 根据肿瘤特点,选择正确手术入路.采用枕下后正中入路24例,采用改良的枕颈侧入路4例;在高倍手术显微镜下锐性分离,分辨并保护好重要的血管和神经.瘤内分块切除,减容减压后,牵拉显露被颈髓或延髓遮挡肿瘤部分,逐步切除,尽可能避免牵拉已受压迫的延髓、颈髓和重要的血管神经;肿瘤难以切除或与延髓、上颈髓粘连严重部分,不能强求全部切除.结果 28例中全部切除肿瘤21例(75%),次全切除5例(18%),未能切除2例(7%),只行减压术.术后症状消失11例,症状改善13例,无改善和加重4例.结论 选择合理的手术入路和显微外科技术是切除枕骨大孔区肿瘤获得良好临床效果的重要方法.     

脊髓血管母细胞瘤的诊断与治疗

目的 :探讨脊髓血管母细胞瘤的诊断与治疗方法。方法 :分析 30例脊髓血管母细胞瘤的MRI、DSA的影像学特点 ,总结栓塞、手术的操作技巧和治疗结果。结果 :脊髓血管母细胞瘤MRI表现为边界清楚的实性占位、增强后明显均匀强化。DSA表现为边界清楚、圆形、椭圆形高密度影 ,有明确供血动脉。直接手术 1 2例 ;栓塞后手术 1 8例。术后功能恢复正常 2 2例 ;生活自理 3例 ;需他人照顾 5例。全切除 2 5例 ;次全切除 5例。结论 :栓塞可以降低血管母细胞瘤的血液供应 ,提高治愈率 ,扩大手术适应证     

Hemorrhagic intramedullary hemangioblastoma of the cervical spinal cord presenting with acute-onset quadriparesis: Case report and review of the literature

Context

Hemangioblastomas of the spinal cord are uncommon vascular tumors. Patients commonly present with subtle neurologic findings that are thought to represent growth of the lesion over time. Hemorrhage of an intramedullary hemangioblastoma presenting as acute neurologic deficit is an extremely rare occurrence. Although the cervical spine is the most common location for hemangioblastoma of the spinal cord, there have been no previously published cases in the literature of intramedullary hemorrhage from such a lesion.

Findings

A 22-year-old woman with a previously undiagnosed spinal cord hemangioblastoma presented with sudden-onset dense quadriparesis due to intramedullary hemorrhage in the cervical spinal cord. The patient did not have any clinical findings of von-Hippel Lindau disease. Laminoplasty from C5 to T2 and posterior midline myelotomy for resection of the intramedullary tumor with hematoma evacuation were completed without complication.

Conclusion

Intramedullary hemangioblastoma of the spinal cord is uncommon, and hemorrhage from a cervical spinal cord lesion has not previously been reported. Symptoms from these usually indolent lesions are commonly associated with tumor growth, edema, or associated syrinx, whereas devastating acute neurologic deficit from hemorrhage is exceedingly rare. Microsurgical resection should be done in cases of symptomatic lesions and considered in isolated symptomatic lesions without the known diagnosis of von Hippel-Lindau disease.     

Diagnosis and surgical treatment of spinal hemangioblastoma

Spinal hemangioblastoma is a rare tumor. Its incidence varies from 1.6 to 2.1% of primary spinal cord tumors. In this report, the authors described MRI (magnetic resonance imaging) of spinal hemangioblastoma and its surgical results. [MATERIALS AND METHODS] This series included 10 spinal hemangioblastomas studied with CT or MRI. There were 8 men and 2 women. The age ranged from 21 to 68 years, with a mean age of 45 years. 6 patients were preoperatively and postoperatively studied with a resistive 0.15 T system (Toshiba MRT 15A) or a superconductive 1.5 T system (GE Signa or Siemens Magnetom). The lesions were single in 8 out of 10 patients and multiple in 2. 10 spinal hemangioblastomas were located in intramedullary space and 2 in both intramedullary and extramedullary space. 8 out of 10 patients (80%) were associated with cyst. [RESULTS] (1) MRI In T1-weighted MR images after administration of Gd-DTPA, the solid component of the tumor enhanced brilliantly. The enhanced lesions contained serpiginous areas of signal void, reflecting vascular structures in 5 out of 6 cases. The intrinsic spinal cord signal was heterogenous with low intensity areas representing the associated cyst. The cyst appeared either isointensive to cerebrospinal fluid (CSF) or hyperintense relative to CSF and slightly hypointense relative to the spinal cord. The precise delineation of the tumor was impossible without enhancement. Noncontrast T1-weighted MR images displayed diffuse widening of the spinal cord. On T2-weighted MR images, all regions of the spinal cord enlargement increased in signal. (2) Postoperative results All 10 cases of spinal hemangioblastomas were totally removed with good postoperative results and the associated cysts were drained. The postoperative MRI showed the disappearance of the tumor and significant reduction in the size of the cyst. [CONCLUSION] (1) Gd-DTPA enhanced MRI was useful in defining and outlining the solid component of spinal hemangioblastoma. (2) The complete removal of the tumor with only drainage of the cyst was possible with good postoperative results.     

多节段颈髓室管膜瘤的手术治疗

目的探讨多节段颈髓室管膜瘤显微外科手术治疗可能性和疗效。方法回顾性分析1990年10月至2006年10月,我们治疗的26例多节段颈髓室管膜瘤的临床资料、影像学特点、手术中、术后注意要点。结果肿瘤完全在颈髓内14例、主要位于颈髓累及胸髓者12例,平均累及4．5个节段。双下肢不完全截瘫18例,不完全高位截瘫8例,呼吸困难6例,括约肌功能障碍10例。MRI显示脊髓空洞形成24例。20例采用椎板复位固定,6例未采用,其中1例为二次手术无法复位固定者。术后患者肌力恢复21例,无改变4例,1例手术后临床症状较术前加重。术后呼吸困难1例。MRI均未见术后肿瘤残留,1例未固定者脊柱不稳定。结论显微外科手术可以全切除多节段颈髓室管膜瘤,术后患者症状多有明显改善;手术后应进行椎板复位固定以保持脊柱稳定性,提高患者生活质量。     

颈段椎管内肿瘤的显微手术治疗

目的 报道颈段椎管内肿瘤显微手术的临床疗效. 方法 颈段椎管内肿瘤32例,均采用后正中入路显微手术,术后22例进行颈椎稳定性重建.结果 肿瘤全切26例,占81.25%,肿瘤大部分切除6例(包括3例星形细胞瘤,3例包裹并紧密粘连椎动脉的哑铃形神经鞘瘤),占18.75%.按George的方法 评估,恢复良好23例(71.88%),症状改善6例(18.75%),无明显改善3例(9.38%),无手术死亡.30例随访3个月～3年.26例术后3个月MR检查未见肿瘤残存或复发,1例神经鞘瘤维持术后大小未增大,3例星形细胞瘤复发.术后X线检查其中4例出现颈椎不稳,26例稳定性良好. 结论 早期显微手术是颈段椎管内肿瘤的关键治疗手段,术后重建椎管的稳定性对患者的远期恢复意义重大.     

显微手术切除及椎管固定融合治疗高颈段椎管哑铃型肿瘤

目的探讨显微手术切除高颈段椎管哑铃型肿瘤及椎管固定融合的方法及效果。方法回顾性分析11例高颈段椎管哑铃型肿瘤患者的临床资料,其中ToyamaⅡ型6例,Ⅲ型4例,Ⅴ型1例。均行显微手术切除,其中远外侧入路3例,颈后正中入路8例。同时行椎管固定融合6例。结果本组全切10例,次全切除1例。术后病理学诊断为神经纤维瘤9例,脊膜瘤2例。术后症状明显改善9例,改善2例,无感染及死亡病例。随访10例,平均时间27个月（3个月～3年）,患者的症状和神经功能均有不同程度的改善,无颈椎不稳及后凸畸形。结论高颈段椎管哑铃型肿瘤显微手术切除并椎管固定融合能明显改善症状,安全性好,并发症少。     

Intramedullary hemangioblastomas: timing of surgery,microsurgical technique and follow-up in 23 patients

Hemangioblastomas are highly vascularised tumors of the central nervous system and account for 1.5–2.5% of all spinal cord tumors. Because of the rarity of these tumors, surgical experience is often limited and, therefore, treatment and indications for timing of surgery are discussed controversial. The authors reviewed their data of 23 consecutive patients with respect to timing of surgery, microsurgical technique, and follow-up. Clinical records of 23 consecutive patients with intramedullary hemangioblastomas who underwent first surgery in our department between 1990 and 2005 were reviewed. In three cases the tumors were localised at the craniocervical junction; four patients had a single tumor in the cervical spine, six patients multiple tumors in the cervical and thoracic spine, eight patients in the thoracic spine only, one patient in the conus region, and one patient had multiple tumors located in the thoracic and lumbar spine. In eight patients, a von-Hippel-Lindau disease (VHL) was associated. The neurological follow-up was evaluated according to the classification of McCormick. Operation was recommended to every symptomatic patient as early as possible. In asymptomatic patients with a sporadic tumor surgery was discussed for diagnostic purposes at any time. In VHL patients, surgery was recommended if tumor growth was observed on MRI in the next practicable time. All tumors were diagnosed by magnetic resonance imaging and in all cases but one a DSA was performed. All patients were treated microsurgically through a posterior approach. The tumors in the spinal cord were removed microsurgically through a partial hemilaminectomy (n = 1), a hemilaminectomy (n = 15), or laminectomy (n = 4) and at the craniocervical junction (n = 3) through a suboccipital craniotomy. During follow-up after 6 months, 18 patients remained neurologically stable (17 in McCormick grade I and 1 in McCormick grade II) and 5 patients recovered to a better status (3 from grade III to II, 2 from grade II to I). There was one complication with a CSF fistula and one recurrence/incomplete removal. Following the above-mentioned principles of microsurgical removal of intramedullary hemangioblastomas, operation is possible with a low procedure-related morbidity and can be recommended especially in VHL patients with progressive symptoms or tumor growth during follow-up. Patients without VHL most frequently require hemangioblastoma resection for diagnostic purposes and/or because symptoms prompted an imaging work-up that lead to the discovery of the tumor.     

Differentiation of localization of spinal hemangioblastomas based on imaging and pathological findings

Intramedullary + extramedullary hemangioblastomas with largely extramedullary growth are rare and often incorrectly assigned as intradural-extramedullary tumors preoperatively. Preoperative evaluation of the precise tumor location is important for total resection of tumor and improving the surgical outcome. The aim of this study was to provide the first identification of the key differences among of preoperative MR images of hemangioblastomas in different locations and to correlate these with pathological findings. The subjects were 26 patients with surgery for spinal hemangioblastoma in our department, including 6 with an intramedullary tumor who were complicated with von Hippel Lindau disease. Intramedullary, intramedullary + extramedullary, and intradural-extramedullary tumors were present in 22, 3 and 1 cases, respectively. Sagittal MR images showed that intramedullary and intramedullary + extramedullary tumors gave intramedullary T2 high intensity areas (HIAs) spreading toward the craniocaudal sides of the tumor, whereas such findings were absent for the intradural-extramedullary tumor. All the tumors showed strong contrast on axial images, with focal enhancement of hemangioblastomas limited to the intramedullary region (focal type); smooth boundary lines between the spinal cord and the extramedullary tumor (smooth type); and a snowman sign for intramedullary + extramedullary tumors, which provided a key characteristic for differentiating intramedullary + extramedullary tumors from those limited to the extramedullary region. In pathological findings, the Ki67 activity was less than 1% for intramedullary and intradural-extramedullary tumors, but 18–25% in all cases with an intramedullary + extramedullary tumor. In conclusion, on preoperative MRI, a change in the intramedullary HIAs spreading the craniocaudal sides of the tumor on sagittal T2 weighted image (T2WI) and a snowman sign on contrast axial T1WI may be important for differentiation among spinal hemangioblastomas in different locations. Pathologically, we found that intramedullary + extramedullary hemangioblastoma has high cell proliferative activity, which may suggest that enlargement of this tumor occurs faster than that of intramedullary hemangioblastoma.     

Unusual spinal cord enlargement related to intramedullary hemangioblastoma

In a series of 60 intramedullary spinal cord tumors, there were eight cases of hemangioblastoma. Seven of these eight patients displayed evidence of diffuse spinal cord enlargement over multiple levels at a considerable range beyond the actual location of the tumor. One patient had a large intramedullary cyst that accounted for only part of the enlargement, and one had multiple tumor nodules. Six other patients had no obvious explanation for the diffuse cord enlargement. This phenomenon of extensive spinal cord enlargement appears to be unique to this type of tumor and not related to multiple tumors or extensive cyst formation. The cord enlargement seems to be related to edema and congestion of the spinal cord, perhaps secondary to the vascular shunt present in the hemangioblastomas. The possible pathophysiology and clinical importance of this observation is discussed.     

无骨折、脱位的颈脊髓损伤

通过对176例外伤性颈脊髓损伤中24例无骨折、脱位病例的回顾分析,认为MRI对不伴骨折或脱位的颈髓损伤的诊断是目前较可靠手段。提出这些病例可分为脊髓压迫型和无脊髓压迫型。治疗上前者以前路减压为佳,而脊髓内外联合减压术对阻止后者神经损害的进展有帮助。早期诊断,尽早制动,牵引乃至手术十分必要。