显微外科手术治疗脊髓髓内肿瘤21例分析

目的探讨显微神经外科手术切除脊髓髓内肿瘤的方法、技巧和疗效。方法回顾分析经显微外科手术治疗的21例脊髓髓内肿瘤患者的临床资料。7例部分切除,14例镜下全切除,术中有20例应用术中神经电生理监测。结果病理类型为室管膜瘤11例,星形细胞瘤7例,畸胎瘤、血管网状细胞瘤多发性原始神经外胚叶肿瘤各1例。患者平均随访时间42.8个月,随访期内1例肿瘤复发并死亡。术后神经功能障碍情况：16例较术前不同程度缓解,3例无变化,1例加重。结论术中针对不同肿瘤采用不同手术策略和技巧、应用术中神经电生理监测是保证疗效、减少并发症的关键。     

颈髓髓内肿瘤的显微外科治疗

目的 探讨颈髓髓内肿瘤的临床特征、手术时机和手术技巧。方法 回顾性分析21例颈髓髓内肿瘤的病理类型、临床表现、手术切除程度及临床疗效。结果肿瘤镜下全切除14例（室管膜瘤8例、星形细胞瘤3例、血管母细胞瘤3例）,次全切除5例（室管膜瘤2例、星形细胞瘤3例）,部分切除或活检2例（均为星彤细胞瘤）。1例死于术后呼吸功能障碍。术后随访3个月-5年,平均25个月,神经系统症状好转13例,无改善3例,加重1例,失访3例。结论 绝大多数颈髓髓内肿瘤可通过显微外科手术切除,对恶性肿瘤及未全切除的肿瘤应辅以放射治疗。     

脊髓髓内肿瘤的外科治疗

目的　本研究根据我科治疗脊髓髓内肿瘤的经验, 对其疗效进行评估。方法　对我科经手术治疗的７１ 例脊髓髓内肿瘤进行回顾性研究, 对肿瘤病理类型、肿瘤部位、临床症状及体征、辅助检查、手术切除程度、临床疗效进行分析。结果　本组室管膜瘤占３９４ ％ , 星形细胞瘤占２９６ ％ , 脂肪瘤占１２７ ％ , 血管母细胞瘤占９９ ％ , 全组手术全切除率为６２ ％ , 而室管膜瘤可达９２９ ％ , 近全切除率为１９７ ％ , 部分切除或活检率为１８３ ％ , 手术死亡率为２８ ％ 。结论　对绝大多数脊髓髓内肿瘤应早期诊断早期手术治疗, 如室管膜瘤等多能做到肿瘤全切除, 对恶性肿瘤或切除不完全者应行放射治疗     

脊髓髓内肿瘤显微手术疗效的长期随访

目的：总结脊髓髓内肿瘤的手术经验，对手术治疗脊髓髓内肿瘤的价值及疗效进行评价。方法：对两个神经外科中心手术治疗的123例脊髓髓内肿瘤进行回顾性分析，对肿瘤部位、病理类型、手术切除程度、手术 前后临床症状与体征的变化，进行长期随访，以评估手术疗效。结果：本组室管膜瘤占脊髓髓内肿瘤的34．1％，手术全切除率为90．5％，次全切除率为7．1％，部分切除及活检率为2．4％；星形细胞瘤占26．8％，全切除率为30．3％，次全切除率为39．4％，部分切除及活检率为30．3％；脂肪瘤占14．6％，全切除率为11．1％，次全切除率为38．9％，部分切除或活检率为50．0％；血管网状细胞瘤占10．6％，全切除率为76．9％，次全切除率为23．1％；其它肿瘤占13．9％，全切除率为82．4％，次全切除率为11．7％，部分切除及活检占5．9％。94例经平均38．6个月长期随访，89例存活，5例死亡。结论：脊髓髓内肿瘤以良性及低恶性度肿瘤多见，早期手术预后较好，应力争在脊髓功能未出现严重损害前手术，以争取得到较好的手术疗效。     

高颈髓髓内肿瘤显微外科治疗分析

目的 探讨显微神经外科手术治疗高颈髓髓内肿瘤的方法及临床疗效.方法 回顾分析我院显微外科手术切除15例高颈髓髓内肿瘤的临床资料.其中达到镜下全切除9例,次全切除3例,部分切除或活检3例.结果 术后病理显示:室管膜瘤8例,星形细胞瘤5例,血管母细胞瘤2例.平均随访25个月,症状好转13例,无变化1例,1例症状加重.结论 对脊髓髓内病变应早期诊断,显微手术治疗高颈髓髓内肿瘤可取得较好疗效.     

脊髓血管网状细胞瘤的诊断及显微外科治疗

目的探讨脊髓血管网状细胞瘤的诊断方法和显微外科手术治疗技巧与疗效。方法分析25例脊髓血管网状细胞瘤患者的临床资料、影像学特点及显微外科治疗方法及效果。结果根据术前MRI及DSA影像学确诊,均在手术过程中应用荧光造影,显微镜下全切肿瘤。术后神经症状明显改善21例,无变化3例,1例加重(1w后恢复),无死亡病例。结论 MRI对脊髓血管网状细胞瘤有重要诊断意义,脊髓血管造影能帮助明确诊断,同时确定肿瘤供血动脉;显微外科手术是治疗脊髓血管网状细胞瘤的最有效的方法;术中荧光造影可以明确肿瘤供血动脉及引流静脉,判断手术切除范围,减少术中出血及防止脊髓肿胀,提高手术成功率。     

脊髓髓内星形细胞瘤的显微外科治疗

目的总结脊髓髓内星形细胞瘤的手术经验。方法回顾性分析59例脊髓髓内星形细胞瘤的临床资料,包括影像特征、手术技术、术中电生理监护、病理类型、术后并发症、疗效预后等。均行显微手术,术后辅以放疗。采用McCormick分级和MRI影像评估手术疗效。结果肿瘤全切除8例,近全切除26例,部分切除14例,活检11例。随访3个月~2年,术后近期临床神经功能改善32例,无变化23例,加重4例。肿瘤复发13例,其中胶质母细胞瘤11例,间变型星形细胞瘤2例。结论有明确边界的低级别星形细胞瘤首选显微手术治疗,尽可能全切除肿瘤;为保留脊髓功能,对边界不清的高度恶性胶质瘤可行部分切除或活检,以明确诊断和减压为原则。     

脊髓髓内肿瘤的显微手术治疗

目的介绍脊髓髓内肿瘤的显微手术治疗经验。方法显微手术治疗脊髓髓内肿瘤40例,随访术后神经功能状态,并对髓内肿瘤显微手术治疗的手术时机、手术技巧、脊柱稳定性及术后是否放疗等问题进行探讨。结果肿瘤全切除率75%,其中室管膜瘤全切除率94.8%,星形细胞瘤全切除率14%。出院时神经功能障碍加重14例,改善或稳定26例。结论及时采用显微外科技术切除肿瘤是提高脊髓髓内肿瘤病人生存质量的主要治疗手段。     

显微手术治疗脊髓髓内肿瘤

目的探讨显微手术治疗脊髓髓内肿瘤的效果。方法我科2002年至2006年采用显微手术治疗脊髓髓内肿瘤15例,其中室管膜瘤8例,星形细胞瘤5例,海绵状血管瘤2例。结果肿瘤全切除11例,大部分切除4例(均为星形细胞瘤)。出院时10例症状有不同程度改善,4例无变化,1例术后加重,无手术死亡病例。结论把握适当的手术时机,结合术前影像学检查结果,术中在显微镜下仔细分辨肿瘤与脊髓的分界面,这些都将有助于提高显微手术治疗脊髓髓内肿瘤的临床疗效。     

脊髓髓内肿瘤显微外科治疗

目的 总结并探讨脊髓髓内肿瘤显微外科手术的治疗经验。方法 统计近3年来显微外科手术治疗18例髓内肿瘤的临床资料、手术方式及术后转归。结果 手术全切17例,大部分切除1例;病理学诊断室管膜瘤8例,星形细胞瘤6例,血管母细胞瘤3例,血管畸形1例;术后运动及感觉障碍改善14例,不明显3例,加重1例;随访共16例,未见1例复发。结论 髓内肿瘤一旦诊断应早期手术治疗。脊髓髓内肿瘤应强调显微手术镜下操作,这不仅使病变与正常脊髓更易辨清,同时使操作更为细致轻柔。仔细辨认肿瘤与脊髓界限,对全切肿瘤和保护脊髓是有帮助的。对于肿瘤与脊髓有较清楚界限时应争取显微镜下全切,但当肿瘤侵蚀已至软膜下区时,此时不能盲目追求全切,以避免永久性功能障碍。     

Pediatric intramedullary spinal cord tumors Critical review of the literature

The objective of this review was to analyze the literature on the management of intramedullary spinal cord tumors to determine whether enough information was available for treatment guidelines to be established. Using standard computerized search techniques, databases containing medical literature were queried for keywords related to intramedullary spinal cord tumors, beginning in 1966. Of the 445 articles published in English and with potential relevance, only 75 articles were included in the final analyses. Based on the strength of their recommendations for the treatment of this controversial condition, articles were divided into class I, class II and class III data. There were no class I studies related to any aspect of the treatment of intramedullary spinal cord tumors. Based on this critical review of literature, gross total removal of an ependymoma confirmed by immediate postoperative magnetic resonance imaging and adjunctive treatment for high-grade tumors using radiotherapy, with or without chemotherapy, can be recommended as standards of therapy. With the strength of a guideline, radiotherapy should be withheld after gross total removal of intramedullary ependymomas and radical resection of low-grade intramedullary astrocytomas. The use of intraoperative ultrasonography and evoked potentials, important surgical adjuncts, can also be considered guidelines. The radical resection of intramedullary low-grade astrocytomas is an option. Received: 15 October 1998     

显微手术治疗颈段髓内肿瘤10例

目的:报道应用显微外科手术切除颈段髓内肿瘤的临床疗效。方法:对10例颈段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7例,次全切除2例,部分切除1例。术后临床神经功能改善6例,保留术前神经功能3例,术后神经功能变差1例;术后无死亡病例及手术致残者。结论:显微外科能提高手术切除颈段髓内肿瘤的临床疗效,改善患者症状。     

Thoracic exophytic ependymoma masquerading as a benign extra-axial tumor

Spinal tumors are conventionally differentiated based on location in relation to the spinal cord. Benign spinal tumors such as schwannomas and meningiomas are typically extra-axial (intradural extramedullary) lesions, whereas more aggressive primary spinal tumors such as ependymomas are typically intramedullary masses. Rarely, ependymomas can have both intramedullary and extramedullary components (typically referred to as exophytic ependymomas). We report a case of a spinal exophytic ependymoma that radiographically masqueraded as a benign intradural extramedullary lesion causing cord compression and neurologic deficit in a 47-year-old man. The diagnosis of exophytic ependymoma was made intra-operatively, with resultant gross total resection of the extramedullary portion and subtotal resection of the intramedullary portion. Histopathological examination confirmed ependymoma with World Health Organization grade II/IV. Pre-operative suspicion of an exophytic ependymoma influences operative planning and clinical management. We review the literature and discuss clinical management strategies for these interesting spinal tumors.     

脊髓室管膜瘤的显微外科治疗

目的探讨脊髓室管膜瘤显微外科治疗中的相关问题。方法回顾性分析22例脊髓室管膜瘤患者的临床资料。结果22例脊髓室管膜瘤中，肿瘤主体位于颈段12例，胸段7例，腰段3例。其中15例在肿瘤头端和，或尾端合并有脊髓空洞，囊性空洞呈分隔状5例，2例瘤体内有囊变。肿瘤全切15例，次全切除7例。根据治疗前后神经功能综合评价，好转14例，稳定7例，加重1例。结论对脊髓室管膜瘤应行积极的显微外科手术治疗，肿瘤能否全切与瘤体大小无明显关系，主要取决于肿瘤与脊髓的粘连程度；手术不能全切者术后辅以局部放疗可获得良好的疗效。     

A child with spinal intramedullary abscess

CASE REPORT: We report a case of an intramedullary spinal cord abscess (ISCA) in a 14-month-old child. This case demonstrates clinical and radiological features and emphasizes the importance of early diagnosis and treatment. Early surgical intervention and adjuvant antibiotic therapy have been shown to improve the clinical outcome. Successful outcome depends on early diagnosis and aggressive management. DISCUSSION: Spinal intramedullary abscess is a rare neurosurgical entity. They can hardly be distinguished from neoplasms. Hart described the first case in 1830. Since then, approximately 70 cases have been reported. An acute spinal intramedullary abscess may present as a cord syndrome with back pain and fever, contrasting with chronic spinal intramedullary abscess, which tends to have a less specific symptomatology.     

颈段髓内肿瘤的显微手术方法及疗效评价

目的 探讨应用显微外科手术切除颈段髓内肿瘤的手术技巧及临床疗效.方法 徐州医学院附属连云港医院神经外科自2006年1月至2008年12月对收治入院的11例颈段髓内肿瘤施行显微手术治疗,回顾性分析所有患者的临床特征、影像学表现、诊断、肿瘤切除情况以及术前术后神经功能改变.结果 本组患者肿瘤全切除8例,次全切除3例;术后临床神经功能改善7例,保留术前神经功能3例,术后神经功能加重1例;术后无死亡病例.结论 正确的手术方法和熟练的显微手术技巧是提高颈段髓内肿瘤的手术疗效的基础,采用显微外科手术切除肿瘤可获得较好的疗效.     

Targeting hyaluronan interactions in spinal cord astrocytomas and diffuse pontine gliomas

Although significant advances have been made in treating malignant pediatric central nervous system tumors such as medulloblastoma, no effective therapy exists for diffuse pontine glioma or intramedullary spinal astrocytoma. Biology of these 2 tumors is poorly understood, in part because diffuse pontine gliomas are not treated surgically, and tumor specimens from intramedullary spinal astrocytomas are rare and minuscule. At the 2007 Neurobiology of Disease in Children Symposium, we presented evidence that malignant glioma behaviors, including antiapoptosis, invasiveness, and treatment resistance, are enhanced by hyaluronan, an extracellular glycosaminoglycan. We review the clinical course of pediatric intramedullary spinal astrocytoma and diffuse pontine glioma, and show expression of membrane proteins that interact with hyaluronan: CD44, extracellular matrix metalloproteinase inducer, and breast cancer resistance protein (BCRP/ABCG2). Furthermore, we describe novel animal models of these tumors for preclinical studies. These findings suggest that hyaluronan antagonism has potential therapeutic value in malignant central nervous system tumors.