MRI和CTA术前评估枕骨大孔区肿瘤的价值

目的 探讨MRI和CTA在枕骨大孔区肿瘤患者术前评估中的应用价值。方法 回顾性分析32例经手术病理证实为枕骨大孔区肿瘤的临床资料及影像学表现，评估肿瘤的部位、范围及与周围重要结构的关系，并与术中结果进行比较。结果 32例枕骨大孔区肿瘤中，良性29例，其中血管母细胞瘤4例，室管膜瘤3例，毛细胞型星形细胞瘤2例，脑膜瘤13例，神经鞘瘤5例，脂肪瘤1例，表皮样囊肿1例；恶性3例，其中软骨瘤样脊索瘤1例，黑色素瘤1例，转移瘤1例。位于髓内9例，髓外23例（腹侧5例、腹外侧7例、背侧11例）。MRI诊断准确率为93.75%（30/32），且对肿瘤范围的评估与手术所见一致。CTA对血管评估与术中所见符合率为100%。结论 MRI和CTA能在术前准确评估枕骨大孔区肿瘤的部位及范围，明确病变与邻近组织及血管的关系，为临床选择手术入路、确定切除范围及处理重要血管提供依据。

Value of MRI and CTA in preoperative assessment of tumors in foramen magnum region

Objective To explore the clinical value of MRI and CTA in the preoperative assessment of tumors in the foramen magnum region. Methods Clinical and imaging data of 32 patients with foramen magnum region tumors confirmed by surgical pathology were retrospectively analyzed. Tumor location, extent and the relationship of the tumor and surrounding important structures were assessed and compared with surgical findings. Results Among 32 patients with foramen magnum region tumors, there were 29 cases of benign tumors, including 4 cases of angioblastomas, 3 cases of ependymoma, 2 cases of hairy cell astrocytoma, 13 cases of meningioma, 5 cases of schwannoma, 1 case of lipoma and 1 case of epidermoid cyst; there were 3 cases of malignant tumor, including 1 case of chondromatoid chordoma, 1 case of melanoma and 1 case of metastasis. Nine tumors located in intramedullary, 23 in extramedullary, including ventral in 5 cases, ventrolateral in 7 cases, dorsal in 11 cases. The diagnostic accuracy of MRI was 93.75% (30/32), and the evaluation of tumor scope was consistent with that of surgery. The coincidence rate of CTA in evaluation on supplying artery with intraoperative findings was 100%. Conclusion MRI and CTA play an important role in evaluating the location and extension of tumors in the foramen magnum region, as well as the relationship with adjacent tissue and vessels, which is useful for determining the surgical approach, the extent of tumor resection and management of the surrounding vessels in clinical routine.