多节段脊髓室管膜瘤的显微外科治疗

目的 探讨多节段脊髓室管膜瘤的手术技术和手术治疗疗效。方法 本文回顾分析了2003年至2005年治疗的10例多节段脊髓室管膜瘤的临床资料。结果 颈髓室管膜瘤6例，胸髓室管膜瘤3例，1例术后复发肿瘤累及胸、腰髓并累及椎旁。平均累及脊髓9．4个节段。双下肢截瘫4例，高位截瘫6例，括约肌功能障碍5例，呼吸困难4例。MRI可见脊髓空洞形成8例。手术采用椎板复位9例，C-D钉棒系统脊柱后路内固定1例。术后患者肌力恢复7例，无改变3例。呼吸困难，应用呼吸机辅助呼吸1例。术后复查MRI无肿瘤残留9例，1例部分椎旁肿瘤残留。结论 采用显微神经外科技术可以达到镜下多节段室管膜瘤全切，患者术后症状大多数可以明显改善。多节段椎板切开术后应考虑椎板复位或脊柱内固定，以保持脊柱的稳定性。

Microneurosurgery of multisegmental intramedullary spinal cord ependymomas

Objective To discuss the microneurosurgery techniques in the treatment of muhisegmental intramedullary spinal cord ependymomas and the effect of treatment. Methods Reviewed and analyzed the clinical materials of 10 cases muhisegmental intramedullary spinal cord ependymomas patients. Result 6 cases Cervical spinal cord ependymoma, 4 cases thoracic spinal cord ependymomas, 1 case was recurrent ependymomas involves thoracic and lumbar spinal cord and paraspinal cord. 9.4 segments of spinal cord were involved in average. Inferior paraplegia in 4 cases, high paraplegia in 6 cases, sphincter dysfunction in 5 cases, dyspnea in 4 cases. MRI detected syringomyelia formation in 8 cases. Vertabral lamina were reposited in 9 cases. C-D screw and stick system internal fixation of the spine in 1 cases, muscle strength recovered in 7 cases, no changed in 3 cases. Total resection of the tumor in 9 cases, part resection of the tumor in 1 cases. Conclusion Microneurosurgery with technique the muhisegmetal intramedullary spinal cord ependymomas can be resected totally. Most of the symptoms can be released after microsurgical treatment. After muhisemental laminotomy the vertebral plate should be reposited or the spine should be internal fixed to ensure the stability of the spinal column.