椎管内髓外硬膜下肿瘤的显微手术治疗

目的 探讨椎管内髓外硬膜下肿瘤影像学特征、临床特征、显微手术疗效。方法 回顾性分析2014年4月至2019年12月手术治疗的34例椎管内髓外硬膜下肿瘤的临床资料。结果 34例中，脊膜瘤19例，神经鞘瘤15例；脊膜瘤以女性多见，疼痛少见，多出现囊变，T2WI多为等信号；而神经鞘瘤以男性多见，多有疼痛表现，囊变较少，T2WI多为高信号。34例肿瘤均全切除；全椎板切除28例，半椎板切除6例。术后未出现感染、脑脊液漏和脊髓缺血病变。术后随访12个月，McCormick脊髓功能分级Ⅰ级28例，Ⅱ级5例，Ⅲ级1例。结论 椎管内髓外硬膜下肿瘤以脊膜瘤和神经鞘瘤最为常见，T2WI具有鉴别诊断价值；全椎板或半椎板入路手术治疗，肿瘤全切率高，复发率低，术后并发症少，能有效改善病人预后。

Microsurgical treatment for patients with intradural extramedullary tumors

Objective To investigate the imaging features, clinical features, and microsurgical outcomes of patients with intradural extramedullary tumors (IETs). Methods The clinical data of 34 patients with IETs who underwent microsurgery from April 2014 to December 2019 were retrospectively analyzed. Results Total laminectomy was performed in 28 patients and semi-laminectomy in 6. Total tumor resection was achieved in all the patients. There was no infection, cerebrospinal fluid leakage, or spinal ischemia after the operation. Of the 34 patients, 19 patients were spinal meningiomas, and 15 spinal schwannomas. The ratios of female, cystic change, and isosignal on T2WI of tumor in the patients with spinal meningioma were significantly higher than those in the patients with spinal schwannoma (P<0.05), but the ratio of pain in the patients with spinal meningioma were significantly lower than those in the patients with spinal schwannoma (P<0.05). Following up 12 months after surgery showed McCormick grade Ⅰ in 28 patients, grade Ⅱ in 5, and grade Ⅲ in 1. Conclusions The most common IETs are spinal meningiomas and spinal schwannomas, and MRI T2WI is valuable in the differential diagnosis between spinal meningiomas and spinal schwannomas. Microsurgery through total laminectomy or semi-laminectomy can achieve good outcomes.