脊髓髓内室管膜瘤的外科治疗

目的研究脊髓髓内室管膜瘤的显微外科手术技术。方法本文回顾分析了手术治疗318例脊髓髓内室管膜瘤的临床资料。结果全切除肿瘤311例,近全切除7例。随访129例,其中痊愈65例,症状明显减轻46例,症状无变化9例,症状加重7例,术后复发2例。无手术死亡。结论应用显微技术可以全切大多数髓内室管膜瘤。椎板成形术可提高术后脊柱稳定性,全切或近全切患者术后不需放疗。     

椎管内脊膜瘤的显微外科治疗——附70例临床报告

背景与目的：脊膜瘤是椎管内的常见良性肿瘤，随着影像学、显微外科学、神经电生理学等的发展．手术治愈率逐年提高，本研究旨在总结脊膜瘤的临床特点，显微外科治疗手术技巧，以期对提高其临床疗效起到一些作用。方法：对我院神经外科2000—2005年收治的70例经病理证实的脊膜瘤患者临床资料进行回顾性分析。结果：所有患者术前均行MRI、诱发电位检查，采取显微手术治疗，术中辅以电生理监测。肿瘤位于颈段21例（30％），胸段45例（64_3％），胸腰交界2例（2．9％），腰骶段2例（2．9％）。全切63例．近全切除5例．大部分切除2例，无手术死亡。术后症状均缓解，神经功能明显改善，随访3-6个月．无影像学上复发。结论：脊膜瘤是椎管内的良性肿瘤，胸段好发，娴熟的显微神经外科操作及合理的手术入路．可尽量避免脊髓及神经损伤．提高治疗效果。如能全切除肿瘤及受累硬脊膜，可降低肿瘤复发率，预后良好。     

椎管内肿瘤107例临床分析

目的 总结分析椎管内肿瘤治疗经验。方法 回顾性分析最近3年来我科经治的107例椎管内肿瘤的临床特点，诊断要点及手术疗效。结果 本组椎管内肿瘤中神经鞘瘤37例（34．6％），脊膜瘤12例（11．2％），室管膜瘤7例（6．5％），胶质瘤6例（5．6％），星形细胞瘤5例（4．6％），血管母细胞瘤4例（3．7％），血管脂肪瘤4例（3．7％），神经母细胞瘤2例（1．8％），蛛网膜囊肿及脊髓血管畸形各2例。本组髓内肿瘤22例占20．6％，髓外肿瘤75例占70％，复发性肿瘤10例占9．3％。肿瘤全切除率为89．2％，次全切除为9．8％。出院时运动功能改善88．4％，感觉功能改善86．5％，括约肌功能改善79．9％，自发性疼痛消失率85％。结论 椎管内肿瘤以良性居多，手术效果佳，MRI检查及显微外科技术的应用是提高治疗效果的关键。     

髓内室管膜瘤的手术治疗(附23例报告)

髓内室管膜瘤虽然较为少见,但仍是成人最常见的髓内肿瘤[1].我们在临床中常常可以见到髓内室管膜瘤术后神经功能状态没有改进,甚至恶化.为了阐明髓内室管膜瘤的外科治疗策略和与手术疗效有关的预后因素.本文回顾研究了1996年1月～1999年12月间,手术治疗的23例髓内室管膜瘤患者的临床资料并进行了统计学分析.     

儿童髓母细胞瘤的显微手术治疗——附24例报告

背景与目的：髓母细胞瘤是儿童常见的中枢神经系统恶性肿瘤，手术是其治疗的主要手段。本文通过对24例儿童髓母细胞瘤显微外科治疗分析，总结儿童髓母细胞瘤的显微手术经验。方法：收集1999-2007年我院经手术证实的儿童髓母细胞瘤24例，对其临床资料进行回顾性分析。其中男16例，女8例，平均年龄7．5岁，常见症状和体征为高颅压征和共济失调，全部患者均行显微手术治疗，术后辅助放射治疗。19例随访6个月至6年。结果：全组病例中，肿瘤全切21例，大部分切除2例，部分切除1例，手术死亡率4．2％（1／24），未出现严重并发症．患儿生存质量得到提高。结论：掌握显微手术方法和手术中注意事项，有利于提高肿瘤切除程度及减少手术并发症．手术后辅助放疗有利于改善预后。     

脊髓髓内肿瘤的显微外科治疗——附53例临床分析

背景与目的：脊髓髓内肿瘤作为神经外科的一种常见疾病被广大神经外科医生所重视，其治疗效果随着显微外科技术的发展在近几年得到了较大的提高。通过总结我科近一年来收治的脊髓髓内肿瘤患者的治疗情况探讨治疗经验并评估其效果。方法：对我科2006～2007年经手术治疗的53例脊髓髓内肿瘤患者进行回顾性研究。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、术后疗效进行分析。结果：本组室管膜瘤49．1％，星形细胞瘤30．2％，脂肪瘤15．1％，血管母细胞瘤5．7％，本组总全切率为56．6％．次全切除率为30．2％，部分切除或活检率为13．2％，室管膜瘤全切率可达96％，无手术死亡患者。结论：通过早期诊断及早期显微手术治疗脊髓髓内肿瘤可以明显减轻患者症状，改善其生活质量，特别是对室管膜瘤及血管母细胞瘤大都可做到全切并且少有复发。     

影响鞍结节脑膜瘤手术治疗后视力改善的相关因素分析

目的：鞍结节脑膜瘤常会因为压迫视神经导致视力丧失，手术治疗最重要目的是为了改善视力．视力恢复的程度也是衡量手术治疗效果的重要指标。本文重点分析显微外科手术治疗鞍结节脑膜瘤影响视力功能改善的相关因素。方法：回顾近10年来手术治疗的51例鞍结节脑膜瘤病例，这些患者均接受经翼点入路或经额下入路手术治疗。其中41例（80．4％）患者就诊时有视力障碍症状，男17例，女24例，平均42．4岁。症状中位持续时间为11个月。单眼视力障碍25例，双眼视力障碍16例，2例只有视野的缩小。通过MRI测量肿瘤的直径为0．6～5．4cm．无和轻度瘤周水肿26例，严重瘤周水肿15例。结果：手术全切率为80．4％。术前有视力障碍的术后30例（73．2％）改善，2例（4．9％）加重，9例（22％）无变化。术后其他并发症包括：尿崩症8例（均为术后一过性，术后1周内缓解）。垂体功能低下2例，癫痫2例，下丘脑功能障碍1例，颅内感染1例。随访6～60个月。结论：标准的显微外科开颅术治疗鞍结节脑膜瘤，暴露充分，肿瘤全切率高且并发症少。分析发现以下因素不利于术后视力功能的改善：患者年龄大于60岁；视神经功能障碍超过1年；视神经功能障碍严重；瘤周水肿明显；肿瘤与脑组织间缺少明确的蛛网膜层面；肿瘤未能全切。     

垂体生长激素腺瘤的诊断和治疗95例分析

背景与目的：生长激素腺瘤的诊断和治疗方法不一，疗效一直不尽如人意。本文回顾性总结和分析垂体生长激素腺瘤的临床诊疗经验，探讨现代诊断标准的制定意义和治疗方案的可行性。方法：2004年6月至2005年12月收治垂体生长激素腺瘤病例共95例，其中Ⅰ级29例，Ⅱ级36例，Ⅲ级30例，侵袭性腺瘤11例。除1例接受额下入路手术外，其余94例均接受经鼻蝶手术治疗，其中单纯手术（手术组）62例，术前结合生长抑素类药物治疗（手术＋药物组）33例。采用目前国际标准方法来评估治疗效果及其预后。结果：全部病例中，手术全切除81例（85．3％），次全切除14例（14．7％），其中11例侵袭性腺瘤均为次全切除。IGF-1恢复至与性别和年龄组相匹配正常范围者64例（67．4％）。除外侵袭性腺瘤，手术组全切除率为94．7％，IGF-1恢复正常者39例（68．4％），手术＋药物治疗组的全切除率为100％，IGF-1恢复正常25例（92．6％）。结论：经鼻蝶手术是目前治疗垂体生长激素腺瘤的首选方法，术前应用生长抑素类药物可以缓解术前高血糖、心肺功能不全等症状，提高手术安全性。术前用药可以明显改善术后IGF-1的水平，正常的IGF-1水平预示患者生存时间接近正常人群。制定和实施国际统一的生长激素腺瘤诊断标准对于疗效评估、术后随访治疗和预后判断具有重要的指导意义。     

142例胸腺瘤临床分析

目的：分析胸腺瘤的分期、病理类型、临床特点及治疗方法，评价影响预后的因素。方法：对1954年1月～1997年1月收治的142例胸腺瘤患者进行统计学分析，按Masaoka分期法进行分期，运用寿命表法计算生存率，回顾性分析影响预后的因素结果：手术治疗109例(76．8％)，根治性切除71例(65．1％)，姑息性切除16例(14．7％)，探查术22例(20．2％)放疗94例(66．2％)，单纯放疗6例(6．4％)。随访所有患者，5年、10年生存率分别为59．9％，45．8％，其中Ⅰ期93．8％，，79.2％，Ⅱ期79.3％，55.2％，Ⅲ期51．5％，33．3％，Ⅳ期0。结论：胸腺瘤诊断主要依靠临床及病理学判断，治疗原则应尽可能广泛切除肿瘤，术后根据具体情况辅以放疗、化疗。手术方式、分期对预后影响最大。     

放射治疗124例原发性脑瘤临床分析

本文回顾124例原发性脑瘤的单纯放疗和术后放疗的5年生存情况。材料与方法：分析经术后病理或CT、MRI证实的124原发性脑瘤。8mv－x线或60Co常规分割全脑照射，中线剂量30～40Gy，局部追加照射DT10－20Gy。全脊髓预防照射DT25～30Gy。结果：5年生存率：全部切除者和部分切除者分别是7／13（53．4％）、8／23（34.8％）；放射剂量50～60Gy者好于低剂量组；胶质瘤、髓母细胞瘤、室管膜瘤分别为10/32（31.2％）、2／6（33．3％）、1／2。结论：病人生存期长短取决于手术切除程度、放射剂量与肿瘤组织学类型。     

Long-term outcomes of surgical resection with or without adjuvant radiation therapy for treatment of spinal ependymoma: a retrospective multicenter study by the Korea Spinal Oncology Research Group

Background

We sought to determine the surgical treatment and functional outcome and identify the predictors of survival in a retrospective cohort of patients with spinal cord ependymoma using data collected from the Korea Spinal Oncology Research Group database.

Methods

The data regarding 88 patients who had been surgically treated for histologically confirmed spinal cord intramedullary and extramedullary ependymoma from January 1989 to December 2009 were retrospectively reviewed.

Results

Histopathological examination revealed myxopapillary ependymoma in 24 patients, ependymoma in 61 patients, and anaplastic ependymoma in 3 patients. Gross total removal was achieved in 72 patients, subtotal removal in 15 patients, and partial removal in 1 patient. Twenty patients were treated with postoperative radiation. Fifty-two patients had stable or improved postoperative neurological function, while 36 experienced neurological deterioration. A permanent decrease in McCormick classification grade was seen in 17 patients. The progression-free survival rate was 87% for all patients at 5 years and 80% at 10 years. During follow-up, local recurrence/progression was seen in 13 patients. Diffuse meningeal spread developed in 2 anaplastic ependymoma patients. Postoperative radiotherapy after incomplete resection did not significantly correlate with longer times to recurrence. Multivariate analysis revealed histology and surgical extent of resection as independent predictors of longer progression-free survival.

Conclusions

Gross total removal alone is a good treatment strategy for spinal ependymomas. Early diagnosis and surgery, before severe paralysis, are important to obtain good functional outcomes. Subtotal resection with radiation therapy for intramedullary lesions appears to offer no advantages over gross total removal.     

椎管内肿瘤107例临床分析

目的　总结分析椎管内肿瘤治疗经验。方法　回顾性分析最近 3年来我科经治的 10 7例椎管内肿瘤的临床特点 ,诊断要点及手术疗效。结果　本组椎管内肿瘤中神经鞘瘤 37例 (34 6 % ) ,脊膜瘤12例 (11 2 % ) ,室管膜瘤 7例 (6 5 % ) ,胶质瘤 6例 (5 6 % ) ,星形细胞瘤 5例 (4 6 % ) ,血管母细胞瘤 4例(3 7% ) ,血管脂肪瘤 4例 (3 7% ) ,神经母细胞瘤 2例 (1 8% ) ,蛛网膜囊肿及脊髓血管畸形各 2例。本组髓内肿瘤 2 2例占 2 0 6 % ,髓外肿瘤 75例占 70 % ,复发性肿瘤 10例占 9 3%。肿瘤全切除率为89 2 % ,次全切除为 9 8%。出院时运动功能改善 88 4% ,感觉功能改善 86 5 % ,括约肌功能改善79 9% ,自发性疼痛消失率 85 %。结论　椎管内肿瘤以良性居多 ,手术效果佳 ,MRI检查及显微外科技术的应用是提高治疗效果的关键。     

Surgical Outcome and Prognostic Factors of Spinal Intramedullary Ependymomas in Adults

The goal of treatment for spinal ependymoma is complete removal with minimal postoperative neurological deficit. The authors correlated the results of surgical management for spinal cord ependymoma with the rate of postoperative disease progression and the prognostic factors. Thirty-one cases of spinal ependymomas, surgically treated between 1979 and 1998, were retrospectively analyzed. The authors reviewed clinical features, radiological characteristics and operative findings for the surgical outcome analysis. Thirty-five percent of patients with preoperative Nuricks grade better than grade 4 showed improvement in functional status, whereas no improvement was observed in patients with preoperatively poorer functional status (P=0.05). The proportion of complete surgical removals was influenced by tumor location (40% in cases around the conus versus 97% in other regions, P=0.003) and histology (42% in the myxopapillary subtype versus 97% in the non-myxopapillary subtype, P=0.001). Disease progression was observed in six cases, the mean progression free interval after surgical removal was 83 months and the 5-year progression free rate was 70%. Disease progression was found in two out of 23 cases from the complete removal group and in four out of eight cases from the incomplete removal group (P=0.008). In the aspect of disease progression, the only statistically significant factor by multivariate analysis was the surgical extent of removal (P=0.010). Of those patients where there was incomplete removal, radiation therapy lead to improved clinical results, which were not statistically significant (P=0.27). In the surgical treatment of spinal cord ependymoma, preoperative functional status and the extent of removal were the significant prognostic factors influencing postoperative outcome. Early diagnosis is vital and complete removal of the tumor should be attempted in all surgical treatment of spinal ependymoma.     

Treatment of spinal cord ependymomas by surgery with or without postoperative radiotherapy

Purpose: To evaluate the effectiveness of complete resection and postoperative radiotherapy in spinal cord ependymomas. Methods and materials: We conducted a retrospective study over 20 patients (13 males and 7 females) with histologically confirmed spinal cord ependymomas between July 1985 and April 2001. Among them, 13 patients had ependymomas, 6 had myxopapillary ependymomas, and 1 had anaplastic ependymoma. All patients received radical surgery for tumor removal with 13 patients achieving complete resection and 7 incomplete resection due to technical difficulty. Among those with incomplete resection, 6 patients received postoperative radiotherapy to tumor bed and only one patient with anaplastic ependymoma received surgery alone. The total tumor dose ranged from 50 to 60 Gy. Results: Among the 20 patients, 19 patients were alive and showed local control. The median survival time of all patients was 109 months, with 104 months in the complete resection alone group and 135 months in the incomplete resection with postoperative radiotherapy group. One patient with anaplastic ependymoma and no postoperative radiotherapy developed leptomeningeal seeding 9 months after surgery. Salvage therapy of radiotherapy and chemotherapy maintained normal neurological functions. The patient expired 34 months from the initial diagnosis due to progression of leptomeningeal seeding. Conclusion: Complete resection alone in spinal cord ependymoma can achieve excellent local control and survival. Patients should receive complete resection if technically possible. Postoperative radiotherapy is not recommended for complete resection. For incomplete resection, postoperative local radiotherapy is recommended and it can also achieve excellent local control and survival. Local radiotherapy with 50-60 Gy is effective and safe. Salvage radiotherapy improves quality of life for local recurrence or leptomeningeal seeding patients.     

脊髓髓内胶质瘤的外科治疗——附56例临床分析

背景与目的:脊髓胶质瘤的治疗一直为临床难题,对分化良好的低级别髓内星形细胞瘤手术治疗依然可以取得良好效果,但分化差的高级别髓内星形细胞瘤或胶质母细胞瘤预后很差,放疗效果不确定。本文旨在探讨脊髓质瘤的治疗方法及预后。方法:本文总结了56例脊髓髓内胶质瘤的临床资料,对其病理类型、性别比例、年龄构成、发生部位、影像特征、手术技术、术中电生理监护、术后并发症、疗效预后等进行了讨论分析。结果:肿瘤近全切除及大部分切除为26例(46%),其余病例(54%)为部分切除或活检。55例患者行椎板切除减压,1例肿瘤边界清楚,镜下全切除肿瘤,术中行椎板复位。术后随访资料显示:星型细胞瘤Ⅰ~Ⅱ级,术中肿瘤边界相对清楚且近全切除的26例患者,术后3个月运动、感觉等功能有明显改善,其余肿瘤部分切除或活检的患者神经功能无显著改变。55例患者在术后3周至3个月内行普通放疗。脊髓圆锥部位的肿瘤,术后大小便困难发生率高达60%。结论:有相对边界的髓内星形细胞瘤手术治疗为最佳选择,术后辅助放疗,预后良好。恶性髓内胶质瘤手术以明确诊断,部分切除加脊髓减压为原则,手术难以改善神经功能状况,总的预后差。     

Intramedullary spinal cord tumors: Patterns of care in Victoria from 1998–2000

Aim:   This study describes the management of and outcomes for adult patients with newly diagnosed intramedullary spinal cord tumors during 1998–2000 in Victoria.
Methods:   The adult patients were identified in a retrospective cohort study conducted by surveying doctors involved in managing incident glioma cases identified from the population-based Victorian Cancer Registry.
Results:   Sixteen patients were considered eligible for this review. Of these 15 (94%) had a histological diagnosis: an ependymoma was diagnosed in 13 patients (81%). A complete macroscopic resection was achieved in eight patients (50%). A variety of tumor types and grades were observed with surgery and radiotherapy the mainstays of therapy. One patient received chemotherapy (7%). One patient died from disease within six months of diagnosis. Of the remaining 15 patients, all were alive at 5 years and 10 (63%) remain disease free.
Conclusion:   This review documents characteristics of a rare condition and suggests that, overall, prognosis is excellent.     

椎管内肿瘤23例显微手术治疗

 目的　研究椎管肿瘤有效的诊断与显微外科治疗方法。方法　回顾分析2002年4月至2006年5月收治的23例椎管肿瘤患者的诊治方法及预后。结果　所有病例均经手术治疗，肿瘤完全切除17例（73.9 %），次全切除5例（21.7 %），1例（4.3 %）行肿瘤大部分切除加椎管减压术。该组治愈20例（86.9 %）。神经系统症状明显好转2例（8.7 %），无明显改善1例，无术中死亡。结论　椎管肿瘤的早期诊断和治疗是影响其预后的重要环节，影像学检查和显微外科手术则是其关键的诊治手段。     

髓内星形细胞瘤与室管膜瘤的MRI诊断与鉴别诊断

目的:探讨髓内星形细胞瘤与室管膜瘤的MRI表现及鉴别诊断要点。方法:回顾性分析12例髓内星形细胞瘤与室管膜瘤患者的临床资料和MRI资料,并总结其MRI特征。结果:12例患者中,星形细胞瘤7例,室管膜瘤5例。7例星形细胞瘤中,4例位于颈段脊髓,3例位于胸段脊髓,MRI表现为浸润性生长,范围广泛,增强扫描呈不均匀强化,边界不清,趋向于散在强化。5例室管膜瘤中,3例位于颈段脊髓,2例位于圆锥和终丝段,多呈膨胀性生长,可占据整个脊髓断面,增强扫描呈较均匀性强化,边界可相对清楚,多伴有脊髓空洞和囊变,出血常见。结论:髓内室管膜瘤手术可完全切除,预后较好;星形细胞瘤较难完全切除,预后相对较差,MRI可提供对于二者的鉴别依据,具有一定的临床意义。     

后正中入路显微治疗椎管内肿瘤24例

【摘要】目的：探讨后正中入路显微治疗椎管内肿瘤的随访结果和手术体会。方法：回顾性分析2016年-2018年间采取后正中入路显微治疗椎管内肿瘤24例,包括颈椎4例,胸椎11例,腰椎7例,胸腰椎2例。其中髓外硬膜下肿瘤21例,髓内肿瘤3例。术前McCormick脊髓功能评分Ⅰ级7例,Ⅱ级12例,Ⅲ级3例,Ⅳ级2例,根据肿瘤生长特点采用11例半椎板入路和13例全椎板入路手术。术中借助电生理监测皮质脊髓束电位变化,所有肿瘤均在显微镜下切除。结果：术后全切除21例,其中髓外19例,髓内2例,次全切除3例,髓外2例,髓内1例。24例患者症状术后均得到不同程度缓解。1例髓外肿瘤随访1年余复发予以再次手术切除。结论：后正中入路切除椎管内肿瘤,正确的显微切除技巧,合适的椎板暴露,电生理监测,必要时椎弓根内固定等方法有助于提高术中脊髓和神经根功能的保护,维持术后脊柱稳定性,是保证手术疗效的关键因素。