颈髓肿瘤的外科治疗

目的 探讨如何提高颈髓肿瘤的手术治疗效果。方法 显微手术切除71例颈髓肿瘤，其中髓内23例，髓外48例，根据其部位和病理类型采取不同入路和手术方法。结果 髓内肿瘤全切16例(69．6％)，髓外肿瘤全切44例(91．7％)。18例髓内肿瘤(78．3％)和43例髓外肿瘤(89．6％)术后脊髓功能改善或保持稳定。结论 对颈髓肿瘤应该积极采用显微神经外科手术治疗。应根据肿瘤位置、大小、范围和病理学类型选择手术入路和方法。     

延颈髓交界处髓内肿瘤的诊断与显微手术治疗

报道显微手术治疗10例延颈髓交界处髓内肿瘤(ITCJ),肿瘤全切除6例,次全切除4例,无手术死亡,70％病例术后好转。ITCJ可分为颈延型和延颈型两大类型。MRI是诊断本病的主要方法,并且具有指导手术的重要意义。结果也表明,显微手术方法和术后呼吸功能监护很有必要。     

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。     

高颈段椎管内肿瘤的诊断与手术治疗

目的 探讨高颈段椎管内肿瘤的诊断和手术治疗方法。方法 回顾性分析2004年7月至2007年3月在我科手术治疗的18例高颈段椎管内肿瘤病人的临床资料，对诊断和治疗经验进行总结。结果 肿瘤位于髓外硬脊膜下13例（其中哑铃形肿瘤2例），髓内3例，硬脊膜外2例。病理类型为神经鞘瘤10例，脊膜瘤4例，胶质瘤2例，脂肪瘤1例，节细胞神经瘤1例。18例均采用经枕下颈后正中入路，哑铃形肿瘤中有1例行二期手术，采用经颈外侧入路。肿瘤全切除14例（77．8％），部分切除4例（22．2％）。术后随访1～2个月，症状消失10例（55．6％），明显改善6例（33.3％），无变化2例（11、1％）。结论 高颈段椎管内肿瘤的诊断要依靠MRI检查，手术应持积极的态度，根据肿瘤的不同类型采取相应的手术方法，术后要加强对并发症的防治。     

脊髓肿瘤的手术治疗

目的 探讨脊髓肿瘤的手术方法和技巧。方法 回顺性分析421例脊髓肿瘤(髓外264例，髓内157例)病人的手术入路、操作方法和手术疗效。结果 肿瘤全切除率88．6％(髓外91．7％，髓内83.4％)，神经功能保留率(改善 不变)91.0％(髓外96.6％，髓内81．5％)。结论 对不同部位和不同病理类型肿瘤的切除要遵循不同的方法。     

多种电生理监测技术结合显微手术切除颈髓髓内肿瘤

目的探讨多种电生理监测技术联合辅助显微手术切除颈髓髓内肿瘤的应用价值。方法回顾性分析单中心20例颈髓髓内肿瘤病人的临床资料,应用电生理监测技术辅助显微手术切除肿瘤。肿瘤位于颈髓20例,其中累及延髓5例,累及胸髓5例。结果显微镜下肿瘤全切除17例,次全切除3例。采用脊髓地形图描记脊髓协助判断脊髓后正中沟8例。术中13例躯体感觉诱发电位(SEP)预警1～3次,16例运动诱发电位(MEP)报警1～3次,8例肌电图(EMG)报警1～4次。McCormick评估结果显示:与术前比较,术后3个月脊髓功能好转明显(P 0.05),但是术后3个月和6个月间差异无统计学意义(P0.05)。随访20例,时间6～30个月,肿瘤复发3例,术后12～16个月死亡。术后1例出现颈椎后凸畸形,随访观察。结论电生理监测技术辅助显微手术是颈髓髓内肿瘤有效的治疗方法,术后3个月内是脊髓功能恢复的黄金时期。     

颈髓肿瘤的显微外科治疗

目的 探讨颈髓肿瘤的显微外科治疗方法. 方法 根据肿瘤的不同部位和病理类型,对36例肿瘤(髓内12例,髓外24例)选择不同的手术人路和方法.结果 髓内肿瘤12例中10例获得全切,7例术后神经功能明显改善或稳定.髓外肿瘤24例中22例获得全切,23例术后神经功能明显改善或稳定.结论 颈髓肿瘤应采用显微外科技术治疗,能有效的保护脊髓组织及神经,减少神经功能障碍的进一步加重,提高手术全切率,改善预后.手术入路的选择应根据肿瘤的部位、大小、发展方向和病理类型选择不同的手术入路.     

显微手术治疗颈髓髓内肿瘤

报道显微手术治疗５８例颈髓髓内肿瘤。获全肿瘤切除者５０例，占８６．２％；术后神经系统状态改善者４５例，占７７．６％。表明颈髓髓内肿瘤适宜作肿瘤全切除，手术时机选在患者处于中度神经系统障碍时为好；描述了不同种类肿瘤的手术方法，认为激光手术对脂肪瘤切除最有帮助。提出了术中注意事项和肿瘤全切除的判断标准；阐述了术前放疗的危害性；对治疗后脊髓变细也作了简要讨论。     

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     

颈髓髓内血管母细胞瘤的诊断与治疗

目的 探讨颈髓髓内血管母细胞瘤的诊断与治疗。方法 分析19例患者的MRI表现，及其手术治疗的效果。结果 这类肿瘤在MRI上可分为三型：A.空洞型，肿瘤大小不等，且继发延、脊髓空洞；B.囊肿型，为囊内小的附壁结节；C.实体型，为巨大的实体性肿瘤。所有患者均经手术全切除肿瘤，并经病理证实为血管母细胞瘤。术后患者神经系统状态好转者18例，加重1例。结论 颈髓MRI能对颈髓髓内血管母细胞瘤作出定位、定性诊断，并可将其分型，以利选择不同的手术方法；诊断时，还需与胸廓出口综合征和颈椎病相鉴别。认为颈髓髓内、即使累及延髓的血管母细胞瘤宜行积极手术治疗；手术方法随肿瘤类型不同而各异，最为重要是：需沿正确的界面分离，并应在离断供血动脉后切除肿瘤。     

高颈段椎管内肿瘤的显微外科治疗

目的分析高位颈段椎管内肿瘤病例特点，探讨其手术方法和疗效。方法22例高位颈段椎管内肿瘤中，位于髓内者5例．位于髓外硬脊膜下者17例，其中有11例呈哑铃形生长。全部患者均行显微神经外科手术治疗，对于颈髓受压较严重者手术后采用大剂量甲基强的松龙治疗。结果本组5例髓内肿瘤中，3例室管膜瘤全切除，1例星形细胞瘤行部分切除，另1例星形细胞瘤行椎板内减压后活检。17例髓外硬脊膜下肿瘤中，有15例均在显微镜下全切除，有2例行大部切除；其中呈哑铃形生长的11例肿瘤中．有9例获得显微镜下全切除。结论术前MRI对高颈段椎管肿瘤有较好的诊断价值，而显微神经外科手术则有助于此类肿瘤的全切除。     

Exophytic intramedullary meningioma of the cervical spinal cord

Intramedullary spinal cord neoplasms are relatively uncommon. The most common intramedullary tumors are astrocytomas and ependymomas. Meningiomas can occur as an intradural tumor; however, they are typically in the extramedullary compartment. A 42-year-old male presented with progressive sensory loss in the upper extremities and lower extremity weakness. Pre-operative imaging suggested an intramedullary cervical lesion. To treat the progressive neurological abnormality, surgical resection was planned. At surgery, it was noted that the tumor originated in the cervical spinal cord and extended into the extramedullary region. Histology confirmed the lesion to be a meningioma. This meningioma variant has not previously been described. Spinal meningiomas may occur in locations other than intradural, extramedullary locations, and should be included in the differential diagnosis of intramedullary lesions. Intramedullary meningiomas can be successfully treated with surgery.     

显微手术治疗高颈髓肿瘤(53例报告)

本文报告53例高颈髓肿瘤,计髓外肿瘤31例,髓内肿瘤22例。总的肿瘤全切除率达88.7％,临床改善率为81.1％。无手术死亡病例。作者认为,临床诊断高颈髓肿瘤时,需与运动神经元疾病,多发性硬化,脑干脑炎和颈椎病等相鉴别;MR对确诊高颈髓肿瘤最有帮助。本文还分析了影响肿瘤切除程度的相关因素和描述了手术方法与注意事项,指出显微手术能提高肿瘤全切除率和术后疗效。     

Tanycytic ependymoma in association with neurofibromatosis type 2.

A rare case of tanycytic ependymoma associated with neurofibromatosis type 2 (NF2) is presented for the first time, with emphasis on its clinical course and histopathological features. A 30-year-old man had developed gait disturbance in his childhood, and harbored multiple tumors in spinal nerve roots, in the intradural extramedullary and intramedullary spinal cord. The spinal root tumor and intradural extramedullary tumor were histologically diagnosed as schwannoma and meningioma, respectively. Magnetic resonance imaging showed two intramedullary cystic lesions, one in the cervical and the other in the thoracic spine. Because his sensorimotor dysfunction in the lower extremities continued to worsen gradually, three of the multiple nodular tumors in the thoracic cystic lesion were removed. All three tumors were composed of eosinophilic piloid cells with modest nuclear pleomorphism. No Rosenthal fibers were found. A concentration of slender eosinophilic cellular processes surrounding the vascular wall was seen. Periodic acid Schiff and Masson trichrome-positive balloons were seen in the extracellular space. Detection of ependymal rosettes, although only few in number, led the diagnosis as a tanycytic ependymoma. Recognition of this ependymoma variant should be emphasized to avoid confusion with pilocytic astrocytoma or intramedullary schwannoma.     

Adult Primary Intradural Spinal Cord Tumors: A Review

Primary spinal cord tumors constitute 2% to 4% of all central nervous system neoplasms and are characterized based on their location as intramedullary, intradural extramedullary, and extradural. A contemporary literature review of primary intradural spinal cord tumors was performed. Among intramedullary tumors, ependymomas are more common and often can be surgically resected. However, astrocytomas infiltrate the spinal cord and complete resection is rare. Intradural extramedullary tumors include schwannomas, neurofibromas, and meningiomas and are usually amenable to surgical resection. Radiotherapy is reserved for malignant variants and recurrent gliomas, whereas chemotherapy is administered for recurrent primary spinal cord tumors without surgical or radiotherapy options. Early recognition of the signs and symptoms related to primary spinal cord tumors facilitates timely discovery, treatment, potentially minimizes neurologic morbidity, and may improve outcome. Treatment consists of surgical resection, and predictors of outcome include preoperative functional status, histologic grade of tumor, and extent of surgical resection.     

神经电生理监测技术在脊髓手术中应用11例报告

目的 总结脊髓手术中应用神经电生理监测技术的初步经验.方法 同顺性分析11例腰骶段椎管内病变手术中应用运动诱发电位(MEP)+体感诱发电位(SEP)+电刺激器触发肌电图(EMG)监测脊髓和神经根功能的效果和体会.结果 1例脊髓内囊性病变获得次全切除;1例脊髓内肿瘤大部分切除:9例脊髓拴系综合征术后自觉症状明显好转者8例,1例与术前相比症状无明显变化.11例手术中脊髓和脊神经功能保留率100%;无圆锥、马尾神经损害发生.结论 联合应用MEP+SEP+触发EMG对于脊髓和神经根的保护和拴系组织的判断以及提高手术的安全性具有重要价值.     

Surgical management of long intramedullary spinal cord tumors

Object Spinal cord tumors represent approximately 10–20% of primary central nervous system tumors. Only 20–30% of primary intradural tumors are intramedullary. The incidence of longitudinally extensive tumors involving the cervical, thoracic, and lumbar spine is very low (<1% of intramedullary lesions); hence, little literature exists on the management of this entity. Materials and methods We retrospectively reviewed all patients undergoing surgical resection of longitudinally extensive intramedullary spinal cord tumors involving the majority of the spinal cord between 1990 and 2002. Clinical, radiographic, operative, and outcome variables were retrospectively recorded and reported. Results Thirteen patients (eight male, five female) were included in the study. Mean age was 15 years (range, 3–45) at the time of the initial resection. Gross total resection was achieved in eight cases and subtotal resection in five cases. Pathology revealed astrocytoma in six cases (two pilocytic, four grade II), gangliogliomas in four cases, oligodendroglioma in two cases (one anaplastic), and lipoma in one case. One (8%) patient died from progression of anaplastic oligodendroglioma, and two (15%) underwent reoperation for recurrent tumor (ganglioglioma, grade II astrocytoma). With a mean of 3.4 years (range, 1–12) after surgery, the modified McCormick score (MMS) had worsened in only two (15%) patients, improved in three (23%) patients, and remained stable in seven (54%) patients compared to preoperative MMS. Five (38%) patients required fusion for progressive spinal deformity. Conclusion Gross total resection of holocord and longitudinally extensive intramedullary spinal cord tumors can be achieved with preservation of long-term neurological function in many cases. Serial imaging is recommended to guide subsequent resection for tumor recurrence and stabilization of progressive spinal deformity.     

电生理监测下高颈段髓内室管膜瘤的外科治疗

目的 探讨高颈段髓内室管膜瘤的显微外科治疗.方法 回顾性分析23例高颈段脊髓髓内室管膜瘤,均行显微外科切除,术中均采用联合体感诱发电位(SEP)和运动诱发电位(MEP)监测辅助肿瘤切除.结果 手术全切除肿瘤17例,近全切或大部分切除5例,部分切除1例;全组无手术死亡;术后门诊或电话随访22例,随访3个月至6年,神经功能改善16例(73%),稳定无变化4例(18%),加重2例(9%),随访期间无复发;术中诱发电位结果:真阴性18例(18/19),假阴性1例,真阳性2例(2/3).结论 尽早显微手术切除是高颈段脊髓髓内室管膜瘤的有效治疗措施,术中联合SEP和MEP监测可提高肿瘤全切率,减少术后并发症,最大程度地稳定和改善神经功能.

Abstract：

Objective To investigate the mieroneurosurgcial management for intmmedullary spinal ependymomas in the superior cervical spinal cord.MethodsClinical data of 23 patients with intramedullary ependymoma in the superior cervical spinal cord were analyzed retrospectively.All the patients were treated by microsurgery assisted with somatosensory evoked potential(SEP)and motor evoked potential(MEP).Results Total removal was achieved in 17 cases,subtotal removal in 5 cases and partial resection in 1 case.No patients died.A follow up of 3 months to 6 years by out-patient review and telephone interview were performed in 22 cases:neurological function was improved in 16 cases(73%),no changes occurred in 4(18%),deteriorated in 2(9%)and none was recurrence.Results of introperative monitoring:18 patients presented true negative findings,while 2 patient presented true positive findings,1 false positive findings.Conclusions Early microsurgical treatment is the most effective measure for intramedullary ependymoma in the superior cervical spinal cord.The combined applications of intraoperative SEP and MEP monitoring can increase removal rate,reduce postoperative complication,and improve the prognosis of the patients.     

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。