脊髓内肿瘤伴全长空洞的诊治体会

目的探讨髓内肿瘤伴脊髓全长空洞的诊断、治疗方法及空洞形成机制.方法对6例确诊为髓内肿瘤伴脊髓全长空洞的患者行显微镜下肿瘤摘除术,空洞不予处理.结果经3年的随访,6例均疗效明显,肿瘤摘除完整,空洞自行缩小或消失,症状改善.病程越短,疗效越好.结论脊髓全长空洞发生率可能比文献报道高.空洞是由于肿瘤本身的梗阻引起,显微外科技术能最大限度地保留脊髓功能,空洞不需处理.     

颅内血管母细胞瘤的MRI表现及病理分析

目的探讨颅内血管母细胞瘤的MRI表现及其病理基础。方法回顾性分析26例颅内血管母细胞瘤的MRI和病理资料,分析其影像学特点。结果单发病灶22例,多发病灶4例,共31个病灶,均位于后颅窝内,其中右侧小脑半球14个,左侧小脑半球9个,4脑室下方小脑下蚓部2个,延髓4个,4脑室2个。19个病灶呈囊结节型、1个病灶呈囊肿型、11个病灶呈实质型或偏实质型。病灶囊性区呈长T1长T2信号,实性区T1WI多呈稍长T1稍长T2信号,其中12个病灶内见稍短T1信号,增强示实性区明显强化,囊性区无强化,3个囊结节型病灶囊壁轻度强化。DWI实性区呈低信号。MRS示胆碱峰明显升高,肌酸及N-乙酰天门冬氨酸峰明显减低或接近消失,可见高尖的脂质及乳酸峰。结论颅内血管母细胞瘤常规MRI及功能成像表现均有一定特征性,MRI对其定位、定性均有较大的临床诊断价值。     

颈髓髓内血管网织细胞瘤的诊断及显微外科治疗

目的探讨颈髓髓内血管网织细胞瘤的诊断及显微外科治疗。方法分析26例患者的MRI表现及其显微外科手术治疗的效果。其中男19例，女7例，年龄17～55岁。结果根据肿瘤在MRI上的表现可分为囊肿型12例，实体型14例，均行肿瘤全切除术。术后患者神经系统症状好转者17例，7例无改善，2例加重。结论颈髓MRI能对颈髓髓内血管母细胞瘤作出定位诊断，并可将其分型，以利选择不同的手术方法。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；根据肿瘤类型不同选择不同手术方法，在手术显微镜下沿正确的界面进行分离，先离断动脉后处理静脉，避免分块切除而力争全切，是减少术中出血和避免神经功能损害的关键。     

Intraoperative ultrasound imaging of the spinal cord: Syringomyelia, cysts, and tumors — A preliminary report

Dynamic intraoperative imaging of the spinal cord was done using a real-time ultrasound scanner. Prior to opening the dura mater the neurosurgeon is able to “explore” the intradural space and with a 7.5 MHz transducer visualize the normal spinal cord, including the central canal and the dentate ligaments. Anterior and posterior spinal arteries may be seen in certain patients. In syringomyelia the fluid-filled cavities may be visualized with ultrasound and drained or shunted with intraoperative ultrasound guidance. Spinal cord cysts or cystic components of tumors can be precisely identified and drained using ultrasound. Intramedullary tumors can be demonstrated sonographically, as can the location and extent of intradural extramedullary tumors and tumors that have both extradural and intradural components. Experience to date with intraoperative imaging of the spinal cord and with the real-time ultrasound scanner is very encouraging, and in the future it should allow for a more precise characterization of and operative approach to lesions of the spinal cord.     

Primary spinal extradural hydatid cyst causing spinal cord compression

Primary spinal hydatid disease is rare and represents an uncommon but significant manifestation of hydatid disease. We report a case of primary intraspinal extradural hydatid cyst of the thoracic region causing spinal cord compression. The presenting symptoms were mostly atypical and the diagnosis was established preoperatively on the basis of magnetic resonance imaging. The patient underwent surgery resulting in complete recovery and is recurrence-free after 24 months follow-up.     

急性颈髓损伤1H-MRS与MRI的对照研究

目的对照研究磁共振质谱(1H-MRS)与MRI对急性颈髓损伤的诊断价值.方法根据19例急性颈髓损伤患者的MRI表现,分为脊髓正常信号组(损伤组Ⅰ)和脊髓异常信号组(损伤组Ⅱ),并以9例健康者作对照.进行1H-MRS检查,并计算氮-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、乳酸(Lac)波峰面积,分析NAA/Cho、NAA/Cr、Cr/Cho、Lac/Cho.结果损伤组Ⅰ与对照组比,仅Lac/Cho值升高(P＜0.05).损伤组Ⅱ与对照组比,NAA/Cho、NAA/Cr值降低,Lac/Cho值升高(P＜0.01).损伤组Ⅱ较损伤组Ⅰ NAA/Cho、NAA/Cr显著减低(P＜O.05).结论1H-MRS可定量测定创区颈髓相关代谢介质的变化,从代谢水平反映颈髓损伤的不同程度.MRI结合1H-MRS更有利于颈髓损伤评价.     

Intramedullary spinal cord metastasis in breast cancer: clinical features, diagnosis, and therapeutic consideration

Intramedullary spinal cord metastases (ISCMs) are very rare, but can cause devastating complications from underlying breast cancer. We report the case of a woman with known metastatic breast cancer and progressive neurologic deterioration caused by an ISCM. The epidemiology, pathogenesis, clinical presentation, diagnostic considerations, and therapeutic options are discussed.     

Multiple hemangioblastomas accompanied by syringomyelia in the cerebellum and the spinal cord

The present report covers an autopsied case of multiple hemangioblastomas in the cerebellum and the spinal cord, which did not involve the retinas and other organs. An intramedullary hemangioblastoma was found at the C3-4 level of the spinal cord and similar small tumors were present at the C-7 and Th-4 levels. Multiple cysts were located from the C1-2 to the lumbar level; some of these seemed to be longitudinally continuous, like syringomyelic cavities. These findings appear only rarely in published reports of autopsied cases of hemangioblastomas in the spinal cord.     

Phase contrast magnetic resonance of the spinal cord preliminary results in spinal cord arterio-venous malformations

Summary In spite of the recent advances in neuroradiology including the CT scan and the spin-echo-magnetic resonance (MR), accurate diagnosis of arteriovenous malformations (AVMs) involving the spinal cord is still based on selective angiography. This last procedure is invasive and needs to be repeated during the follow up. Phase contrast angio MR was performed with a 0.5 Tesla unit on 12 patients with an AVM involving the spinal cord (7 intramedullary AVMs, 4 perimedullary fistulas, and 1 dural fistula with perimedullary venous drainage); 4 of these were investigated before and after treatment. Angio MR showed abnormal vascular patterns within the spinal canal in all cases, without distinguishing between arteries and veins; the nidus of the intramedullary AVMs was displayed in all cases. Angio MR provided images of the whole AVMs comparable to the angiographic pictures, in contrast to the spin-echo MR, which provided only discontinued images of the vessels. The efficient range of velocity providing images varied, according to the type of the malformation (slow for dural fistulas, rapid for intra-medullary AVMs). In the 4 patients investigated after treatment, comparison of the images obtained before and after treatment permitted assessment of the degree of occlusion of the malformation. Finally, angio MR as a complement of spin-echo MR can now be used as a reliable tool for detection of spinal cord AVMs, assessing the indication for angiography, and, furthermore, it can probably replace most of the postoperative control angiographies. The value of the efficient imaging velocity is disputable but seems to depend on the haemodynamic characteristics of the malformation and may then serve as a guide to angiography.     

MRI早期诊断脊椎转移癌

目的 评价ＭＲＩ对脊椎转移癌早期诊断的价值。方法 回顾分析１３例脊椎转移癌的ＭＲＩ资料,并与其他影像资料比较。结果 全部患者ＭＲＩ均有明显异常;Ｘ线平片仅６例显示明显骨破坏;４例同时行ＣＴ检查者仅１例明确诊断为转移癌;４例同时行核素骨扫描检查,在两者能同时显示的兴柱区域,骨扫描异常区ＭＲＩ信号均有改变,另２例患者共５个椎体ＭＲＩ信号有局灶改变而骨扫描无异常。结论 ＭＲＩ是诊断脊椎转移癌的一种敏感的     

Surgical treatment of late neurological deterioration in children with myelodysplasia

Summary Late deterioration of the neurological condition in patients operated on for myelomeningocele repair has been repeatedly reported in the literature. At the present time magnetic resonance imaging (MRI) allows one to recognize various pathological conditions which can be amenable to surgical correction in these patients, such as Chiari type II malformation, hydro/syringomyelia, decompensated hydrocephalus, and tethered spinal cord.The authors report their experience with 26 myelodysplastic children operated on for myelomeningocele repair in the early neonatal period, who exhibited late deterioration at variable time intervals from the first operation. The children were examined pre-operatively by means of MRI; the results were compared with those provided by MRI in 46 myelodysplastic children who underwent the investigation as a routine follow-up control. The MRI findings were subdivided into 4 main groups of increasing severity from 1 to 4; in some subjects, associated pathological conditions (Chiari II malformation, hydromyelia, etc.) were detected as well.Twenty-two out of the 26 patients with late neurological deterioration were operated on. Eleven of them (grades 2 to 4) underwent detethering of the fixed conus, with an improvement of their clinical picture from mild to good. On the other hand the remaining 11 subjects (grades 1 to 2) improved their condition following the correction of the associated abnormalities (malfunctioning CSF shunt: 5 cases; hydromyelia: 4 cases; symptomatic Chiari II malformation: 2 cases).     

Cystic spinal cord tumors: Magnetic resonance imaging correlated to histopathological findings

We report the characteristics of magnetic resonance imaging (MRI) of cystic intradural extramedullary spinal cord tumors (cystic neurilemmoma, epidermoid cyst, and enterogeneous cyst). T1-weighted MRI enhanced with gadolinium-DTPA clearly demonstrated the rim morphology of these tumors. The comparison between the rim enhancement pattern and histopathological findings offered possible qualitative diagnosis of these cystic spinal cord tumors by MRI.     

急性无骨折脱位型颈髓损伤的诊断与治疗

目的 探讨急性无骨折脱位型颈髓损伤的诊断及手术治疗方法。方法：对１３例接受手术治疗的患者行ＭＲＩ、体感诱发电位（ＳＥＰ）和运动诱发电位（ＭＥＰ）检查。１３例均采用颈髓前减压和植骨融合术治疗。结果 １３例患者ＭＲＩ检查均发现有颈椎间盘突出压迫脊髓及相应节段脊髓损伤征象,双上肢各神经的ＳＥＰ和ＭＥＰ均能引出。术后随访５个月￣２年６个月,１３例均有不同程度恢复。结论 无骨折脱位型颈髓损伤主要为过伸急性外     

影像学研究硬脊膜动静脉瘘进展

硬脊膜动静脉瘘(SDAVF)为低发病率脊柱血管畸形,临床表现不典型且较为隐匿,易误诊。早期诊断SDAVF主要依靠影像学检查,包括MRI、CT血管造影及数字减影血管造影,三者各有其优势。本文就影像学研究SDAVF进展进行综述。     

脊髓神经鞘瘤的临床诊治体会

目的 探讨脊髓神经鞘瘤的诊断及治疗方法。方法 对１２例脊髓神经鞘瘤患者进行脊髓造影或ＭＲＩ检查。１０例患者肿瘤全部切除,１例次全切除,１例部分切除。其中５例患者采用显微外科手术治疗。结果 肿瘤全部切除术后神经功能均有明显恢复,次全切除１例有好转,部分切除１例复发。结论 脊髓神经鞘瘤行手术全部切除是可行的。熟练的手术技巧及肿瘤全切是取得良好效果的关键。     

Dorsal intramedullary spinal epidermoid cysts: Report of two cases and review of literature

Intramedullary epidermoid cysts of the spinal cord are rare tumors, especially those not associated with spinal dysraphism. About 50 cases have been reported in the literature. Of these, only seven cases have had magnetic resonance imaging (MRI) studies. We report two cases of spinal intramedullary epidermoid cysts with MR imaging. Both were not associated with spina bifida. In one patient, the tumor was located at D4 vertebral level; while in the other, within the conus medullaris. The clinical features, MRI characteristics and surgical treatment of intramedullary epidermoid cyst are presented with relevant review of the literature.     

自发性脊髓硬膜外血肿的MRI诊断及鉴别诊断

目的探讨自发性脊髓硬膜外血肿的MRI表现及鉴别诊断。方法11例自发性脊髓硬膜外血肿，男7例，女4例，年龄27～74岁，均无明确外伤史。常规行SET1WI、T2WI矢状位及T2WI轴位，部分病例行脂肪抑制扫描，6例注射Gd-DTPA后行增强扫描。结果11例自发性脊髓硬膜外血肿中，9例位于椎管内背侧脊髓后方，2例位于椎管内背外侧。病变范围覆盖4～5个锥体节段，颈段8例，胸段3例。血肿呈长条状及长梭形，5例血肿呈T1WI、T2WI高信号，4例血肿呈T1WI、T2WI等、低、高混杂信号，2例呈T1WI及T2WI等信号。增强扫描2例血肿壁强化，4例未见强化。结论MRI是脊髓硬膜外血肿最佳检查方法，能清楚显示血肿部位，范围，区分急慢性血肿，判定脊髓受压受损情况     

椎管内注入Gd-DTPA磁共振造影术

目的 探讨椎管内注入Gd-DTPA磁共振造影术的临床应用价值。方法 41患者造影术前术后均常规自旋回波矢状和轴位扫描，22例术前行水成像脊髓造影术，10例术后行T2WI矢状扫描，9例术后行脂肪抑制自旋回波扫描，腰穿注药量1-2ml，注药后间隔扫描时间为1/2-1h(n=8),1-2h(n=23),2-5h(n=10),5例10-32h内造影术后第2次重复扫描，依据Gd-DTPA与脑脊液混合均匀程度，信号强度和弥散范围分为图像一般和图像良好两类，结果 造影术显示脊髓损伤坏死液化灶与脑脊液相通3例，脑脊液外漏3例，蛛网膜下腔阻塞6例，骶管囊肿与脑脊液相通2例。注药后1h内复查，图像良好3例；2-5h复查，图像良好33例，3例出现轻度头痛，头晕及恶心。结论 该方法是一种安全，有价值的检查技术，它集常规MR检查，X线脊髓造影和CTM的优点，可以发现常规MR检查不能显示的异常改变。     

Stabwound of the cervical spinal cord. Two case reports

Two cases of Brown-Sequard syndrome following a stab wound of the cervical spinal cord are reported. Spinal cord hemisection was confirmed by magnetic resonance imaging and surgical exploration. Both patients presented leakage of the cerebrospinal fluid and underwent surgical repair. In the first case, the pia-mater was sutured to close the wound and decrease the risk of post-traumatic syringomyelia. Outcome at ten and two years follow up was good in both patients who were able to walk. One of them returned to work. The contribution of surgical repair of spinal cord stab wounds and mechanisms of recovery are discussed.