脊髓髓内肿瘤显微外科治疗

目的总结脊髓髓内肿瘤的治疗经验。方法回顾性分析11例脊髓髓内肿瘤病人的临床资料,位于颈段2例,胸段6例,腰段3例。行MRI平扫和增强扫描明确诊断,均采用显微外科手术治疗,结合术中所见对诊断及治疗进行分析。结果肿瘤全切除7例,次全切除4例。术后症状明显改善8例,无改善2例,加重1例,无手术死亡。按McCormick脊髓功能状态分级标准:Ⅰ级8例,Ⅱ级1例,Ⅲ级1例,Ⅴ级1例。随访7例,时间6～24个月,复发2例。结论 MRI是诊断脊髓髓内肿瘤的首选方法,手术切除肿瘤能改善症状。     

椎管内室管膜瘤的显微手术治疗

目的 探讨椎管内室管膜瘤的显微手术方法及其疗效。方法 回顾性分析31例椎管内室管膜瘤的临床资料,肿瘤位于髓内25例,髓外硬脊膜下6例;颈段10例,颈胸段5例,胸段3例,胸腰段5例,腰段8例;均在神经电生理监测下行显微手术治疗。结果 6例髓外硬脊膜下肿瘤均全切除;23例髓内肿瘤,全切除15例,次全切除5例,大部分切除2例,部分切除1例。除1例髓内肿瘤病人术后神经功能较术前稍差,其余病人神经功能障碍均不同程度改善。术后随访3~36个月,行颈,胸,腰椎MRI及X线或CT复查,除2例椎板未复位,出现脊柱后凸畸形外,其余脊柱稳定性良好;未见肿瘤复发。结论 在神经电生理监测下手术,是治疗椎管内室管膜瘤的有效方法。     

腰骶段髓内肿瘤全切除术

脊髓髓内肿瘤约占椎管内肿瘤的15%～2%,以颈、胸段多见。国内文献报道腰骶段髓内肿瘤全切除的病例数不多。我院自1972年10月以来共收治8例腰骶段髓内肿瘤患者,经行肿瘤全切除治疗,效果满意。现报道如下:     

脊髓髓内肿瘤的显微手术治疗

目的介绍脊髓髓内肿瘤的显微手术治疗经验。方法显微手术治疗脊髓髓内肿瘤40例,随访术后神经功能状态,并对髓内肿瘤显微手术治疗的手术时机、手术技巧、脊柱稳定性及术后是否放疗等问题进行探讨。结果肿瘤全切除率75%,其中室管膜瘤全切除率94.8%,星形细胞瘤全切除率14%。出院时神经功能障碍加重14例,改善或稳定26例。结论及时采用显微外科技术切除肿瘤是提高脊髓髓内肿瘤病人生存质量的主要治疗手段。     

显微手术治疗颈段髓内肿瘤10例

目的:报道应用显微外科手术切除颈段髓内肿瘤的临床疗效。方法:对10例颈段髓内肿瘤施行显微手术治疗。采用McCormick临床神经功能分级方法及MRI检查,对患者术前、术后神经功能改变,以及肿瘤切除情况进行评估分析。结果:肿瘤全切除7例,次全切除2例,部分切除1例。术后临床神经功能改善6例,保留术前神经功能3例,术后神经功能变差1例;术后无死亡病例及手术致残者。结论:显微外科能提高手术切除颈段髓内肿瘤的临床疗效,改善患者症状。     

半椎板入路微创治疗椎管内肿瘤

目的探讨半椎板入路手术治疗椎管内肿瘤的可行性及效果。方法回顾性分析106例经半椎板入路微创手术治疗椎管内肿瘤的临床资料。半侧椎板开窗从1个节段到9个节段不等。开窗大小约10～15cm：其中行神经电生理监护20例。结果肿瘤全切除98例,近全切除5例,大部分切除3例。除1例髓内肿瘤病人术后神经功能较术前稍差,其余病人神经功能障碍均不同程度改善。术后随访3～34个月,行颈、胸、腰椎MRI及x-线或CT复查,脊柱稳定性完好,脊膜瘤术后复发1例。结论半椎板入路手术创伤小,对脊柱稳定性影响小,术后恢复快,适合于椎管内大部分肿瘤的切除,术中辅以高速磨钻、神经电生理监护及超声技术,可提高对脊髓、神经功能的保护,降低手术风险及并发症。     

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。     

显微手术治疗脊髓髓内肿瘤

目的探讨脊髓髓内肿瘤的显微手术治疗效果。方法回顾性分析经显微手术治疗的27例脊髓髓内肿瘤病人的临床资料。结果肿瘤全切除13例,次全切除10例,大部分切除4例。术后1月症状明显改善21例,稳定3例,加重3例。本组无死亡病例。术后随访6-24个月,复发2例;按McCormick脊髓功能状态分级：Ⅰ级17例,Ⅱ级6例,Ⅲ级3例,Ⅳ级1例。结论MRI是诊断脊髓髓内肿瘤的首选方法,显微手术切除脊髓髓内肿瘤是一种有效的手段。     

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。     

显微手术结合脊柱内固定技术治疗椎管内外沟通性肿瘤(附129例报告)

目的 探讨既能手术全切椎管内外沟通性肿瘤,又能维护和保证术后脊柱稳定性的最佳手术治疗策略.方法 回顾性分析2008年8月至2012年12月作者采用显微手术结合术中脊髓神经电生理监测和脊柱内固定技术治疗的129例椎管内外沟通性肿瘤患者的临床资料.其中,硬膜外椎间孔内外沟通型49例,硬膜下椎间孔内外沟通型68例,椎旁巨大型12例.术中采用脊髓肌电或脊髓体感诱发电位监测相应节段脊髓和脊神经功能.对肿瘤侵犯椎体、椎弓根或椎间关节严重影响到脊柱稳定性时,在切除肿瘤的同时,行相应节段椎体重建和(或)椎弓根固定融合手术.结果 手术全切123例,近全切除6例;切除肿瘤后同时行脊柱内固定手术47例,其中3例行颈前路椎体重建及固定融合术,44例行经椎弓根后路脊柱内固定术.术后病理:神经鞘瘤99例,神经纤维瘤8例,脊膜瘤9例,节细胞神经瘤5例,畸胎瘤1例,其他恶性肿瘤7例.术后2周原术前神经功能改善122例,症状同术前6例,加重1例.无手术感染、瘫痪及死亡病例.术后随访4～40个月,平均15个月;其中122例良性肿瘤患者均恢复正常工作生活,无加重及复发病例.7例恶性肿瘤患者中,3例死亡.结论 全切除椎管内外沟通性肿瘤的同时,行相应的椎体重建和脊柱内固定手术,是治疗此类肿瘤、维护脊柱稳定性并巩固手术治疗效果的关键.     

Concurrent split cord malformation and teratoma: Dysembryology,presentation, and treatment

Split cord malformation (SCM) is a rare form of spinal dysraphism in which the spinal cord is divided in the sagittal plane, forming a double neural tube. In addition to being associated with a variety of malformations, SCM may occur with spinal cord tumors, with only exceptional cases involving teratomas. As only eight patients with a teratoma associated with SCM have been reported, their presentation characteristics and treatment are currently unclear. We review the literature of all patients with SCM with concurrent spinal teratoma, discuss the potential dysembryology, and report the first case of SCM with concurrent spinal teratoma in an elderly patient. The mean age of those with concurrent SCM and teratomas was 39.4 years, with 55.6% occurring in females. The lumbar spine was the most frequent location for teratomas (66.7%), with the Type II malformation more commonly occurring with these tumors (75%). The duration of symptoms varied widely, ranging from 1 month to 5 years, with the average duration being nearly 2 years. Back pain (87.5%) and lower extremity weakness (75%) were the most common presenting symptoms. As SCM may be associated with progressive neurological deterioration and teratomas can contain immature or malignant components, surgery should be attempted with the goal of gross total resection. Nonetheless, in patients with a concurrent tumor and spinal dysraphism, spinal teratomas should be considered in the differential diagnosis. Gross total resection of these lesions may be safely achieved even in the presence of SCM using intraoperative electrophysiologic monitoring.     

椎管内原发性畸胎瘤的诊治分析（附13例报道）

目的 探讨椎管内原发性畸胎瘤的临床特点及治疗情况。方法 回顾性分析2016年12月至2019年6月手术治疗的13例椎管内原发畸胎瘤的临床资料。结果 肿瘤全切除1例,次全切除12例。13例术后病检结果均为成熟性畸胎瘤。术前肢体无力6例中,改善5例;术前大小便功能障碍7例中,改善6例;2例性功能障碍、9例腰背部疼痛、7例肢体疼痛麻木,术后均改善。术后发热3例,感染1例。术后随访1~29个月,中位数为7个月,平均11.2个月;4例复发。结论 椎管内原发性畸胎瘤发病率低,多位于胸、腰段,髓内、髓外均可,显微手术为主要治疗方法,并发症少,病理检查以成熟性畸胎瘤居多。     

脊髓圆锥马尾区畸胎瘤合并终丝牵张型脊髓拴系综合征的手术治疗

目的 探讨脊髓圆锥马尾区畸胎瘤合并终丝牵张型脊髓拴系综合征（TCS）的临床特点、手术方法及其疗效。方法 回顾性分析2007年2月～2022年3月手术治疗的50例脊髓圆锥马尾区畸胎瘤合并终丝牵张型TCS的临床资料。结果 畸胎瘤内容物及囊性部分内壁剥离切除45例,囊壁次全切除加电灼5例;50例终丝均分离、切断。术后病理均为成熟囊性畸胎瘤及内终丝结构。术后随访6个月～14.5年,中位数75个月,按Hoffman脊髓功能评分,脊髓功能状态好转27例,不变22例,恶化1例;1例畸胎瘤内膜次全切除术后复发再次手术,其余49例未见肿瘤复发,无再拴系。结论 椎管内畸胎瘤多分布于脊髓圆锥马尾区,以慢性神经压迫为表现;对合并终丝牵张型TCS,一期行畸胎瘤切除术及终丝切断脊髓栓系松解术,疗效满意。     

Intramedullary immature teratoma in a young infant involving a long segment of the spinal cord

Intramedullary teratoma is a rare lesion, located in the majority of cases in the lumbosacral area, and such lesions involving an extensive area of the spinal cord in young infants have seldom been reported. We present the case of a 3-month-old girl with an intramedullary spinal immature teratoma extending from C-5 to T-12, which was totally removed. The patient had suffered from paraplegia for 15 days, after which spinal MRI revealed a heterogeneously enhancing intramedullary lesion. Biopsy of the lesion demonstrated mature intestinal tissue. After total removal of the tumor, paraplegia and sphincter disturbances improved. Intramedullary teratoma should be included in the differential diagnosis of holocord tumors in young infants with rapidly progressing symptoms and if found should be radically excised. This case also emphasizes the importance of histological diagnosis and demonstrates the possibility of neurological recovery even in the case of paraplegia lasting for more than 1 month in a young infant.     

Tumor of the conus medullaris treated with antituberculous therapy

This case report concerns a 21-year-old man developing left leg paresis. Evaluation with magnetic resonance imaging (MRI) showed an intramedullary tumor in the conus region. He was planned for surgery but preoperative investigation indicated he had tuberculosis and the tumor was presumed to be a tuberculoma. Antituberculous therapy was started and the patient improved neurologically. The patient was followed clinically and with consecutive MRI during 2 years and the last MRI showed that the lesion had disappeared completely. Intramedullary tuberculomas are rare but important differential diagnosis in patients with spinal cord mass lesions. The role of medical and surgical treatment of intramedullary tuberculomas is discussed.     

Intramedullary spinal teratoma with spina bifida

Spinal intramedullary teratoma is a rare tumor. We report a case of intramedullary teratoma of the conus medullaris with spina bifida. A 5-year-old boy was admitted to our hospital for removal of a lumbosacral tumor sited in an intramedullary location at the conus medullaris, which was totally resected with neuroendoscopic assistance. The pathological diagnosis was mature teratoma consisting of three germ cell layers. The pathogenesis of spinal intramedullary teratoma is discussed with special reference to spina bifida. Received: 21 July 1999 Revised: 21 December 1999     

A case report of an intramedullary cervical teratoma in an adult patient with cervical spondylotic radiculopathy

Spinal cord teratomas are rare. There are few reports of teratomas affecting the cervical spine and their association with spondylotic radiculopathy has not been described. A 59-year-old woman with history of fecal incontinence attended with cervical radicular pain radiating to upper limbs. Physical examination showed distal muscle hypotrophy and abolishment of bicipital, tricipital, and brachioradialis reflexes of the right arm, preserving proximal strength. Also, hiporreflexia and loss of proprioception in the right lower limb was observed. Magnetic resonance imaging showed an intramedullary mass at C7-T1, accompanied by intervertebral disk protrusions and dural sac compressions at the same level. One-stage posterior–anterior operative approach for tumor resection, decompression of the radiculopathy and replacement of intervertebral discs was performed. The histopathological diagnosis was for a mature teratoma. We described the first case of an intramedullary cervical teratoma associated with radiculopathy in an adult, providing evidence of rare long-lasting teratomas affecting the cervical spine.     

Intracranial teratomas in children: a clinicopathological study

Introduction

Intracranial teratoma is a rare entity, accounting for 0.5 % of all intracranial tumors and 2–4 % of intracranial tumors in children.

Objective

To study the demographic profile, clinical, radiological, and histopathological features of pediatric intracranial teratomas.

Methods

All cases of intracranial teratoma diagnosed over an 11-year period (2001–2011) were retrieved from records of the departments of Neurosurgery and Neuropathology. Patients’ demographic profile, clinical and radiological features and intraoperative findings were recorded.

Results

We identified 43 cases of CNS teratoma, which included 8 adults and 35 children. Of the pediatric cases, 23 were spinal in location. Twelve cases of pediatric intracranial teratoma were identified (eight males, four females). Eight occurred in the first decade and four in the second decade (age range 3 days to 16 years). Third ventricle was the most common site (six cases). Four cases were seen in association with occipital encephalocele. All patients underwent surgery except for a newborn, which died 3 days after birth and was autopsied. Histologically, eight cases were classified as mature teratomas and four as immature teratomas. All four cases of immature teratoma were located in the posterior third ventricle.

Conclusion

A diagnosis of teratoma should be considered in young children presenting with a solid-cystic tumor in the region of the posterior third ventricle. Teratomas located in the posterior third ventricle are more likely to have immature components. In view of the coexistence of teratoma with occipital encephalocele, thorough histopathological sampling of the excised sac and contents is advised.     

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。     

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。