显微手术治疗21例颈椎管内髓外硬膜下肿瘤的疗效

颈椎管内髓外硬膜下肿瘤的传统手术采用后正中全椎板入路切除肿瘤,先切除肿瘤相应节段脊柱的棘突和椎板,再显露并切除肿瘤。手术需要切除全部椎管后部骨质,手术创伤大,容易引起术后脊柱不稳定。我们于2006年6月至2010年5月采用半椎板切除入路显微手术治疗21例颈椎管     

椎管内肿瘤显微外科治疗56例报告

目的探讨椎管内肿瘤的显微外科治疗术式与方法选择,脊柱脊髓与神经功能的保护和重建,评价半椎板切除入路的优缺点。方法回顾性分析2004年1月至2007年7月经半椎板或全椎板手术切除椎管内肿瘤及对沟通性肿瘤部分采用附加切121手术共56例。椎管内外沟通性肿瘤8例;1例颈部与1例胸部沟通性肿瘤未切除椎板,余下均行椎板切除。结果手术后病理为：神经鞘瘤28例,脊膜瘤18例,神经节细胞瘤4例,星形细胞瘤4例,室管膜瘤2例;除星形细胞瘤2例外未能全切,其余均全切。半椎板切除入路者无手术并发症和脊柱畸形,术后下床早。结论经半椎板切除入路较全椎板入路显微外科手术切除椎管内肿瘤,能够尽可能减少对椎体损伤,保留脊柱后柱结构,组织的完整性;增强脊柱稳定性及减少脊柱功能损伤;患者术后效果好,卧床时间短;对椎管内外沟通性肿瘤根据具体情况选择合适的人路方法,同样可取得较好疗效。     

半椎板入路显微外科切除椎管内肿瘤简

目的：探讨半椎板入路显微外科切除椎管内肿瘤的可行性和安全性.方法：回顾性分析我院33例椎管内肿瘤经半椎板入路,显微外科切除椎管内肿瘤的方法.结果：椎管内肿瘤33例,其中肿瘤全切32例,近全切除1例.无手术死亡,2例创腔积液,3例轻度脑脊液漏,经局部处理愈合.结论：经半椎板入路行椎管内肿瘤切除术,能充分暴露肿瘤,并在显微镜下安全切除肿瘤,并发症少,患者恢复快,适用于各级医院开展.     

半椎板入路显微手术与全椎板切除手术治疗脊髓肿瘤的疗效比较

目的比较半椎板入路显微手术与全椎板切除手术治疗脊髓肿瘤的临床疗效。方法将90例脊髓肿瘤患者按照入院时间先后顺序分为对照组与观察组,各45例。对照组采用全椎板切除术治疗,观察组采用半椎板入路显微切除术治疗。统计与比较2组的平均手术时间和术中出血量及术后下床活动时间、平均住院时间、临床疗效等。结果2组患者手术均获得成功。2组平均手术时间比较,P>0.05;观察组术中出血量、术后下床活动时间、平均住院时间分别为(141.21±42.61)ml、(7.22±0.91)d、(8.79±0.86)d,与对照组(278.63±52.89)ml、(24.36±1.27)d、(13.02±1.17)d比较,P<0.05。随访3~24个月,2组患者疗效和脊柱稳定性及术后并发症发生率比较,P<0.05。结论脊髓肿瘤采用半椎板入路显微切除手术治疗,与全椎板切除术时间相近,但术中出血量较少,并发症发生率较低,临床疗效较好,患者住院时间和下床时间都明显缩短。     

半/全椎板入路显微手术切除椎管内肿瘤的疗效对比研究

目的:探讨与比较半/全椎板入路显微手术切除椎管内肿瘤的临床疗效.方法:收集2013年3月至2016年3月入院的80例椎管内肿瘤患者随机分为两组,半椎组患者予以半椎板入路显微手术切除术治疗,全椎组患者予以全椎板入路显微手术切除术治疗,比较两组患者相关临床指标、近期、远期临床效果、稳定性评价、MRI影像情况、并发症发生率与满意度.结果:半椎组患者术中出血量、住院时间与下床时间显著性低于全椎组,存在显著性差异,具有统计学意义(P<0.01);半椎组患者总体远期疗效与脊柱稳定性明显优于全椎组,存在明显差异,具有统计学意义(P<0.05);半椎组总体并发症发生率显著性低于全椎组;半椎组患者总体治疗满意度显著性优于全椎组,存在显著性差异,具有统计学意义(P<0.01).结论:半/全椎板入路显微手术切除均可呈现良好的近期治疗效果,但半椎板入路显微手术切除术创伤更小,恢复更快,远期效果更佳,脊柱稳定性更高,并发症少,从而提高患者满意度,具有借鉴性.     

椎管内海绵状血管瘤的显微外科治疗——26例临床分析

背景与目的：随着MRI检查的普及，椎管内海绵状血管瘤的诊断变得相对简单。因椎管内海绵状血管瘤以髓内型最多见．显微外科治疗甚为关键。本研究旨在探讨椎管内海绵状血管瘤的临床特点和显微手术治疗效果。方法：2000年1月至2005年4月间北京天坛医院神经外科治疗椎管内海绵状血管瘤26例，均行MRI检查，全组均经后正中直入路显微手术治疗。结果：26例病灶均为单发，均经手术切除。其中23例全部切除，2例近全切除，1例大部切除。所有病例术后均经病理证实为海绵状血管瘤。术后神经功能状况改善20例，无变化5例．恶化变差1例。全组无手术死亡。结论：显微手术切除椎管内海绵状血管瘤是本病的首选治疗方法，全切除病灶可避免病变复发和再出血。术中精细的显微操作是手术成功的关键，术前症状轻和病灶处理及时与术后恢复良好相关。     

小切口单侧半椎板切除入路治疗脊髓肿瘤60例疗效分析

目的 探讨小切口单侧半椎板切除入路治疗脊髓肿瘤的疗效.方法 选取脊髓肿瘤患者60例,按住院单双号分为两组,观察组(31例)行小切口单侧半椎板切除入路治疗,对照组(29例)行全椎板切除入路治疗,观察并记录患者围手术期指标,神经功能恢复,肿瘤切除情况及随访3个月期间并发症发生情况,评价小切口单侧半椎板切除入路治疗脊髓肿瘤的疗效.结果 观察组手术时间,术中出血量,住院时间上均明显优于对照组(P＜0.05),虽然两组医疗费用上相比,没有明显统计学差异(P＞0.05),但观察组医疗费用仍低于对照组;术后3个月神经功能恢复方面,观察组患者恢复较好(P＜0.05),神经功能处于Ⅰ级和Ⅱ级的患者居多,术后观察组患者肿瘤切除情况明显优于对照组(P＜0.05),完全切除达24例,多于对照组(15例),随访3个月期间,观察组并发症发生率明显低于对照组(P＜0.05).结论 综上所述,采用小切口单侧半椎板切除入路治疗脊髓肿瘤,术后患者神经功能恢复良好,肿瘤切除较完全,并发症较少.故患者恢复快,花费少,值得临床推广使用.     

经小脑延髓裂显微外科切除第四脑室肿瘤（附22例报告）

目的：总结经小脑延髓裂入路显微手术切除第四脑室内肿瘤的手术方法,提高手术治疗效果.方法：回顾性分析2006年3月至2010年9月收治的22例第四脑室肿瘤患者的临床资料.患者均采用枕下后正中切口,打开小脑延髓裂后暴露并显微切除第四脑室肿瘤.1例患者为获得充分显露而切开下髓帆,硬脑膜予以严密缝合或修补.结果：病变全切除19例,近全切除3例.术后病理证实为室管膜瘤10例,星形细胞瘤4例,髓母细胞瘤2例,血管母细胞瘤2例,海绵状血管瘤3例,表皮样囊肿1例.无围手术期死亡,术后患者均未出现与手术入路及术中牵拉有关的并发症.1例患者术后脑积水,行脑室腹腔分流术后好转.结论：经小脑延髓裂入路能较好地暴露第四脑室肿瘤,对小脑损伤小,牵拉轻,是一种安全的手术入路.     

经胸切除椎管内外巨大哑铃形肿瘤1例

资料 :患者女 ,６０岁 ,因双下肢麻木１年 ,加重伴乏力７个月入院。查体发现脊髓胸９段以下浅、深感觉减退 ,左下肢肌力３级 ,右下肢肌力４级 ,双下肢肌张力增高 ,腱反射活跃 ,病理征阳性。Ｘ片示Ｔ９ 右缘、后纵隔内有一约８ｃｍ×８ｃｍ的密肿块 ;椎管造影示Ｔ１０髓外硬膜外占位。手术中插管全麻 ,右第７肋间隙入路 ,术中见后纵隔内肿瘤约１０ｃｍ×８ｃｍ×７ｃｍ ,其蒂经右侧第８椎间孔与椎管内肿瘤相连 ,大小约２ｃｍ×２ｃｍ×４ｃｍ。胸科医师切除后纵隔肿瘤后 ,我科医师切除相应椎板 ,打开第８椎间孔 ,碎块切除椎管内肿瘤 ,并切除…     

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。     

Adult intradural primary spinal cord tumors

Primary spinal cord tumors represent 4.5% of all central nervous system neoplasms. They are either intradural intramedullary or intradural extramedullary. Intramedullary tumors are predominantly intrinsic gliomas (astrocytomas and ependymomas). Spinal ependymomas can usually be completely removed by separating the tumor from the spinal cord and, when complete, no further therapy is required. Astrocytomas, by contrast, infiltrate the myelon, and therefore surgery is frequently incomplete. Intradural extramedullary tumors are mostly benign (WHO grade 1) and comprise either peripheral nerve sheath tumors (neurofibromas and schwannomas) or meningiomas. Complete resection can be performed on both lesions and is often curative. Radiotherapy is indicated for primary malignant tumors (WHO grade 3 and higher) and for patients in whom surgery is contraindicated. For grade 1 and 2 tumors, the role of radiotherapy is controversial. Chemotherapy is reserved for recurrent primary spinal cord tumors with no other options. However, the lack of clinical trials for these tumors is problematic. Consequently, treatment is similar to that for intracranial histologies. Early recognition of the signs and symptoms of primary spinal cord tumors facilitates early treatment, potentially minimizes neurologic morbidity, and improves outcome. Primary treatment for almost all spinal cord tumors is surgery, with predictors of outcome being preoperative functional status, grade of tumor, and extent of resection.     

应用后路钛网椎管成形术治疗胸椎椎管内肿瘤

目的椎管内肿瘤全椎板减压术是椎管内肿瘤摘除的常规手术方式,术后易造成椎管内粘连导致椎管再次狭窄引起一系列的并发症,造成2次手术困难,本文对这一术式进行改良,采用后路钛网椎管成形对所减压的椎管进行修复重建,恢复椎管内有效容积、减少粘连。方法2007年10月至2011年2月共收治9例胸椎椎管内肿瘤的患者,男6例,女3例,年龄25～64岁,平均37．8岁。硬膜外肿瘤5例,硬膜内肿瘤4例。全部给予后路全椎板减压,肿瘤切除,椎弓根钉内固定并钛网椎管成形术。术后病理学诊断：神经鞘瘤3例,脊膜瘤2例,脂肪瘤2例,囊肿2例。肿瘤复发1例,给予2次手术切除后未复发。结果手术时间90—185min,平均142min,失血量200-1200ml,平均521ml,全部9例患者术后得到定期随访12—45个月,平均21个月。采用Frankel评分标准对术后患者症状进行评价,A：0例,B：1例,C：3例,D：2例,E：3例。术后复发1例。术后CT显示椎管内未出现粘连。对术前术后肿瘤占位所在节段椎管横截面CT图片进行分析,每例患者随机取5个横截面进行椎管内矢状径测量,取平均值,术前矢状径为16．89±1．27mm,术后矢状径为27．11±2．52mm,进行配对,检验,t=-15．441,P〈0．01,术后椎管矢状径明显大于术前。结论后路钛网椎管成形手术难度相对较低,减少手术时间,降低术中出血量,术后对椎管起到较好的即刻保护作用,同时增加了术后椎管容积,减少了术后粘连,为肿瘤复发后的2次手术剥离减少风险。     

Spinal extramedullary anaplastic ependymoma with spinal and intracranial metastases

Summary We describe a 29-year-old woman who presented with progressive neck pain, sensory deficit and weakness in both arms. Magnetic resonance imaging (MRI) of the cervical spine revealed an extramedullary tumor with severe spinal cord compression. During surgery an intradural extramedullary tumor was found. Further imaging showed a second lumbar spinal tumor. Microscopy of both tumors showed that both tumors were anaplastic ependymomas, which almost never present as extramedullary tumors. Two years after surgery, an intracranial extracerebral metastasis was found, without evidence of spinal recurrence.     

胸腰椎脊髓外硬脊膜内肿瘤手术中脊柱稳定性重建探讨

目的探讨胸腰椎脊髓外硬脊膜内肿瘤手术中脊柱稳定性重建的重要性。方法选取2005年6月至2008年3月间收治的80例胸腰椎脊髓外硬脊膜内肿瘤患者,在手术治疗的同时采用椎弓根钉-棒内固定-植骨融合术进行脊柱稳定性重建,术后随访5个月至5年,对患者的脊柱稳定性进行观察。结果术后通过X射线检查确定,12例未作内固定患者中,4例患者发生轻度脊柱失稳,68例进行内固定患者均未出现脊柱失稳征象,所有患者的植骨均融合良好,融合时间2~6个月,平均为（3.5±1.6）个月。随访期间80例患者未出现肿瘤复发或内固定松动、断裂。结论胸腰椎脊髓外硬脊膜内肿瘤患者的脊柱稳定性对手术治疗效果有重要影响。     

Intradural extramedullary spinal nerve sheath myxoma: a report of two cases

Nerve sheath myxoma, a myxoid variant of schwannoma, is a dermal tumor that usually occurs in the upper extremities, head and neck region, or trunk; occasionally, however, it has also been reported to develop in the spinal canal. Here, we describe two cases of intraspinal nerve sheath myxoma. Case 1 was a 74-year-old man with left hypochondrial pain. Gadolinium-enhanced magnetic resonance imaging (MRI) of his spine revealed a well-demarcated intradural extramedullary tumor with peripheral enhancement at the Th8 level. Case 2 was a 58-year-old man with lower back and left buttock pain. Gadolinium-enhanced MRI revealed a well-demarcated intradural extramedullary tumor with peripheral enhancement at the Th12-L1 level. Both cases were clinically diagnosed as schwannoma. Histological studies revealed characteristic myxoid lobules which were separated by fibrous septa or bands of more compact cellular area. The tumor cells were diffusely positive for S-100 and focally positive for Schwann/2E, which reacts with Schwann cells and myelin in the peripheral nervous system. The positive reaction to Schwann/2E confirmed the occurrence of peripheral nerve sheath differentiation. Nerve sheath myxoma should be included in differential diagnosis of spinal canal tumors.     

A clinicopathological study of the spinal leptomeningeal dissemination from cerebral malignant gliomas without a recurrence of the primary lesions

Reported are three cases of a spinal leptomeningeal dissemination from supratentorial malignant gliomas, in which the recurrence of the primary tumors of the intracranial leptomeningeal involvement was not observed clinicopathologically. All cases complained of spinal cord symptoms such as paraplegia or a sensory disturbance from time to time after the initial operation for their intracranial primary tumors. The duration between the first operation and the appearance of the spinal cord symptoms ranged from 11 to 17 months. In all cases, a computerized tomography scan demonstrated no recurrence of the primary tumor and no findings indicating intracranial leptomeningeal gliomatosis, such as a diffuse contrast enhancement of the ventricular wall or the subarachnoidal space, or hydrocephalus. Myelography showed a block or an irregular filling defect in two cases given immediate operations for spinal mass lesions. In one of these cases, a well-defined extramedullary tumor was removed at the level of the 7th-8th thoracic vertebrae. The pathological diagnosis was a glioblastoma multiforme, which was similar to the primary tumor. The patient survived for 18 months after total removal of the spinal tumor followed by postoperative spinal irradiation. All patients died of recurrent tumors from 3 to 18 months (mean: 8 months) after the appearance of the spinal cord symptoms. In the other case, an intramedullary tumor was found by a laminectomy. These two cases were autopsied. In one, an intramedullary tumor was found to extend from the lower medulla oblongata to the cervical cord, whereas the recurrence of the primary tumor was not seen and there was no intracranial leptomeningeal invasion nor any spinal subarachnoid seeding. The pathological diagnosis of this intramedullary tumor was a glioblastoma. In the other, there was a diffuse leptomeningeal dissemination of glioblastoma multiforme throughout the spinal cord, with an intramedullary invasion to almost all parts. A partial intracranial subarachnoid seeding of a malignant lower grade tumor than seen in the spinal lesion was found, though there was no recurrence of the primary tumor.     

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。     

胸腰椎神经鞘瘤手术治疗的临床分析

目的　探讨胸腰椎神经鞘瘤应用后正中入路实施一期肿瘤切除手术的疗效及并发症。方法　２００１年至２０１０年我科收治胸腰椎椎管内神经鞘瘤患者３９例,其中男性２５例,女性１４例;年龄１４～７２岁,平均年龄４１.５岁;发病部位：胸段椎管１７例,胸腰段椎管４例,腰段椎管１５例,腰骶段椎管３例,均为单发。手术均取后正中切口,切除相应节段的小关节突和椎板,一期切除椎管内外的神经鞘瘤,部分患者行椎弓根螺钉内固定。结果　３９例手术均完整切除肿瘤。随访时间为１０～６９个月,平均３５个月。１例良性神经鞘瘤术后局部复发,１例恶性神经鞘瘤患者术后１７个月因复发及肺转移死亡。２２例存在感觉障碍的患者术后ＡＳＩＡ感觉评分平均提高１.６分。１０例存在运动障碍的患者术后ＡＳＩＡ运动评分提高７例,平均提高２.５分。未行内固定的６例患者中术后有２例发生脊柱失稳。结论　胸腰椎神经鞘瘤切除术中需确保术野足够显露,必要时可切除一侧的横突和肋骨头,为勉强保留神经根而忽略肿瘤切除的彻底性可能带来较高的局部复发率和相应增高的再次手术率。除肿瘤位于中段胸椎管外,术中均应通过确切的内固定和植骨融合来维持远期的脊柱稳定性。     

显微手术治疗颈段椎管内肿瘤预后的相关影响因素分析

目的分析显微手术治疗颈段椎管内肿瘤预后的相关影响因素。方法选取颈段椎管内肿瘤患者79例,均行显微手术治疗,统计预后效果,收集患者性别、年龄、肿瘤直径、肿瘤性质等信息,分析预后相关影响因素。结果 79例患者中,预后良好63例(79.75%),预后不良16例(20.25%)。年龄、肿瘤直径、肿瘤性质、手术方法、肿瘤切除情况、术中有无神经电生理监测、术前肌力情况、术后是否使用激素是颈段椎管内肿瘤患者预后不良的影响因素(P<0.05);Logistic回归分析显示,年龄≥60岁、肿瘤直径≥4 cm、恶性肿瘤、全椎板手术、肿瘤次切除、术中无神经电生理监测、术前肌力<3级、术后未使用激素为颈段椎管内肿瘤患者预后不良的危险因素(P<0.05)。结论老年患者、肿瘤直径长、恶性肿瘤、全椎板手术、肿瘤次切除、术中无神经电生理监测、术前肌力分级低、术后未使用激素是显微手术治疗颈段椎管内肿瘤预后不良的危险因素,临床可据此制定合理防范措施,提高预后效果。     

脊髓血管网状细胞瘤的显微外科治疗——附38例临床分析

背景与目的：脊髓血管网状细胞瘤诊断困难，且手术风险较高，本研究旨在探讨其诊断及显微外科治疗。方法：分析38例患者的MRI表现及其显微外科手术治疗的效果。结果：根据肿瘤在MRI及DSA上的表现可以确诊的病例均行肿瘤显微手术全切除术。术后患者神经系统症状好转者28例，8例无改善，2例加重。结论：MRI能对髓内血管网状细胞瘤作出诊断，而DSA则能帮助了解肿瘤血液供应情况．必要时可在术前先行栓塞，减少术中出血，降低手术风险，减少术后并发症。手术时应在显微镜下严格沿肿瘤界面进行分离，先离断动脉后处理静脉，尽量避免分块切除而力争整块全切，这是减少术中出血和避免神经功能损害的关键．术中电生理监测,对减少术中脊髓、神经损伤非常有帮助。