脊髓肠源性囊肿的显微外科手术治疗

目的探讨脊髓肠源性囊肿的临床、组织病理及形态学特点.方法回顾性分析自1983年至2003年11例脊髓肠源性囊肿病例.临床表现为病变相应部位的神经根性疼痛和脊髓压迫症状.11例患者的影像学分别为髓外型6例、髓内型3例和哑铃型2例.结果全部手术的11例患者中,7例全切(均为髓外型和哑铃型),4例次全和部分切除.5例神经根痛症状明显减轻或消失,下肢肌力减弱2例明显改善,2例无变化.1例术前截瘫患者,术后1周肌力恢复为Ⅲ～Ⅳ级.尿失禁1例术后无明显变化.结论肠源性囊肿早期采取手术切除,是治疗此病的最佳方法.     

脊髓蛛网膜囊肿的显微手术治疗

一、临床资料本组共 2 8例 ,男 17例 ,女 11例。年龄 7～ 5 8岁 ,平均 32 4岁。术前病程 6个月至 12年 ,平均 2 1 6月。囊肿部位颈段 3个 ,胸腰段 19个 ,骶部马尾 6个。临床表现肌力障碍 2 8例 ,深感觉障碍 13例 ,浅感觉障碍18例 ,二便障碍 10例 ,自发疼痛 15例。有明显感染史者 2例 ,有外伤史者 4例 ,不明原因者 2 2例。本组 2 8例全部做ＭＲＩ检查 ,其中 3例呈蛛网膜囊肿样改变 ,有占位效应。其余 2 5例表现脊髓明显增粗 ,呈均匀低信号 ,常伴有多个囊腔。Ｔ2显示异常高信号 ,难以区分界限。强化扫描囊肿壁显示局限性强化。二、结果2 8例…     

脑干脊髓腹侧肠源性囊肿的显微手术治疗

目的 探讨位于脑干及脊髓腹侧肠源性囊肿的诊断及显微手术方法.方法 回顾位于脑干脊髓腹侧肠源性囊肿8例,其中4例颅颈交界部囊肿采用远外侧手术入路,3例颈段采用后正中入路,1例胸段采用胸椎侧前方入路进行手术切除.结果 MRI是早期诊断肠源性囊肿的有效手段.7例囊肿获得全切除,1例大部切除;所有患者术后神经功能恢复良好.结论 肠源性囊肿虽然是先天性良性肿瘤,但多位于脑干、脊髓腹侧,手术易造成脑干、脊髓损伤,全切除难度大;采用枕下远外侧经髁入路或胸椎侧前方入路,通过显微外科操作可在对脑干、脊髓最小干扰下获得全切除.     

小儿椎管内肠源性囊肿的显微手术治疗

目的 总结12例小儿椎管内肠源性囊肿的显微手术经验.方法 回顾性分析2005年1月至2012年4月收治的12例椎管内肠源性囊肿患儿的临床表现、显微手术过程及治疗效果.结果 12例囊肿均行显微手术切除,全切7例,次全切5例.所有病例临床症状及神经功能短期内均有改善.随访4个月至6年,除1例单侧下肢肌力Ⅳ级外,其余均恢复正常.随访期间无复发.结论 显微手术切除是治疗椎管内肠源性囊肿惟一有效方法,全切或次全切均能达到满意的疗效.正确的显微手术操作是取得满意疗效及避免并发症的保证.     

脊髓肠源性囊肿20例分析

脊髓肠源性囊肿是少见的先天性椎管内良性瘤样病变。我院1976～1990年经手术和病理证实的脊髓肠源性囊肿20例,现报告如下。     

显微手术治疗颅内蛛网膜囊肿

颅内蛛网膜囊肿 (ｉｎｔｒａｃｒａｎｉａｌａｒａｃｈｎｏｉｄｃｙｓｔ,ＩＡＣ)是非肿瘤良性病变 ,约占颅内占位性病变的 0 .4 %～ 1.0 % [1] 。一般认为有症状的ＩＡＣ需手术治疗 ,手术方法较多 ,但并非全部有效 ,部分患者仍有复发。我科从 1998至 2 0 0 1年间收治有症状的ＩＡＣ患者 5 9例。其中 34例行常规开颅 ,ＩＡＣ囊壁肉眼大部分切除术 ,效果不甚理想 ,复发率较高 ,其余 2 5例行显微手术治疗 ,取得了较为满意的结果 ,现报告如下一、对象与方法1.临床资料 :本组男 18例 ,女 7例 ,年龄 15～ 4 8岁 ,平均31.5岁。病程 4周～ 5年不等。…     

脊髓圆锥髓内肿瘤的诊断及显微手术治疗

目的探讨脊髓圆锥髓内肿瘤的诊断及显微手术技巧。方法回顾性分析9例显微手术切除的脊髓圆锥髓内肿瘤的临床资料。结果肿瘤全切2例,次全切5例,部分切除2例。术后随访648个月,症状明显改善8例,复发死亡1例,Mc Cormick分级：Ⅰ级6例,Ⅱ级2例。结论脊髓圆锥髓内肿瘤多为低级别胶质瘤或良性肿瘤。手术全切除较困难,但争取手术全切或次全切除可获得良好预后。     

脊髓髓内肿瘤的显微手术治疗

目的研究脊髓髓内肿瘤的显微手术技巧。方法回顾分析了25例采用显微手术切除的脊髓髓内肿瘤病例。结果全切除18例,次全切除4例,部分切除3例。术后随访3～78个月,19例结果良好,6例结果差(3例死亡)。结论显微手术治疗脊髓髓内肿瘤大多数结果良好。不同类型的肿瘤采用不同的手术方法,熟练的显微技术和对脊髓保护的意识是手术成功的关键。     

脊髓血管母细胞瘤的显微手术治疗

目的脊髓血管母细胞瘤相对少见，本文总结显微外科手术治疗脊髓血管母细胞瘤的经验，探讨其治疗方法。方法回顾性分析近10年来显微外科手术治疗12例脊髓血管母细胞瘤的临床资料、治疗方式及术后转归。结果本组12例患者中男7例，女5例；年龄25～54岁，平均37岁；8例为单发病灶：位于颈段2例，胸段5例，腰段1例；4例为多发病灶：1例为颈段2个病灶，1例为胸段2个病灶，2例为胸腰段各1个病灶。12例患者均经手术全切除病变，病理学诊断为血管母细胞瘤；术后运动及感觉障碍改善7例，不明显3例，即刻加重1个月内恢复2例；无手术死亡病例。随访6～60个月，未见1例复发。结论脊髓血管母细胞瘤手术治疗效果好，有症状者应早期手术治疗。强调显微手术镜下操作，有助于肿瘤全切除和保护脊髓。     

显微手术治疗颅内蛛网膜囊肿

一、临床资料1 .一般资料 :男 58例 ,女 2 8例 ,男∶女为 1∶0 48。年龄 1 0～ 61岁 ,平均 (2 4 5± 3 4)岁。病程 3个月至1 5年 ,平均 (2 1± 2 5)年。 2例病前有颅脑外伤史 ,1例有脑炎史。2 .临床表现 :癫痫大发作 2 9例 ,类神经分裂症偏执型 6例 ,抑郁状态 1 2例 ,躁狂状态 5例 ,类癔症样发作 1例 ,焦虑状态 2例 ,多动症 2例 ,颅高压症状 1 5例 ,局灶性神经系统症状和定位体征 1 6例。3 .囊肿部位 :透明隔 2 2例 ,外侧裂池 2 5例 (左 1 0 ,右 1 5) ,枕大池7例 ,顶叶 8例 (左 6 ,右 2 ) ,额叶 9例 (左 3 ,右 6) ,小脑半球 3例 (左1 ,…     

Spontaneous hemorrhage into spinal neurenteric cyst

Case report A case of spontaneous hemorrhage into an intradural extramedullary neurenteric cyst at the C4–C6 level in a 6-year-old boy is reported. The child presented with sudden neck pain, torticollis, and myelopathy. The cyst was of high signal intensity on both T1- and T2-weighted magnetic resonance images, suggesting hemorrhage into the cyst. The combination of CT and MR provided useful preoperative information regarding the nature and the location of the cyst. A posterior approach via osteoplastic laminotomy was used for this anteriorly localized cyst. The use of intraoperative ultrasound was helpful in identifying and puncturing the cyst to minimize the spinal cord manipulation during the excision of the cyst wall.Discussion We report the first documented case of hemorrhage into a spinal neurenteric cyst that has been confirmed surgically and histopathologically.     

Cervico-thoracic neurenteric cyst: clinicoradiological correlation with embryogenesis

Two cases of cervico-dorsal neurenteric cysts are presented, one located dorsal and the other ventral to the spinal cord, with associated Klippel-Feil anomaly, meningocele, spinal dysraphism and possibly spinal cord malformation. One patient was operated on as a neonate for a cervico-thoracic meningocele and presented during adolescence with spastic quadriparesis. Imaging revealed spina bifida, a dorsally located neurenteric cyst and a tendency towards split cord malformation. The other child presented with cervicothoracic kyphoscoliosis and paraparesis. Imaging demonstrated persistence of a cervico-thoracic remnant of the primitive neurenteric canal through the upper thoracic spine.     

Intraparenchymal temporal neurenteric cyst

A 41-year-old male presented with a rare temporal intraparenchymal neurenteric cyst. A definitive preoperative diagnosis was not possible based upon the neuroradiological features. A complete excision of the cyst was achieved. Histopathology confirmed the diagnosis of a neurenteric cyst, an endodermally derived lesion of the central nervous system.     

Cerebellopontine angle neurenteric cyst with focal malignant features

Neurenteric cysts are uncommon cystic lesions lined by endodermal‐derived epithelium, which are rarely found in the CNS, especially in the intracranial region. Although recurrences and disseminations of these cysts have been reported, only one case of intracranial malignant transformation has previously been described. Here we report a cerebellopontine angle neurenteric cyst in a 26‐year‐old woman. The cyst wall was lined by columnar epithelium with atypical nuclei and high MIB‐1 index. In addition, stromal invasion was found in the subepithelial areas, which shows malignant features. Dissemination was speculated on MRI 6 months after total excision of the original cyst.     

斜坡表皮样囊肿的显微外科治疗

目的：报道２４例颅底斜坡区表皮样囊肿的显微外科治疗，就其手术入路及肿瘤切除程度加以讨论。方法：分析了临床特点和ＣＴ、ＭＲＩ影像的特征性表现和特殊生长形状，深入分析其手术方法、手术结果和术后并发症等。结果：肿瘤全切除１５例，次全切除７例，大部切除２例，无手术死亡。术后有９例症状体征完全恢复。术后并发症以无菌性脑膜炎最多见，本组９例术后出现持续性高热及颈强直，经连续腰穿放脑脊液治疗后痊愈。可逆性颅神经功能障碍也常见，外展神经麻痹４例，后组颅神经麻痹３例，滑车神经及面神经麻痹各１例。术后迟发血肿４例。结论：颅底斜坡区表皮样囊肿手术选择颞枕经小脑幕入路和经桥小脑角（ＣＰＡ）入路是最常使用的手术入路。手术全切肿瘤及包膜可减少无菌性脑膜炎的发生。对减少术后迟发血肿的发生亦有裨益。     

Supratentorial neurenteric cysts—A fascinating entity of uncertain embryopathogenesis

The histopathological, immunologic, and ultrastructural findings of neurenteric cysts support an endodermal derivation. These developmental cystic lesions are generally located in the posterior mediastinum, abdomen, and pelvis and may also contain some mesodermal and neuroectodermal elements. In contrast, neurenteric cysts of the central nervous system are very infrequent and occur most commonly in the spinal canal. Intraspinal neurenteric cysts are usually encountered in the cervicothoracic region with an intradural, extramedullary location and are commonly associated with congenital defects of the overlying skin and/or vertebral bodies.