高颈髓髓内肿瘤显微外科治疗分析

目的 探讨显微神经外科手术治疗高颈髓髓内肿瘤的方法及临床疗效.方法 回顾分析我院显微外科手术切除15例高颈髓髓内肿瘤的临床资料.其中达到镜下全切除9例,次全切除3例,部分切除或活检3例.结果 术后病理显示:室管膜瘤8例,星形细胞瘤5例,血管母细胞瘤2例.平均随访25个月,症状好转13例,无变化1例,1例症状加重.结论 对脊髓髓内病变应早期诊断,显微手术治疗高颈髓髓内肿瘤可取得较好疗效.     

脊髓髓内肿瘤的手术治疗

目的：探讨各种病理类型的脊髓髓内肿瘤临床和影像学的鉴别诊断，肿瘤囊腔及其空洞的形成机理，脊髓前动脉在病理状态下的作用及各种肿瘤的手术切除技巧。方法：系统分析了经显微手术切除的１０４例（１１６个）髓内肿瘤，包括室管膜瘤，星形细胞瘤，血管网状细胞瘤等十余种病理类型的临床资料，并进行了动物脊髓血管闭塞模型的研究。结果：全组无手术死亡率，亦无手术致残者。绝大多数病人得到满意疗效，并保证了患者良好的术后存活质量。结论：对于绝大多数髓内肿瘤，显微外科手术治疗是目前最根本的治疗方法。强调早期治疗及对不同肿瘤采取相应的微创性手术技巧。对于那些疯狂侵润性生长的恶性肿瘤，要考虑一定剂量的常规放射治疗。     

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。     

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。     

脊髓髓内肿瘤及显微外科治疗

目的 探讨脊髓髓内肿瘤的诊断和显微手术切除方法。方法 对16例脊髓髓内肿瘤手术患者进行回顾性研究。结果 肿瘤全切除10例,近全切除4例,大部切除2例,术后12例均有不同程度的改善和好转,1例肌力较术前减退,3例未见明显好转。随访3个月～4年,室管膜瘤复发1例,星形细胞瘤复发3例,其余未见复发。结论 脊髓髓内肿瘤应作显微手术切除,避免或减少脊髓损伤,尽量做到全切除,减少术后的复发。     

积极开展脊髓髓内肿瘤的显微外科治疗

8脊髓髓内肿瘤并不少见,根据国内外文献报告占椎管内肿瘤的１５％～２０％。脊髓髓内肿瘤位于颈段者占４５％,位于胸段者占３９４％。由于切除肿瘤的操作过程中常并发脊髓损伤、缺血和水肿,可加重患者原有症状和体征,特别是高颈段髓内肿瘤术后可发生呼吸功能障碍,排痰困难,高热,上消化道出血等严重并发症,故以往认为脊髓髓内肿瘤特别是高颈段髓内肿瘤切除术是十分危险的,多数人对本病的手术治疗持悲观态度。７０年代以前,对髓内肿瘤多倾向于采取活检、椎板切除减压术及放疗等姑息治疗方法,患者的预后大多极差。其原因主要有两…     

166例脊髓髓内肿瘤的手术疗效分析

目的:探讨脊髓髓内肿瘤的治疗方法。方法:回顾性分析1993年1月-2 0 0 2年2月,我科收治的166例脊髓髓内肿瘤患者的病史资料,总结分析患者术前脊髓功能、肿瘤类型、手术方法、近期疗效、随访结果等情况。结果:本组室管膜瘤87例,星形细胞瘤41例,血管母细胞瘤16例,海绵状血管瘤8例,脂肪瘤6例,其他少见肿瘤8例;术前以中度脊髓功能障碍者居多。165例(99.9% )患者采用后正中入路,1例采用经肋骨横突入路。肿瘤全切除13 7例(82 .5 % ) ,次全切除2 0例(12 .1% ) ,部分切除9例(5 .4% )。出院时症状体征改善者84例(5 0 .6% ) ,稳定者5 1例(3 0 .7% ) ,加重者2 8例(16.9% ) ,死亡3例(1.8% )。获随访者62例,随访期平均5 .2 9年,随访结果死亡6例(9.7% ) ,存活5 6例(90 .3 % ) ,其中9例(16.1% )恢复工作能力,2 4例(4 2 .9% )生活能自理,15例(2 6.8% )生活能部分自理,8例(14 .2 % )生活完全不能自理。结论:对髓内肿瘤宜采取积极手术治疗的态度,根据不同病理类型、不同部位采用不同治疗策略,应用适当手术入路与手术技巧可获得良好效果。     

髓内肿瘤显微手术治疗中的若干问题

随着磁共振和显微外科技术的发展,越来越多的人主张积极手术切除髓内肿瘤,并取得了良好的效果。本文详细介绍了髓内肿瘤显微手术治疗工作中普遍关心的手术时机、术中神经电生理监护、肿瘤切除技巧、脊柱稳定性以及术后是否放疗、化疗等问题。     

高颈段髓外肿瘤的显微外科治疗

我院自1995年1月至2003年6月共收治高颈段髓外肿瘤34例,手术治疗效果满意,现报告如下. 一、对象与方法 1. 临床资料:本组男19例,女15例;年龄20～73岁,平均33.2岁;病程1～15年.临床表现为颈肩部疼痛20例,神经根刺激症状、肢体麻木、疼痛16例,不同程度的感觉及运动障碍、肌肉萎缩10例.单纯椎管内髓外硬膜下肿瘤25例,哑铃型肿瘤9例.     

显微手术治疗脊髓髓内肿瘤

目的探讨显微手术治疗脊髓髓内肿瘤的效果。方法我科2002年至2006年采用显微手术治疗脊髓髓内肿瘤15例,其中室管膜瘤8例,星形细胞瘤5例,海绵状血管瘤2例。结果肿瘤全切除11例,大部分切除4例(均为星形细胞瘤)。出院时10例症状有不同程度改善,4例无变化,1例术后加重,无手术死亡病例。结论把握适当的手术时机,结合术前影像学检查结果,术中在显微镜下仔细分辨肿瘤与脊髓的分界面,这些都将有助于提高显微手术治疗脊髓髓内肿瘤的临床疗效。     

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。     

Retrospective study of 19 patients with intramedullary spinal cord metastasis

Object

Intramedullary spinal cord metastasis (ISCM) is a rare but devastating complication of cancer. Due to both widespread MRI availability and longer survival of cancer patients, the probability of discovering an ISCM during the course of the disease has increased and raised issues regarding the management of these patients, and particularly the place of surgery. In this study, we assess predictive factors for surgical outcome and survival.

Patients and methods

We retrospectively reviewed a series of 19 patients consecutively admitted in our institution from 1993 to 2006 for ISCM, representing the second largest series published in the literature. MRI was performed on all patients. Thirteen underwent microsurgical excision of ISCM. Functional outcome was evaluated and factors influencing survival were statistically analyzed.

Results

Median survival was statistically longer when surgery was performed (7.4 vs. 2.6 months). Preoperative neurological status, nature of primary cancer, presence of systemic and/or CNS metastases influenced survival, but differences were without statistical significance. Neurological status improved in 58% (11/19) of operated patients.

Conclusions

Optimal management of patients with ISCM is difficult due to the wide variety of clinical situations and the lack of controlled studies on the results of different therapeutic options. Diagnosis should be made as early as possible and surgical resection should be considered as the primary treatment whenever feasible, particularly in the case of rapidly progressive neurological deficits and when a clear cleavage plane exists. Our study shows that surgery could result in both increased survival rate and significant improvement of neurological function.     

Spinal deformity after resection of cervical intramedullary spinal cord tumors in children

Objective Progressive spinal deformity after cervical intramedullary spinal cord tumor (IMSCT) resection requiring subsequent fusion occurs in many cases among pediatric patients. It remains unknown which subgroups of patients represent the greatest risk for progressive spinal deformity. Materials and methods The data for 58 patients undergoing surgical resection of cervical IMSCT at a single institution were retrospectively collected and analyzed for development of progressive spinal deformity requiring fusion. The association of all clinical, radiographic, and operative variables to subsequent progressive spinal deformity as a function of time was assessed via Kaplan–Meier plots and Log-rank and Cox analyses. Results Mean age at the time of surgery was 11 ± 6years. Eleven (19%) patients required subsequent fusion for progressive spinal deformity at a median [interquartile range (IQR)] of 4 (2–6) years after IMSCT resection. Five (36%) of 14 patients with preoperative scoliosis or loss of lordosis developed postoperative progressive spinal deformity compared to only 6 (13%) of 44 patients with normal preoperative sagittal and coronal balance, p = 0.06. Patients <13years of age were more than three times more likely to develop postoperative progressive deformity, p = 0.05. Decompression spanning both the axial cervical spine (C1–C2) and the cervico–thoracic junction (C7–T1) increased the risk for progressive spinal deformity fourfold, p = 0.04. Number of spinal levels decompressed, revision surgery, radiotherapy, involvement of C1–C2 or C7–T1 alone in the decompression, or any other recorded variables were not associated with progressive postoperative spinal deformity. Conclusion Patients possessing one or more of these characteristics should be monitored closely for progressive spinal deformity after surgery.     

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.     

Pediatric intramedullary spinal cord tumors Critical review of the literature

The objective of this review was to analyze the literature on the management of intramedullary spinal cord tumors to determine whether enough information was available for treatment guidelines to be established. Using standard computerized search techniques, databases containing medical literature were queried for keywords related to intramedullary spinal cord tumors, beginning in 1966. Of the 445 articles published in English and with potential relevance, only 75 articles were included in the final analyses. Based on the strength of their recommendations for the treatment of this controversial condition, articles were divided into class I, class II and class III data. There were no class I studies related to any aspect of the treatment of intramedullary spinal cord tumors. Based on this critical review of literature, gross total removal of an ependymoma confirmed by immediate postoperative magnetic resonance imaging and adjunctive treatment for high-grade tumors using radiotherapy, with or without chemotherapy, can be recommended as standards of therapy. With the strength of a guideline, radiotherapy should be withheld after gross total removal of intramedullary ependymomas and radical resection of low-grade intramedullary astrocytomas. The use of intraoperative ultrasonography and evoked potentials, important surgical adjuncts, can also be considered guidelines. The radical resection of intramedullary low-grade astrocytomas is an option. Received: 15 October 1998     

Recurrent intramedullary enterogenous cyst of the cervical spinal cord

Intramedullary enterogenous cysts of the cervical spinal cord are rare. We report a case of symptomatic recurrence of this type of cyst 8 years following its original surgical treatment.     

Neurological outcome after resection of intramedullary spinal cord tumors in children

Objective With modern surgical advances, radical resection of pediatric intramedullary spinal cord tumors (IMSCT) can be achieved with preservation of long-term neurological function. Clinical and radiographic risk factors predictive of postoperative neurological outcome may serve as a guide for surgical risk stratification. Materials and methods We prospectively reviewed the outcomes of 16 consecutive cases of pediatric IMSCT resection at a single institution. Clinical, radiographic, and operative variables were analyzed as predictors of postoperative neurological function defined by the modified McCormick score (MMS). Results Sixteen children 10 ± 5 years old presented with median (interquartile range) MMS score of 2 (1–2) with IMSCTs (eight cervical, eight thoracic) involving 4 ± 2 levels. Pathology revealed astrocytoma in 12 cases (three pilocytic, four grade II, three gradeIII, two GBM), gangliogliomas in two, ependymoma in one, and gliosis in one case. At median follow-up of 7 months, six (38%) patients experienced improved neurological function, eight (50%) remained stable, one (6%) experienced a delayed decrease in neurological function (GBM progression), and one (6%) died (GBM progression). Five (31%) patients developed persistent dysesthetic symptoms. Four (80%) patients with cystic tumors experienced neurological improvement compared to only two (18%) patients with noncystic tumors, p < 0.05. Preoperative steroid use (odds ratio, OR [95% confidence interval, CI] = 18.0 [1.24–260.1], p = 0.03) and cystic tumor (OR [95%CI] = 18.0 [1.24–260.1], p = 0.03) predicted neurological improvement after surgery. Conclusion Radical resection of pediatric IMSCTs can be achieved with low incidence of neurological injury. Sensory syndromes frequently occur after pediatric IMSCT resection and frequently affect patient’s quality of life. Tumors with compressive cysts may identify patients more likely to experience improved neurological function after surgical resection.     

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。     

Microsurgical removal of intramedullary spinal cord gliomas in a rat spinal cord decreases onset to paresis,an animal model for intramedullary tumor treatment

OBJECTIVE: Intramedullary spinal cord tumors (IMSCT) pose significant challenges given their recurrence rate and limited treatment options. Using our previously described rat model of IMSCT, we describe a technique for microsurgical tumor resection and present the functional and histopathological analysis of tumor progression. METHODS: Twenty-four Fischer 344 rats were randomized into two groups. All animals received a 5-mul intramedullary injection of 9L gliosarcoma cells. Animals were evaluated daily for signs of paralysis using the Basso, Beattie, and Bresnahan (BBB) scale. Group 1 continued with daily assessments using the BBB scale following tumor implantation, but received no further treatment. Group 2 underwent surgical removal of intramedullary tumor on postoperative day five. At a BBB score less than 5 (e.g., functional paraplegia), all animals of both groups were killed and sent for histopathological analysis. RESULTS: Group 1 had a median onset of functional hind limb paraplegia at 15 +/- 1.0 days. Group 2 had a median onset of hind limb paresis at 53 +/- 0.46 days. Hematoxylin-eosin cross-sections confirmed the presence of intramedullary 9L tumor invading the spinal cord in both groups. CONCLUSION: Animals with 9L IMSCTs consistently developed hind limb paraplegia in a reliable and reproducible manner. Animals undergoing microsurgical resection of IMSCT had a significant delay in the onset of functional paraplegia compared to the untreated controls. These findings suggest that this model may mimic the behavior of IMSCTs following operative resection in humans and thus may be used to examine efficacy of new treatment options for high-grade intramedullary tumors.