髓外硬膜内肿瘤诊断与手术治疗分析

目的探讨髓外硬膜内肿瘤的诊断及手术治疗效果。方法回顾分析我院1996年6月～2009年12月期间治疗的23例髓外硬膜内肿瘤。肿瘤位于颈段2例,胸段16例,腰段5例。神经鞘瘤14例,脊膜瘤8例,神经纤维瘤1例。出现症状至确诊时间1月～6年。采用CTM诊断4例,用MRI诊断19例。术前JOA评分4～15分,平均8.7分。全部病例均以后路手术切除肿瘤。结果手术均完全切除肿瘤。随访6个月～13年,平均1年6个月。所有患者神经功能障碍均有明显改善或缓解,其中2例未完全恢复。术后半年时JOA评分12.7分(10～17分)。全部病例均未见复发,且脊柱稳定性良好。结论髓外硬膜内肿瘤易于误诊漏诊,临床可疑者,MRI或CTM检查可帮助确诊;后路全椎板切除或椎管后中央扩大开窗均可充分显露并彻底切除肿瘤。     

椎管内硬膜下肿瘤的手术治疗

[目的]探讨颈椎管内硬膜下肿瘤的手术治疗方法及疗效。[方法]回顾性分析经手术治疗的21例颈椎管内硬膜下肿瘤患者的I临床资料及治疗效果，所有病人均行颈椎后路椎板切除椎管减压进行肿瘤切除，部分病人并行后路钉棒系统内固定。[结果]15例完全切除，4例次全切除，2例部分切除；症状消失13例，症状减轻7例，症状恶化1例，无死亡病例发生。[结论]术前根据影像学资料仔细评价肿瘤大小及肿瘤与脊髓的关系是决定手术成功的关键，术中仔细操作避免损伤脊髓，并注意保护好椎动脉及防止椎管内静脉丛大出血，是将肿瘤完全切除的前提。     

髓外硬膜下肿瘤的手术治疗与临床效果

[目的]探讨髓外硬膜下肿瘤的诊断、手术方法和临床效果.[方法]患者45例,男28例,女17例;年龄24～71岁,平均45岁.术前影像学检查结果示椎管内髓外硬膜下占位.行后路常规手术入路,全椎板切除,尽量保留小关节突,打开硬膜,直视下神经剥离子分离肿瘤并切除,而后行椎弓根螺钉固定,恢复脊柱稳定性.[结果]随访6～42个月,平均26.2个月.术后Otani'S分级优11例,良18例,优良率64.44%,其中初次就诊至确诊并手术时间在1个月内的患者术后Otani'S等分级方法优良率(84.62%)优于因误诊、漏诊而延迟手术的1～6个月组(64.29%)及＞6个月组(50%).[结论]手术切除肿瘤是治疗髓外硬膜下肿瘤的首选方法,早期确诊及时手术治疗是获得良好临床效果的关键.     

椎管内髓外硬膜下肿瘤的外科治疗

目的：探讨椎管内髓外硬膜下肿瘤的临床特点及手术中应用内固定重建脊柱稳定性的疗效。方法：手术治疗椎管内髓外硬膜下肿瘤24例，男14例，女10例；年龄12～68岁，平均40岁。14例在切除肿瘤后应用内固定及自体植骨，10例未行内固定及植骨。结果：本组24例均行后路一次手术切除肿瘤，平均随访22个月（6～36个月），肿瘤无复发，术后脊髓损伤无加重。随访Frankle分级提高1-3级，无血管、神经并发损伤。植入内固定者无固定物断裂、松动，固定效果满意，相应植骨部位均形成骨性融合。结论：椎管内髓外硬膜内肿瘤外科切除同时结合植骨内固定可有效保持脊柱的稳定性。     

髓外硬膜内肿瘤诊治体会

椎管内肿瘤种类多 ,按其所在部位 ,一般分为髓内肿瘤、髓外硬膜内肿瘤以及硬膜外肿瘤。本院自 1996年 6月～2 0 0 0年 6月 ,收治髓外硬膜内肿瘤 8例 ,报告如下。1　临床资料本组 8例 ,男 2例、女 6例。年龄 17～ 6 5岁 ,平均 41岁。肿瘤部位 :胸段 2例、胸腰段 5例、腰段 2例 (其中 1例为胸段及腰段两处肿瘤 )。症状出现至确诊时间 1月～ 6年。临床表现 :胸腹部痛 6例 ,其中束带状痛 3例、一侧痛 3例。单侧下肢痛 2例。单侧下肢麻木 2例 ,双下肢麻木 4例。行走不稳 3例 ,不能行走 1例 ,间歇性跛行 1例。大小便功能失控 4例。脊柱侧弯伴皮肤…     

椎管内髓外硬膜下肿瘤的临床特点及病理学构成———167例病例分析

目的 :总结椎管内髓外硬膜下肿瘤的临床特点及病理学构成情况。方法 :对2006年1月~2014年8月本院脊柱外科收治的167例、平均年龄49.5岁的椎管内髓外硬膜下肿瘤患者的一般情况、影像学资料和病理诊断进行回顾性的统计分析。结果:髓外硬膜下肿瘤女性∶男性比例为1.17∶1,167例患者中75.6%存在疼痛症状,40.1%存在感觉障碍,34.9%存在运动障碍,4.4%合并有大小便功能障碍。髓外硬膜下肿瘤患者中有120例神经鞘瘤,34例脊膜瘤,其他类型肿瘤相对较少。神经鞘瘤患者的平均年龄为47.3±1.3岁,脊膜瘤患者的平均年龄为57.5±2.6岁;神经鞘瘤患者男女比例为1.14∶1,脊膜瘤患者女性∶男性比例为5.8∶1,两者差异具有统计学意义(P<0.001)。神经鞘瘤好发于胸腰段(47.9%),脊膜瘤好发于胸段(35.3%)。神经鞘瘤和脊膜瘤的根性疼痛症状所占比例分别为67.5%和35.3%,感觉障碍症状为28.2%和76.5%,肌力减退症状为25.6%和73.5%,均有显著性差异(分别为P=0.001,P<0.001,P<0.001)。神经鞘瘤和脊膜瘤的体积无显著性差异(P>0.05)。在肿瘤体积在10cm3以内的亚组分析中,神经鞘瘤的平均体积为(3.5±2.2)cm3,脊膜瘤的平均体积为(2.3±1.8)cm3,两者具有显著性差异(P=0.005)。结论:椎管内髓外硬膜下肿瘤主要以神经鞘瘤和脊膜瘤为主。脊膜瘤的平均发病年龄比神经鞘瘤大;神经鞘瘤好发于胸腰段,脊膜瘤好发于胸段;神经鞘瘤的症状以根性疼痛为主,脊膜瘤的症状以感觉和运动障碍为主。     

半椎板切除在硬膜内髓外肿瘤手术中的应用

目的探讨经半椎板切除入路行硬膜内髓外肿瘤切除术的可行性及疗效。方法 2004-01-2009-12共手术治疗36例胸、腰椎硬膜内髓外肿瘤患者,MRI显示肿瘤大小为11mm×14mm～15mm×32mm,均在偏肿瘤侧对应肿瘤节段切除半侧椎板、棘突根部、关节突内侧1/3,切开硬膜,游离并切除肿瘤,随访观察治疗效果。结果 36例肿瘤均获得顺利切除,手术时间55～90min,平均62min,出血量120～350ml,平均150ml。1例患者术后出现脑脊液漏,采取头低脚高位,术后2周愈合。2例术后当天出现尿潴留,给予留置尿管,应用神经营养药物,均在术后1、3个月完全恢复正常。36例均获得6个月～5年4个月(平均2年1个月)随访,无胸、腰痛等症状,不完全性瘫痪患者术前肌力由Ⅱ～Ⅲ级恢复至Ⅳ～Ⅴ级。结论采用半椎板入路行硬膜内髓外肿瘤切除,创伤小,出血少,最大限度地保护脊柱的稳定性,避免了传统的全椎板切除后存在脊柱不稳、瘢痕粘连等并发症。     

显微手术切除高位颈髓髓外肿瘤

显微手术切除高位颈髓髓外肿瘤单宏宽，马长城，宋明高位颈髓髓外压迫性疾病，因颈部肌肉厚、病变部位深，可因技术操作不当损伤颈髓及血管，导致呼吸骤停等严重并发症，手术有一定的死亡率［１、２］。显微外科技术的应用可以预防及减少这些并发症。我院用显微外科技术切...     

椎管内髓外硬膜下多发性肿瘤的诊断与手术治疗

目的探讨椎管内多发性肿瘤的诊断及治疗方法。方法本组男11例,女4例。年龄16～81岁,（51.0±21.2）岁。病程2～27月,（11.0±7.6）月。均无皮肤咖啡斑及体表神经纤维瘤,头颅MR未见异常。增强MR示椎管内髓外硬膜下肿瘤46个,其中≥0.5cm肿瘤35个,肿瘤累及颈段1例,累及胸段5例,累及腰骶段12例。手术方法：采用后正中入路椎板切除术切除肿瘤,〈1cm者切除半椎板,在显微镜下操作,力争保留重要的载瘤神经而将肿瘤自神经上剔除,如肿瘤与神经无法分离,尽可能游离神经根在切除肿瘤后行神经根吻合。术后常规应用抗生素及激素治疗,术后戴颈围领、围腰保护2个月,同时训练腰背部肌肉。结果15例手术肿瘤全切12例,其中1例行神经根吻合;未全切的3例中2例术前诊断为多发神经纤维瘤或神经鞘瘤,因部位散在且直径〈0.5cm未考虑手术切除,另1例术中见肿瘤与多根神经根粘连,病理为转移瘤,仅行部分切除减压术。手术共切除肿瘤33个。病理：神经鞘瘤8例,神经纤维瘤1例,室管膜瘤2例,黑色素瘤1例,腺癌转移1例,脊膜瘤2例。黑色素瘤患者于术后22个月死亡,转移瘤患者于术后1年死亡,余13例随访4～72个月,平均30.1月,肿瘤无复发增长,其中2例多发神经鞘瘤未手术全切除者分别随访12、43个月,肿瘤无明显增长。13例存活者术后KPS评分较术前均有改善（术前75.4±13.3,术后最后一次随访时97.7±6.0,t=-7.366,P=0.000）。结论椎管内髓外硬膜下多发肿瘤以良性居多,中老年多见,半椎板及次全椎板入路显微手术切除是有效的治疗方法,〈0.5cm的无症状肿瘤可严密随访。     

Thoracolumbar intradural extramedullary bronchiogenic cyst

Summary Intradural extramedullary bronchiogenic cysts are rare findings. All five reported cases were located cervically or upper thoracically. To our knowledge, we describe the first case of an intraspinal bronchiogenic cyst in a thoracolumbar location.We present the case of a 41-year-old patient with a known spina bifida occulta who suffered from a continuous, sharp, and therapy-refractory pain in the left leg. Magnetic resonance imaging of the thoracic and lumbar vertebra revealed an intradural extramedullar mass at T12 to L1 level. After laminectomy T-12 through L-1/L-2 and longitudinal opening of the dura mater, the cystic mass was shown to be attached to the conus medullaris and the cauda equina, and therefore could be removed only partially. Histopathological examination revealed the diagnosis of bronchiogenic cyst. We therefore conclude that intradural extramedullary bronchiogenic cysts may appear also at thoracolumbar levels. Surgical resection can be achieved with good outcome.     

Thoracic intradural extramedullary capillary haemangioma

The authors report a rare case of thoracic intradural extramedullary capillary haemangioma, the clinical presentation of which was similar to any other intraspinal mass. Magnetic resonance imaging does not always distinguish this entity from others, but the presence of enlarged vasculature is often a useful clue. Complete resection is the treatment of choice of this hamartomatous lesion.     

Primary spinal intradural extramedullary cysticercosis

BACKGROUND: Spinal cysticercosis represents an uncommon localization of a common parasitic disease and, in most cases, is associated with intracranial involvement. Once confirmed, the entire neuraxis should be evaluated. CASE DESCRIPTION: We present an unusual case of a 60-year-old male patient with isolated localization of spinal intradural extramedullary cysticercosis. The patient was treated successfully with the combination of surgical excision and orally administered albendanzole. We discuss the treatment options, the diagnostic screening, and the possible route of dissemination. CONCLUSIONS: Because this is a rare but potentially life-threatening disease, clinicians should always take it into consideration in the differential diagnosis of spinal space-occupying lesions.     

Lumbar intradural extramedullary bronchiogenic cyst

The pathological findings of an intradural and extramedullary cyst at the L1 level of the spinal canal are described in a 28-year-old male who presented with chronic lumbago and progressive weakness and numbness in both lower limbs. Histopathological examination revealed the diagnosis of bronchiogenic cyst. Bronchiogenic cysts in the spinal canal are uncommon, and cysts at the L1 level are extremely rare. Their pathogenesis is still poorly understood. They are thought to be a malformation arising from a split notochordal syndrome. We conclude that intradural extramedullary bronchiogenic cysts may appear also at lumbar levels. Surgical resection can be achieved with good outcome.     

Solitary thoracic intradural extramedullary plasmacytoma

Summary The bodies of the vertebrae are common locations for plasma cell diseases such as multiple myeloma and solitary plasmacytoma. Secondary invasion of the epidural space is infrequent but can cause neurological symptoms. Spinal cord compression due to pure intradural plasma cell infiltration is very rare. The authors report a 25-year-old woman who developed a progressive difficulty in walking due to a solitary spinal dural plasmacytoma. This is the first reported example in the English language literature of a purely intradural spinal plasmacytoma in a patient without other myelomatous lesions. An entirely intradural solitary plasmacytoma has a relatively better prognosis.     

Multifocal intradural extramedullary ependymoma. Case report

In this paper, the authors present the case of a patient with multifocal intradural extramedullary ependymoma, and they review 18 previously reported cases. A 32-year-old man presented to the authors' institution with a 1-month history of partial medullary syndrome. Magnetic resonance imaging of the neuraxis revealed multifocal intradural extramedullary lesions at the bulbomedullary junction and C2-3, T5-11, L-2, L-4, L-5, and sacrum. Histological examination revealed a WHO Grade II ependymoma. The literature survey yielded 18 cases of ependymoma at the same location; none of them were multifocal at presentation. The authors analyzed the epidemiological, clinical, and surgical features of all 19 cases reported to date, including the present case. Patients' ages ranged from 24 to 69 years; 15 patients were women and 4 were men. The time elapsed from symptom onset to diagnosis ranged from 1 month to 8 years. Pain (in 13 patients) and medullary syndrome (in 12) were reported as the initial symptoms (information was not provided for 1 patient). Tumors were predominantly located in the thoracic spine (11), but they also occurred in the cervicothoracic (3), cervical (2), and lumbar (2) spine. The remaining tumor was multifocal. Solitary extramedullary tumors were found intraoperatively in 13 patients; 3 were described as exophytic and 3 as extramedullary with some degree of medullary invasion. Histological examination revealed 9 WHO Grade II tumors, 4 Grade III tumors, and 1 myxopapillary tumor. Data obtained for the remaining cases proved inconclusive. The clinical condition improved in 11 patients, remained stable in 2, and worsened (recurrence or progression) in 6. Of the 4 patients with Grade II tumors who presented with recurrence or neuraxis spreading, 3 had meningeal infiltration or adhesion to the pia mater, which does not rule out the possibility of neoplastic remnants in that area. Intradural extramedullary ependymomas are rare, they predominate in women in the 5th decade of life, and pain is the most frequent initial symptom. The extent of resection and the presence of meningeal infiltration seem to be key determinants of prognosis. The present case is the first intradural extramedullary ependymoma (with the exception of those occurring at the conus medullaris and terminal filum) with multiple lesions at presentation.     

Spinal intradural extramedullary tumors. Personal experience

BACKGROUND: Spinal intradural extramedullary tumors account for 2/3 of all intraspinal neoplasms and are mainly represented by meningiomas and schwannomas, with the former accounting for the 25-46% of all primary intraspinal tumors. Technical advances in imaging technique, magnetic resonance imaging (MRI) and surgical procedures have brought about significant better clinical results in the last 2 decades. Neverthless a small percentage of patients still present poor postoperative outcome mainly related to the duration of clinical history, the severity of preoperative neurological deficits and to some specific anatomo-surgical aspects. METHODS: In an effort to clarify the influence of these factors on patient's outcome, the authors analyze the clinical, surgical and prognostic data of 41 patients with intradural extramedullary spinal tumor surgically treated between January 1990 and December 1999. The follow-up period ranged from 1 to 9 years. The clinical history until admission and treatment was 3-48 months for meningiomas and 1-72 months for schwannomas. RESULTS: Morbidity and mortality rate was 5 and 0% for meningiomas and 0 and 6% for schwannomas. Almost all the patients experienced a significant neurological improvement after surgery, with a percentage of Nurick's grade 1 and 2 of 68% among patients with meningiomas and 66% among patients with schwannomas. Removal of the tumor was complete in 90% of meningiomas and 94% of schwannomas. CONCLUSIONS: The authors address radical surgery as the ideal goal in these neoplasms, as it gives the patients the best long-terms results, pointing out the importance of systematic early identification of any main radiculomedullary artery during debulking and dissection of the tumor to avoid any risk of severe postoperative neurological worsening of the patients.