脊髓髓内肿瘤的显微外科治疗

目的 总结脊髓髓内肿瘤的治疗经验.方法 回顾性分析36例经显微手术治疗的脊髓髓内肿瘤病人的临床资料,术中超声辅助定位5例.结果 室管膜瘤17例,低级别星形细胞瘤(WHO I ～II级)8例,高级别星形细胞瘤(WHO Ⅲ～Ⅳ级)3例,血管母细胞瘤3例,海绵状血管瘤2例,脂肪瘤、转移瘤、畸胎瘤各1例.室管膜瘤全切率82.4%,低级别星形细胞瘤为50.0%,高级别星形细胞瘤为33.3%,血管母细胞瘤、海绵状血管瘤和转移瘤均全切,脂肪瘤和畸胎瘤次全切.术后随访3个月,根据McCormick脊髓功能状态分级:I级23例,II级7例,Ⅲ级3例,Ⅳ级3例.结论 显微手术切除脊髓髓内肿瘤是目前最有效的治疗措施.术中超声有助于术中肿瘤定位,减少手术创伤.

Microsurgical treatment for intramedullary spinal cord tumors

Objective To review the experiences with microsurgical treatment of intramedullary spinal cord tumors.Methods The clinical data of 36 patients with intramedullary spinal cord tumors who underwent microsurgery were analyzed retrospectively.Intraoperative ultrasound-assisted localization was performed in 5 patients.Results The postoperative pathological analysis showed that there were 17 cases of ependymoma,8 of low grade astrocytoma（WHO Ⅰ~Ⅱ grade）,3 of high grade astrocytoma（WHO Ⅲ~Ⅳ grade）,3 of hemangioblastoma,2 of cavernous hemangioma,1 of lipoma,1 of metastasis and 1 of teratoma.The total resection rate was 82.4% in ependymoma,50.0% in low grade astrocytoma,33.3% in high grade astrocytoma.The complete removal was achieved in hemangioblastoma,cavernous hemangioma and metastasis,while subtotal removal in lipoma and teratoma.Spinal cord function was evaluated by McCormick grade： gradeⅠin 23 patients,grade Ⅱ in 7,grade Ⅲ in 3 and grade Ⅳ in 3 after follow-up period of 3 months.Conclusions Surgical resection is the most effective strategy for intramedullary spinal cord tumors and intraoperative ultrasound is useful for localizing lesions and reducing operative injury.