电生理监测下脊髓黏液乳头型室管膜瘤显微外科治疗

目的探讨脊髓黏液乳头型室管膜瘤的临床特点及在电生理监测下的显微手术切除方法。方法回顾性分析北京天坛医院神经外科收治的13例脊髓黏液乳头型室管膜瘤患者的临床资料,所有患者均行显微外科切除,术中主要应用肌电图（EMG）监测辅助肿瘤切除。结果本组患者中7例患者做到手术全切,近全切除3例,大部分切除2例,部分切除1例,全组无手术死亡,平均随访时间为33.2个月,其中神经功能改善6例（46%）,稳定无变化4例（13%）,加重3例（23%）,随访期间原位复发2例,播散1例。13例患者术中均监测到自发肌电反应。结论早期显微手术是治疗脊髓黏液乳头型室管膜瘤最有效的方法,术中应用电生理监测可有效提高肿瘤全切率,减少术后并发症,最大程度的改善神经功能。

Microsurgical treatment of spinal myxopapillary ependymoma with electrophysiological monitoring

Objective To investigate the clinical features and microneurosurgical management of spinal myxopapillary ependymoma with electrophysiological monitoring.Methods Clinical data of 13 patients with spinal myxopapillary ependymoma were analyzed retrospectively.All the patients were treated by microsurgery assisted with electromyography（EMG）.Results Total removal was achieved in 7 cases,subtotal removal in 3 cases,gross removal in 2 case and partial removal in 1 case,no patients died.The mean follow-up period was 33.2 months： neurological function was improved in 6 cases（46%）,no changes occurred in 4（13%）,deteriorated in 3（23%）.Two patients developed tumor local recurrence and one patient developed tumor disseminated recurrence.All the patients had stimulated electromyography responses.Conclusion Early microsurgical treatment is the most effective measure for spinal myxopapillary ependymoma.The applications of intraoperative electrophysiological monitoring can increase removal rate,reduce postoperative complication,and improve the prognosis of the patients.