脊髓髓内神经鞘瘤的诊断与治疗

目的 探讨脊髓髓内神经鞘瘤的诊断和显微外科治疗。方法 回顾性分析2005~2015年显微手术治疗的13例脊髓髓内神经鞘瘤患者的临床资料。结果 13例患者的肿瘤均获得完整切除。术后随访6个月~3年；术后2例肌力较术前出现暂时性减退，术后3个月恢复至术前水平，6个月恢复正常；1例截瘫患者肌力由术前Ⅰ级恢复至术后Ⅲ级，6个月恢复至Ⅴ-级，2年后肌力恢复正常，大小便障碍恢复正常；所有患者疼痛症状术后完全缓解；3例术后出现深感觉障碍，6个月后基本恢复正常；7例遗留有载瘤神经支配区的麻木；其余患者症状均较术前有明显改善；所有患者MRI复查未见肿瘤复发。结论 脊髓髓内神经鞘瘤与脊髓关系密切，临床症状较重，影像学特点没有明显特异性，显微镜下精细操作与预后密切相关。

Diagnosis and treatment of intramedullary spinal schwannomas

Objective To investigate the clinical manifestations and surgical treatment of intrammedullary spinal schwannomas. Methods The clinical data of 13 patients with intramedullary spinal schwannomas were analyzed retrospectively, including manifestations, imaging features and curative outcomes. Before the surgery, there was decreased muscle strength in 9 patients, pain onset in 10, different degrees of sensory dysfunction in 10, numbness in 3, and dysporia and dysuria in a patient with paraplegia. Results The schwannomas were totally resected in 13 patients, who were followed up from 0.5 to 3 years. The muscle strength temporarily decreased after the surgery in 2 patients. The deep sensory impairment appeared in 3 patients, and the symptoms were improved in other patients. The areas managed by the parent nerves were numb in 7 patients during the following up. No tumor recurrence was found by MRI in all the patients. Conclusions The intramedullary spinal tumors which locate at the dorsalateral side of the spinal cord and produced neuralgic pain with clear boundary and homogenous enhancement on MRI should be highly suspected of intramedullary schwannomas. Once intramedullary schwannoma is definitely diagnosed, surgical resection is the best choice. The clinical outcome in the patients with intramedullar schwannomas is closely related to the surgical approach and skill.