高颈段椎管内肿瘤的显微外科治疗

目的分析高位颈段椎管内肿瘤病例特点，探讨其手术方法和疗效。方法22例高位颈段椎管内肿瘤中，位于髓内者5例．位于髓外硬脊膜下者17例，其中有11例呈哑铃形生长。全部患者均行显微神经外科手术治疗，对于颈髓受压较严重者手术后采用大剂量甲基强的松龙治疗。结果本组5例髓内肿瘤中，3例室管膜瘤全切除，1例星形细胞瘤行部分切除，另1例星形细胞瘤行椎板内减压后活检。17例髓外硬脊膜下肿瘤中，有15例均在显微镜下全切除，有2例行大部切除；其中呈哑铃形生长的11例肿瘤中．有9例获得显微镜下全切除。结论术前MRI对高颈段椎管肿瘤有较好的诊断价值，而显微神经外科手术则有助于此类肿瘤的全切除。

Microsurgical Treatment of Intraspinal Tumors in Superior Cervical Spinal Cord

Objective To explore the curative effects of microsurgery on intraspinal tumors in the superior cervical spine cord. Methods The clinical data of 22 patients with intraspinal tumors in the superior cervical spine cord, of whom, 5 suffered from intramedullary of cervical spinal cord and 17 from subdural extramedullary tumors （11 cases of the tumors were dumbbell-shaped） of cervical spinal cord, were analyzed retrospectively. The main symptoms included pains in the necks, numbness and weakness of four limbs and hemisensory disturbance in the patients with intraspinal tumors of superior cervical cord. All the patients underwent microsurgery for the intraspinal tumors. The patients with serious compression of spinal cord were tread by large dose of methylpred- nisolone after the operation. Results Of 5 patients with intramedullary tumors, 3 received total resection of the tumors （ependymomas）, 1 subtotal resection of the tumor （astrocytoma） and 1 laminectomy decomprsession of spinal cord and biopsy （astrocytoma）. The subdural extramedullary tumors in superior cervical cord were totally removed in 15 patients,and subtotally in 2 patients with dumbbell-shaped tumorsl Conclusions Preoperative MRI contributes to total resection of tumors. Microsurgery is helpful to the total resection of intraspinal superior cervical spinal cord tumors.