脊髓髓内海绵状血管畸形的诊断和治疗

目的 探讨脊髓内海绵状血管畸形的诊断以及手术治疗.方法 回顾性总结19例经手术治疗的脊髓内海绵状血管畸形的临床发病特点、影像学特征、诊断和鉴别诊断、手术方法、注意事项.19例患者年龄平均38.7岁,其中男14例,女5例.随访9例患者.结果 19例病理学证实均为海绵状血管畸形的患者,手术疗效优良,1例患者术后出现深感觉障碍.随访的9例患者神经系统状态均有不同程度改善.结论 脊髓海绵状血管畸形大多初始症状轻微,反复出血致症状逐渐加重.MRI表现具有一定特征性,为主要诊断手段.手术切除应在肿瘤与其周围的胶质增生带之间进行,注意防止肿瘤残留.肿瘤出血沿脊髓中央管蔓延时,以切除肿瘤为主,不必强求清除血肿.

The diagnosis and surgical management for intramedullary spinal cord cavernous angioma

Objective The clinical diagnosis and surgical management of intramedullary spinal cord cavernous angioma were discussed. Method Total 19 patients with intramedullary cavernous angioma were analyzed retrospectively on the clinical manifestation, radiographic feature, diagnosis and differentiation,surgical technique and caution. Of all the 19 patients, averaging 38.7 years old, 14 were male and 5 were female. Nine patients were followed. Result All the 19 patients pathologically diagnosed with spinal cord cavernous angioma got good surgical results, besides one patient showed loss of proprioception. Nine patients were followed up and all demonstrated improvement on neurological function. Conclusion The clinical symptom of most of the patients with spinal cord cavernous angioma presented mildly at onset, but deteriorated gradually because of repeated rehemorrhage. Since the lesion showed some characteristic in MRI, MRI examination was regarded as an important diagnostic tool. Dissection should be done between the tumor and the gliosis during the surgical procedure, special attention should be paid to avoiding tumor residual. It was not necessary to aggressively evacuate the hemotoma derived from tumor hemorrhage, which extended along the central canal up and down, except obvious occupied syndrome exited.