椎管内多发性神经鞘瘤的诊断与治疗

目的:探讨椎管内多发性神经鞘瘤的临床和手术特点。方法:对16例经手术和病理证实的椎管内多发性神经鞘瘤进行临床、影像学及疗效总结。结果:16例共行手术28次,切瘤46枚,术后早期神经功能改善10例,稳定5例,加重1例,无手术死亡。随访1~28年,其中8例出现新病灶,1例恶性变肿瘤复发而再次手术;恢复劳动或工作10例,生活自理3例,仍需他人照料3例。结论:椎管内神经鞘瘤疗效通常良好,但椎管内多发性神经鞘瘤在诊治上存在一定难度,新病灶及复发肿瘤需多次手术。该病诊断主要依据MRI等影像学检查及手术时注意小的隐蔽病灶。

Multiple Intraspinal Cord Neurinoma

Objective:To investigate clinical and radiological features and surgical techniques of the multiple intraspinal cord neurinoma.Methods:16 cases of multiple intraspinal cord neurinoma which were proved by operation and pathology were analyzed. The CT and MR imaging characteristic appearances and treatment effect were summarized .Results:These 16 patients were given 28 operations and 46 neurinomas were removed,with all the tumors removed in all cases .At early postoperative days an function improvement was obtained in 10 cases ,stable condition in 5 cases and deterioration in 1 case .No operative mortality .There were new lesions in 8 cases and 1 case of tumor recurrence which underwent reoperation. 16 cases were followed up for a period of 1 to 28 years , among which 10 cases returned to their previous work, and 3 cases led practically normal life and 3 cases still needed care from others .Conclusions:Surgical outcomes for patients with spinal neurinomas were usually effective. However, treatment of multiple intraspinal cord neurinoma used left much to be desired, and recurrent tumors required multiple operations for new lesions .MRI is the most important method for the diagnosis of multiple intraspinal cord neurinoma. Small and occult lesions were detected with the MR imaging of spinal cord and clear operative management and more care to operative management were needed.