多节段颈髓室管膜瘤的手术治疗

目的探讨多节段颈髓室管膜瘤显微外科手术治疗可能性和疗效。方法回顾性分析1990年10月至2006年10月,我们治疗的26例多节段颈髓室管膜瘤的临床资料、影像学特点、手术中、术后注意要点。结果肿瘤完全在颈髓内14例、主要位于颈髓累及胸髓者12例,平均累及4．5个节段。双下肢不完全截瘫18例,不完全高位截瘫8例,呼吸困难6例,括约肌功能障碍10例。MRI显示脊髓空洞形成24例。20例采用椎板复位固定,6例未采用,其中1例为二次手术无法复位固定者。术后患者肌力恢复21例,无改变4例,1例手术后临床症状较术前加重。术后呼吸困难1例。MRI均未见术后肿瘤残留,1例未固定者脊柱不稳定。结论显微外科手术可以全切除多节段颈髓室管膜瘤,术后患者症状多有明显改善;手术后应进行椎板复位固定以保持脊柱稳定性,提高患者生活质量。

Treatment of multisegmental intramedullary cervical spinal cord ependymomas

Objective To discuss the possibility of microneurosurgery techniques in the treatment of muhisegmental intramedullary cervical spinal cord ependymomas. Methods The clinical data of 26 cases of muhisegmental intramedullary cervical spinal cord ependymomas patients was reviewed and analyzed. Results There were 14 cases of cervical spinal cord ependymomas, 12 cases of cervical and thoracic spinal cord ependymomas. 4.5 spinal cord segments were involved in average. Incompletely inferior paraplegia was in 18 cases, incompletely high paraplegia in 8 cases, dyspnea in 6 cases, sphincter dysfunction in 10 cases. MRI detected syringomyelia formation in 24 cases. Vertebral lamina were reposited in 20 cases. Muscle strength recovered in 21 cases, nochanged in 4 cases, aggravated in 1 case. All cases had total resection and 1 cases vertehral was instabitity in MRI. Conclusions Total resection of intramedullary cervical spinal cord ependymomas can be achieved by microneurosurgery. Most of the symptoms can be released after microsurgical treatment. After muhisegmental laminotomy, the vertebral plate should be reposited to ensure the stability.