高颈段髓外肿瘤的临床特点及显微手术治疗

目的：总结高颈段髓外肿瘤患者的临床表现特点，探讨其早期诊断和显微手术治疗等问题，提高诊治水平。方法：回顾性分析该科2001年3月至2004年12月治疗的27例高颈段髓外肿瘤患者临床资料，并复习相关文献。结果：本组患者均全身麻醉后在显微镜下手术，肿瘤全切除23例，次全切除4例。术后发生四肢瘫痪1例，无手术死亡病例。21例患者随访10个月至4年，症状消失13例，症状不同程度减轻7例，1例患者肌力减退加重。结论：高颈段椎管内肿瘤患者临床表现缺乏特异性，以神经根痛和肢体麻木为最常见的临床表现，早期确诊率低。显微技术利于肿瘤全切除，防止脊髓损伤。患者术前神经功能状态和病程长短是决定预后的重要因素。

Clinical features and microsurgery for extramedullary tumors in upper cervical spinal region

Objective: Summarizing the clinical features of upper cervical extramedullary tumors and discussing roles of early detection and microsurgery on the improvement of diagnosis and treatment in this entity. Methods: Documents of 27 patients with upper cervical extramedullary tumors treated from March 2001 to December 2004 in our department were analyzed retrospectively and related literature was reviewed. Results: All patients of this series were microsurgically operated on under general anesthesia.23 tumors were totally removed,and 4 were subtotally resected.One patient was complicated with tetraplegia postoperatively,no surgery related mortality were found.Of the 21 patients followed up from 10 months to 4 years,symptoms disappeared in 13 patients,relieved in 7 at various levels and muscle weakness aggravated in 1 patient.Conclusion: There is no specific symptom for upper cervical extramedullary tumors,radicular pain and paresthesia or dysesthesia of limbs or trunk are common manifestations.Unfortunately,few patients were diagnosed before spinal cords were severely compressed.Microsurgical techniques are important for medulla spinalis protection and total tumor removal.Preoperative neurological status and symptomatic duration are of great prognostic value.