高颈髓室管膜瘤:根治性切除与预后  

High Cervical Spinal Cord Ependymoma: Radical Resection and Outcome

作　　者：王贵怀[1] 张冰克 杨俊[1] 田军[2] 王忠诚 

机构地区：[1]北京市神经外科研究所 [2]贵阳脑科医院,贵州贵阳550005

出　　处：《中国神经肿瘤杂志》2003年第1期26-30,共5页Chinese Journal of Neuro-Oncology

摘　　要：背景与目的:室管膜瘤是脊髓最常见的胶质瘤,起源于颈髓或侵及颈髓者大约占脊髓肿瘤的67%。目前的显微外科技术能够治愈绝大多数髓内室管膜瘤,致残率较低,当肿瘤侵犯高颈髓或延髓交界处时,手术治疗仍存在损害呼吸及其气道保护功能潜在的危险。本文总结我们对高颈髓室管膜瘤手术治疗的经验,详细的分析运动功能、疼痛缓解、手术并发症以及肿瘤复发和病人生存质量等问题。通过对我们手术技术的描述,期望以最小术后神经缺失获得最完全的肿瘤切除。方法:自1999年5月至2002年8月,我院神经外科对16例高颈髓室管膜瘤(肿瘤侵及延髓下段与/或颈1、2、3水平)患者进行了手术治疗。所有病人术前均行核磁共振检查,并注入对比剂观察肿瘤强化情况。随访病人时均进行严格的神经系统检查以及核磁共振检查。神经功能分析参照Frankel分级标准,详细评估术前后情况。结果:手术完全切除是指术后影像学检查没有肿瘤残余,本组所有病例均为肿瘤全切除。有一例患者于术后34天死于呼吸功能衰竭及并发肺部感染。其他病人在随访期间均生存良好。所有病人术后均未行放疗。9例病人术后早期能维持术前神经功能状态(56%),而另7例病人术后早期有新的功能缺失或症状加重(44%)。在术后3个月时,病人神经功能状态均明显改善(以Frankel分级法评估,能提高一个级别)。在半年随访时,12例病人(75%)能超过术前功能状况。在一年随访时所有病人神经功能状态均恢复良好,达到Frankel E级。术前感觉功能异常的严重程度有所不同,主要表现为麻胀感以及持续性烧灼性疼痛。大部分病人术前存在的疼痛在术后半年至一年均能够明显改善。结论:回顾我们的资料可以得到如下结论:(1)使用显微外科技术及术中电生理监测对绝大多数髓内室管膜瘤可以获得手术根治性切除;(2)术�BACKGROUND & OBJECTIVE: Current microsurgical techniques have been promising to cure most of the spinal intramedullary ependymomas with acceptable neurological morbidity. However, when tumor involved high cervical spinal cord or cervicomedullary junction, there is very high risk of impairment of respiration and airway protection following radical surgery. In this paper, we reviewed 16 patients with high cervical spinal ependymomas who re- ceived surgery. METHODS: Sixteen patients (7 male and 9 female) with high cervical and cervicomedullary spinal cord ependymomas between 1999 and 2002 received surgical treatment. We reviewed the neurological progression, surgical complications, tumor recur- rence, pain evolution, and survival of the patients. The median age at diagnosis was 37 years. Tumors extended into the medulla oblongata in 4 patients, from the medulla oblongata to C7 or Tl level in 2 patients, and within the cervical spinal cord in 10 patients. RESULTS: We achieved a gross total resection of the tumors in all patients. Three patients with very poor preoperative neurological status (McCormick Grade IV & V) and one patient suffered from respiratory arrest on the day of surgical operation. They were successfully resuscitated. One patient died from pneumonia on the 34th day after operation. No patient developed recurrence over a mean follow-up of 22 months. Nine patients (56%) maintained the preoperative neurological status at early postoperative days. Seven patients (44%) developed severe neurological deficit after operation. However, neurological deficits started to improve between 1 and 3 months after surgery. All the surviving patients had achieved some functional improvement 1 year after operation and the improvement continued up to 1. 5 year. CONCLUSIONS: We conclude that radical resection of cervical cord ependymomas could be achieved safely in the majority of patients. Postoperatively neurological deficits, if any, will get better within 3 weeks and significantly improved by 6 to 12 months after surger

关 键 词：室管膜瘤 脊髓髓内肿瘤 预后 外科手术 

分 类 号：R739.4[医药卫生—肿瘤]