经单侧半椎板切除髓内海绵状血管瘤  

Microsurgery of intramedullary spinal cord cavernomas by hemilaminectomy

作　　者：卞留贯[1] Helmut Bertalanffy 孙青芳[1] Wuttipong Tirakotai Boris Krischek Ulrich Sure LudwigBenes 

机构地区：[1]上海交通大学医学院附属瑞金医院神经外科,上海200025 [2]德国马尔堡大学医院神经外科,黑森洲马尔堡35033

出　　处：《中国微侵袭神经外科杂志》2006年第9期399-402,共4页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨脊髓髓内海绵状血管瘤的出血性损伤风险、临床特征以及经单侧半椎板切除髓内海绵状血管瘤的手术技巧。方法回顾性分析11例髓内海绵状血管瘤病人的病历资料。均经单侧半椎板切除肿瘤。采用统计学分析,在性别分布、平均年龄、年出血率等方面与同期颅内(145例)、脑干(61例)海绵状血管瘤进行比较。术前Frankel分级D级8例,C级2例,A级1例。结果本组女性7例,男性4例,女性与男性之比高于颅内(80∶65)和脑干(33∶28)海绵状血管瘤;年出血率为2.8%/病人,稍低于颅内(3.3%)和脑干(3.1%)海绵状血管瘤。病变均获全切;术后随访期内8例神经系统症状改善(Frankel分级D级升到E级6例,C级升到D级2例),3例临床症状无变化。结论脊髓髓内海绵状血管瘤应全切以防复发和再出血;选择微侵袭的半椎板入路,以及术中采用体感诱发电位监护,是取得满意结果、预防附加损伤的关键。Objective To determine the potential risk of bleeding in intmmedullary spinal cord cavernomas （ISCCs） and to analyze the clinical features and the surgical technique of unilateral hemilaminectomy for ISCCs. Methods Eleven cases of ISCCs were retrospectively reviewed. The tumor was resected by unilateral hemilaminectomy; ultrasound localization and somatosensory evoked potential were monitored during the operation. The distribution of sex, mean age and annual hemorrhagic rate were compared with the intracranial （145 cases） and brainstem cavemomas （61 cases） at the same time using statistical analysis. Before the surgery, 8 patients were Frankel grade D, 2 were grade C, and 1 was grade A. Results There were 7 females and 4 males having symptomatic ISCCs. The ratio of female to male was higher than those in intracranial （80 ： 65） and brainstem cavemomas （33 ： 28）. The annual retrospective hemorrhage rate was 2.8%, being slightly lower than those in intracranial and brain stem cavemomas （3.3% and 3.1% respectively）. All the cavemomas were completely resected. Eight patients experienced an improvement of the neurological symptoms （Frankel grade C improved to E in 6 cases, grade C to D in 2）, while the other three patients＇ clinical features remained unchanged during the follow-up period. Conclusions ISCCs should be totally removed to avoid the recurrence and rebleeding of the residue. Selection of a minimally invasive microsurgical approach （hemilaminectomy）, together with the intraoperative somatosensory evoked potentials monitoring, can lead to a favorable outcome and prevent additional injury.

关 键 词：血管瘤 海绵状 中枢神经系统 脊髓肿瘤 半椎板切除术 

分 类 号：R739.42[医药卫生—肿瘤]