颈胸交界区多节段脊髓髓内室管膜瘤的显微外科治疗  

Microneurosurgical management of multisegmental intramedullary spinal cord ependymoma in cervico-thoracic junction

作　　者：王长春[1] 王兴文[1] 袁庆国[1] 沙成[1] 王大明[1] 

机构地区：[1]卫生部北京医院神经外科

出　　处：《中国现代神经疾病杂志》2009年第2期149-152,共4页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的回顾分析颈胸交界区多节段脊髓髓内室管膜瘤患者的临床及影像学特征,探讨显微外科治疗方法和临床疗效,以及微型钛钉、钛板内固定技术和改良高架桥式椎管扩大成形术的技术特点和可行性。方法14例颈胸交界区多节段脊髓髓内室管膜瘤患者,肿瘤均累及C7和T1椎体,平均累及4.64个椎体节段。显微外科手术切除肿瘤后行微型钛钉、钛板内固定术,其中8例同时采用改良高架桥式椎管扩大成形术复位、固定椎板,恢复脊柱正常解剖结构。结果14例患者肿瘤完全切除者13例,次全切除者1例;手术后肌力改善10例,无变化3例,症状略有加重1例。随访3个月～8年,平均28个月,无一例肿瘤复发。影像学检查显示椎体间融合良好,脊柱正常解剖结构恢复,无一例钛钉、钛板移位、脱落。结论积极施行显微外科手术完全切除肿瘤是颈胸交界区多节段脊髓髓内室管膜瘤的最佳治疗方案。微型钛钉、钛板内固定技术和改良高架桥式椎管扩大成形术简单、安全、有效,于复位、固定椎板的同时可以恢复脊柱的正常解剖结构。Objective To explore the microneurosurgical technique and result in the treatment of multisegmental intramedullary spinal cord ependymoma in cervico-thoracic junction （CTJ）, and to study the feasibility and technique of modified laminoplasty using miniscrew-plate internal fixation. Methods The clinical data, surgical technique and post-operative treatment of 14 cases with multisegmental intramedullary spinal cord ependymoma in cervico-thoracic junction, treated from January 2000 to April 2008 in our hospital, were analysed retrospectively. The lesions involved 4.64 segments in average, including C7-T1 junction in all patients. All lesions were resected with microneurosurgical technique. The lamina was cut off at the lamina root on both sides with microdrill. The spinal function was protected under the evoked potential monitor. After operation, the lamina was lifted up and fixed back by using miniscrew-plate internal fixation and modified laminoplasty. Results Among 14 patients, total removal was achieved in 13 cases, subtotal removal in one case. Lamina was repositioned in all patients with miniscrew-plate internal fixation to restore the vertebral alignment. Post-operative spinal function was improved in 10 patients. No changes were seen in 3 patients, and aggravation occurred in one patient who was of McCormick grade Ⅳ pre-operatively. No spinal instability was revealed during the follow-up, all miniscrew-plates were well positioned. Conclusion Radical total resection is the best choice for the treatment of intramedullary spinal cord ependymoma by microneurosurgical technique. Prognosis is related primarily with pre-operative neurological conditions of the patients, surgical technique and the degree of removal. Modified laminoplasty by using miniscrew-plate internal fixation is a simple, safe and effective method, in the time of instant stability of the elevated lamina, the integrity of spinal canal is recovered.

关 键 词：脊髓肿瘤 室管膜瘤 颈椎 胸椎 显微外科手术 磁共振成像 

分 类 号：R739.4[医药卫生—肿瘤]