椎管内脊膜瘤出血2例报道并文献复习  

Spontaneous intraspinal bleeding associated with spinal meningioma: Two cases report and review of the literature

作　　者：杨彬彬[1] 唐晓平[1] 赵龙[1] 冯凌[1] 唐文国[1] 张雅坤[2] 

机构地区：[1]川北医学院附属医院神经外科,四川南充637000 [2]川北医学院附属医院肿瘤科,四川南充637000

出　　处：《中国现代医生》2016年第7期116-118,F0003,共4页China Modern Doctor

基　　金：四川省医学重点建设科学基金资助项目[川卫办发(2007)407];四川省教育厅科研课题(13ZB0237)

摘　　要：目的探讨椎管内脊膜瘤出血的临床特征、影像学表现及治疗方法。方法回顾性分析2015年8～11月收治的2例椎管内脊膜瘤出血患者的临床资料,并结合国内外文献复习,分别就其临床表现、影像学特征、诊断及治疗进行探讨。结果 1例患者磁共振（MRI）提示：T_9～10椎管内占位。另外1例患者磁共振提示：C_7～T_1椎管内占位。2例患者全麻后在显微镜下行椎管内占位病变切除术＋椎管减压术。术中见肿瘤均位于椎管髓外硬膜下,血供丰富,1例瘤内可见出血,另一例瘤内含陈旧血凝块。2例患者术中完整切除肿瘤,清除血凝块,术后病理均证实为脊膜瘤。术后2例患者感觉运动均逐渐恢复。第1例患者发病到手术时间为6 h,第2例患者为22 h,第1例患者术后恢复较第2例患者好。结论椎管内脊膜瘤出血罕见,MRI是诊断的最佳手段,早期手术可明显改善患者的预后。Objective To study the clinical features, imaging features and treatment of spontaneous intraspinal bleeding associated with spinal meningioma. Methods Two cases of spontaneous intraspinal bleeding associated with spinal meningioma between August to November in 2015 were retrospectively analyzed and the literature at domestic and overseas were reviewed. The clinical manifestations, imaging features, diagnosis and treatment were discussed. Results The magnetic resonance imaging revealed a mass extending from T_9 to T_10 in one patient and a mass extending from C_7 to T_1 in the other one. The laminectomy was performed after general anesthesia under the microscope and the mass in the spinal canal in the two cases were resected and the spinal canals were decompressed. The tumors of the two cases were showed full of blood supply and both located at subdural place in operation. The hemorrhage was seen in the tumor in one case and outmoded blood clot was seen in the other. The mass and blood clots of the two cases were removed en bloc in the operation. The pathological examination of the two cases revealed meningioma. The neurological function of the two cases was recovered gradually after operation. The time from onset to operation was 6 hours in one case and 22 hours in the other, and the recovery was better in the former. Conclusion Spontaneous intraspinal bleeding associated with spinal meningioma is rare and the magnetic resonance imaging was the best means to diagnosis. Early surgery can obviously improve the prognosis of patients.

关 键 词：椎管 脊膜瘤 出血 硬膜下 

分 类 号：R651.2[医药卫生—外科学]