脊髓髓内神经鞘瘤的显微微创治疗  

Minimally Invasive Microsurgery of Intramedullary Spinal Schwannomas

作　　者：林国中[1] 马长城[1] 王振宇[1] 谢京城[1] 刘彬[1] 陈晓东[1] Lin Guozhong;Ma Changcheng;Wang Zhenyu(Department ofNeurosurgery, Peking University Third Hospital, Beijing 100191,China)

机构地区：[1]北京大学第三医院神经外科,北京100191

出　　处：《中国微创外科杂志》2019年第4期326-329,340,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：首都临床特色应用研究项目(Z171100001017120)

摘　　要：目的探讨脊髓髓内神经鞘瘤的显微微创治疗效果。方法回顾性分析2005年1月～2017年12月16例髓内神经鞘瘤的临床资料。临床症状包括疼痛12例,感觉障碍12例,肢体无力11例(其中截瘫2例,伴二便功能障碍)。首发症状为疼痛10例,麻木3例,肢体无力3例。肿瘤位于颈脊髓9例,颈胸交界区3例,胸脊髓4例,长度0. 5～2. 5 cm,于显微镜下切除髓内外肿瘤。结果 16例肿瘤均获得完整切除,病理均证实为神经鞘瘤。术后10例出现新发症状,其中3例肌力减退,5例深感觉障碍,9例载瘤神经支配区麻木。术后随访6个月～7年,中位数3年。术后新出现的症状均恢复正常。12例疼痛患者疼痛均消失; 12例感觉减退患者中7例完全恢复,5例残余轻度感觉减退; 11例肌力减退者中7例恢复正常,4例仍有肌力下降,其中2例截瘫患者可拄拐行走。所有患者复查MRI未见肿瘤复发。结论脊髓髓内神经鞘瘤与脊髓关系密切,显微镜下精细操作,术后预后大多较好。Objective To investigate the minimally invasive microsurgery of intrammedullary spinal schwannomas.Methods A total of 16 cases of intramedullary spinal schwannomas from January 2015 to December 2017 were respectively reviewed.Clinical symptoms included pain in 12 cases, varying degrees of sensory impairment below the segment of tumor location in 12 cases, and limb weakness in 11 cases ( paraplegia in 2 cases with dysfunction of urine and stool).The onset symptoms included pain in 10 cases, numbness in 3 cases, and limb weakness in 3 cases.The tumors were located in the cervical spinal cord in 9 cases, in the cervicothoracic junction in 3 cases, and in the thoracic spinal cord in 4 cases.The length of tumor was varied from 0.5 to 2.5 cm.The intramedullary and extramedullary tumors were removed under the microscope.Results All of the tumors received total resection and were confirmed to be schwannomas.Postoperatively 10 patients suffered new onset symptoms, including 3 patients with weakness, 5 patients with deep sensory disturbance, and 9 patients with numbness.All the patients were followed up for 6 months to 7 years ( median, 3 years).All of the new onset symptoms were recovered to normal.The pain in 12 patients disappeared.Among the 12 patients with hypoesthesia, 7 patients had complete recovery and 5 had only mild hypoesthesia.Among the 11 patients with weakness, 7 patients had full recovery and 4 still had weakness.The 2 patients with paraplegia were able to walk with a stick.No recurrence was found under MRI.Conclusions Intramedullary spinal schwannomas is closely related to the spinal cord.The prognosis is mostly good after minimally invasive surgery with microscopic fine manipulation.

关 键 词：脊髓 髓内 髓内外 神经鞘瘤 显微手术 

分 类 号：R739.42[医药卫生—肿瘤]