单纯椎管内硬脊膜外海绵状血管瘤7例临床特点分析  

Clinical features of 7 cases of pure spinal epidural cavernous hemangioma

作　　者：徐梦奇 李婧文 Xu Mengqi;Li Jingwen(Department of Neurosurgery,Xiangyang Central Hospital,Affiliated Hospital of Hubei University of Arts and Science,Xiangyang 441021,China;Department of Oncology,Xiangyang Central Hospital,Affiliated Hospital of Hubei University of Arts and Science,Xiangyang 441021,China)

机构地区：[1]湖北文理学院附属医院襄阳市中心医院神经外科,襄阳441021 [2]湖北文理学院附属医院襄阳市中心医院肿瘤科,襄阳441021

出　　处：《中国医师进修杂志》2023年第7期622-626,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的:探讨单纯椎管内硬脊膜外海绵状血管瘤的临床特点,以提高对该病的诊治能力。方法:回顾性分析襄阳市中心医院2013年1月至2022年11月7例单纯椎管内硬脊膜外海绵状血管瘤患者的临床资料。结果:7例患者中,男2例,女5例,平均年龄49.4岁。病变位于颈椎1例,胸椎5例,腰椎1例。单纯神经根症状1例,单纯脊髓病症状4例,既有脊髓病症状又有神经根症状2例。T 1和T 2加权像均呈等或稍长信号,增强扫描均为均匀强化。术前误诊为脊膜瘤1例,该患者术中未仔细辨认病变,误将病变当成手术操作导致的渗血而吸除;误诊为神经鞘瘤2例。患者均行术前定位,经后正中入路于显微镜下行硬脊膜外病变切除术,病变均实现全切,住院期间未见明显并发症。术前神经功能Frankel分级C级1例,D级3例,E级3例;患者随访1~117个月,最后一次随访时神经功能Frankel分级D级3例,E级4例,未见复发。结论:单纯椎管内硬脊膜外海绵状血管瘤在影像学上极易误诊为神经鞘瘤、脊膜瘤,术前应认真阅片。建议术前病变节段棘突注射亚甲蓝并定位照片有助于术中精准定位。一旦考虑该病,术中打开椎板清除硬脊膜外脂肪时应格外注意,病变易出血,且误认为硬脊膜渗血而被吸引器吸除或连同硬脊膜外脂肪一起咬除。手术全切是有效的治疗方法,且应尽早治疗,避免病变急性出血影响预后。Objective To study the clinical features of pure spinal epidural cavernous hemangioma in order to improve the diagnosis and treatment ability.Methods The clinical data of 7 patients with pure spinal epidural cavernous hemangioma from January 2013 to November 2022 in Xiangyang Central Hospital were analyzed retrospectively.Results Among the 7 patients,2 males and 5 females,and the average age was 49.4 years old.Location of the lesion:cervical spine 1 case,thoracic spine 5 cases,and lumbar spine 1 case.One patient had pure radicular symptoms,4 patients had pure spinal cord symptoms,and the other 2 patients had both myelopathy symptoms and radicular symptoms.T1 and T2 weighted images showed equal or slightly longer signals,and the enhanced scans showed uniform enhancement.Before operation,1 case was misdiagnosed as meningioma,and the patient′s lesion was not carefully identified during operation,so the lesion was mistaken for oozing hemorrhage caused by operation;2 cases were misdiagnosed as schwannoma.All patients underwent preoperative localization and microsurgical resection of epidural lesions through the posterior median approach.The lesions were completely removed and no significant complications were observed during hospitalization.Before operation,the neurological function Frankel grade C was in 1 case,grade D in 3 cases,grade E in 3 cases;the patients were followed up for 1 to 117 months,at the last follow-up,neurological function Frankel grade D was in 3 cases,grade E in 4 cases,no recurrence was found.Conclusions The pure spinal epidural cavernous hemangioma is very likely to be misdiagnosed as the schwannoma and meningioma in imaging,the preoperative imaging should be carefully observed.It is recommended to inject methylene blue into the spinous process of the lesion segment before operation and locate the photos to help with precise intraoperative positioning.Once the disease is considered,special attention should be paid when opening the vertebral lamina to remove the epidural fat during the operatio

关 键 词：血管瘤 海绵状 椎管 疾病特征 硬脊膜外 

分 类 号：R654.3[医药卫生—外科学]