钙化型脊膜瘤的临床特征及显微外科治疗  

Clinical characteristics and microsurgical treatment of calcified spinal meningiomas

作　　者：史良 王汉斌 阎涛 王科大 刘龙奇 乔京元 苏亦兵 SHI Liang;WANG Hanbin;YAN Tao;WANG Keda;LIU Longqi;QIAO Jingyuan;SU Yibing(Department of Neurosurgery,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院神经外科,北京100035

出　　处：《中华骨与关节外科杂志》2023年第8期699-705,共7页Chinese Journal of Bone and Joint Surgery

基　　金：北京市属医院科研培育项目(PX2020018);北京积水潭医院学科骨干培养计划(XKGG202115)。

摘　　要：目的:探讨钙化型脊膜瘤的临床特征、影像学表现、显微手术特点、手术治疗效果及预后。方法:回顾性分析2006年1月至2021年1月收治的49例钙化型脊膜瘤患者的临床资料。通过手术前后疼痛视觉模拟评分(VAS)、欧洲脊髓病评分(EMS)及McCormick脊髓功能分级对手术治疗效果及预后进行评估。结果:本组49例患者,病变累及颈椎段7例,胸椎段39例,腰椎段3例;平均累及(1.6±0.7)个椎体。首发症状多为相应节段疼痛、麻木等不适感,进而出现不同程度的脊髓功能障碍,术前VAS评分为2(1,3)分,EMS评分为(12.5±2.6)分,McCormick脊髓功能分级Ⅰ级6例、Ⅱ级17例、Ⅲ级15例、Ⅳ级11例;所有患者均行显微手术治疗,术中SimpsonⅠ级切除29例、Ⅱ级17例、Ⅲ级3例。所有患者随访6~147个月,平均随访(42.2±34.9)个月。术后6个月VAS评分为0(0,0)分,疼痛较术前明显缓解(P<0.01);McCormick脊髓功能分级:Ⅰ级38例,Ⅱ级7例,Ⅲ级3例,Ⅳ级1例;EMS评分为(14.5±2.5),神经功能较术前显著改善(P<0.01)。结论:钙化型脊膜瘤临床表现及影像学特征显著,早期诊治至关重要。显微手术治疗可明显缓解疼痛并改善神经功能,但应注意评估手术风险,制定个性化手术方案,并合理应用显微神经外科技术。Objective:To explore the clinical features,imaging manifestations,microsurgical characteristics,surgical efficacy,and prognosis of calcified spinal meningiomas.Methods:Clinical data of 49 patients with calcified spinal meningiomas treated between January 2006 and January 2021 were retrospectively analyzed.The therapeutic outcomes and prognosis were assessed by visual analogue scale(VAS),European myelopathy score(EMS)and McCormick grade.Results:The imaging examination revealed that the meningioma extended averagely across 1.6±0.7 vertebral levels,including 7 cases in cervical segment,39 cases in thoracic segment,and 3 cases in lumbar segment.The initial symptoms were mostly discomfort such as pain and numbness in the involved segments,and then varying degrees of spinal cord dysfunction presented.On admission,the mean VAS was 2(1,3),EMS was 12.5±2.6,and McCormick grade was gradeⅠin 6 cases,gradeⅡin 17 cases,gradeⅢin 15 cases,and gradeⅣin 11 cases.All the patients underwent microsurgery,including SimpsonⅠincision in 29 cases,Ⅱincision in 17 cases andⅢincision in 3 cases.The mean follow-up time was(42.2±34.9)months(range,6-147 months).Six months after surgery,the patients had significant pain relief(VAS:0[0,0])and neurological function recovery(McCormick grade:Ⅰin 38 cases,Ⅱin 7,Ⅲin 3,andⅣin 1;EMS:14.5±2.5,P<0.01).Conclusions:The obvious clinical features and imaging manifestations can benefit for the diagnosis of calcified spinal meningiomas.Early microsurgical intervention can relieve pain and improve neurological function.But surgeons should pay more attention to risks associated with microsurgery,make individualized surgical plans and properly apply microneurosurgical techniques.

关 键 词：脊膜瘤 钙化 显微手术 

分 类 号：R739.42[医药卫生—肿瘤]