脊髓内复发性室管膜瘤术后并发脊髓疝:附1例报道并文献复习  

Spinal cord hernia after surgery for recurrent intramedullary ependymoma:a case report and literature review

作　　者：韩武 戚继 李勃翰 谢炯 章炜 郭腾显 HAN Wu;QI Ji;LI Bo-han;XIE Jiong;ZHANG Wei;GUO Teng-xian(Department of Neurosurgery,Bejing Fengtai Hospital,Beijing 100071,China)

机构地区：[1]北京丰台医院神经外科,北京100071

出　　处：《中国临床神经外科杂志》2024年第2期88-91,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨脊髓内复发性肿瘤术后并发脊髓疝的预防及治疗方法。方法回顾性分析1例脊髓内复发性室管膜瘤术后并发脊髓疝的临床资料,并结合相关文献进行分析。结果54岁女性,胸8节段脊髓内室管膜瘤(WHO分级Ⅱ级)全切除术后9年复发,再次手术全切除肿瘤,术后2d突发神经功能恶化,复查胸椎CT示脊髓疝,急诊行椎管减压+硬脊膜成形术,术后神经功能改善,但遗留大小便功能障碍。术后3个月随访,恢复到术前状态,但遗留左下肢不自主颤抖,需要拐杖辅助行走。结论脊髓内复发性肿瘤再次切除术后出现神经功能障碍,结合影像学表现,应考虑到脊髓疝的可能,充分的减压、松解及硬脊膜成形术是一种有效的治疗方法。Objective To investigate the prevention and treatment of spinal cord hernia after surgery for recurrent intramedullary tumors.Methods The clinical data of a patient with recurrent intramedullary ependymoma complicated with spinal cord hernia after surgery were retrospectively analyzed,and the relevant literatures were reviewed.Results A 54-year-old female presented to the hospital with left lower limb numbness and weakness for 10 days,who underwent total resection for a intramedullary ependymoma at thoracic 8 segment(WHO gradeⅡ)9 years ago.Contrast-enhanced T1-weighted MR images showed irregular small nodular moderate enhancement signals in the thoracic 8 spinal cord segment,suggesting tumor recurrence.The tumor was totally removed again.The neurological function suddenly deteriorated 2 days after the reoperation,and the thoracic CT showed spinal cord hernia.The emergency spinal canal decompression and dural plasty were performed,and the neurological function improved after the decompression,with residual urinary and fecal dysfunction.At the follow-up 3 months after reoperation,the patient returned to the preoperative state,but left involuntary trembling of the left lower limb,requiring crutches to assist walking.Conclusions The spinal cord hernia should be considered when patients have neurological dysfunction after resection of recurrent intramedullary tumors.Adequate decompression and dural plasty are effective treatments.

关 键 词：脊髓内复发性室管膜瘤 显微手术 脊髓疝 椎管减压术 硬脊膜成形术 

分 类 号：R739.42[医药卫生—肿瘤] R651.11[医药卫生—临床医学]