颈髓髓内室管膜瘤的影像解剖学分型及手术策略

doi:10.13418/j.issn.1001-165x.2016.05.017

中国临床解剖学杂志 ›› 2016, Vol. 34 ›› Issue (5): 563-567.doi: 10.13418/j.issn.1001-165x.2016.05.017

颈髓髓内室管膜瘤的影像解剖学分型及手术策略

陈克恩¹，　王向宇¹，　许典双¹，　周孟¹，　张柳¹，　郭国庆²

暨南大学 1.附属第一医院神经外科；　2.医学院解剖学教研室，广州 510632

收稿日期:2015-10-12 出版日期:2016-09-25 发布日期:2016-10-14
通讯作者: 郭国庆，男，教授，博士生导师，Tel：020-85220251，E-mail：tgqguo @jnu.edu.cn
作者简介:陈克恩（1963-），男，广东人，副教授，研究方向：中枢神经的损伤与再生，Tel：38688640，E-mail：tcken@jnu.edu.cn
基金资助:
广东省医学科研基金(A2014382)

Categorization of intramedullary ependymoma in cervical spinal cord by imaging anatomy and surgical strategy

CHEN Ke-en¹, WANG Xiang-yu¹, XU Dian-shuang¹, ZHOU Meng¹, ZHANG Liu¹, GUO Guo-qing²

1. Department of Neurosurgery, the First Affiliated Hospital, Jinan University, Guangzhou 510630, China; 2. Department of Anatomy, Medical College, Jinan University, Guangzhou 510630, China

Received:2015-10-12 Online:2016-09-25 Published:2016-10-14

摘要/Abstract

摘要：

目的　探讨颈髓髓内室管膜瘤的影像解剖学特点并制定相应的手术策略。方法　用MRI成像技术分析26例颈髓髓内室管膜瘤影像学形态特点及脊髓受压变形情况，将肿瘤进行分型并在电生理实时监测下手术分离切除肿瘤。结果　按肿瘤形态及其与脊髓之间的解剖学关系分为3种类型：I型：实质伴有空洞型；II型：实质型； III型：囊肿内瘤型。对I型肿瘤从肿瘤极端和空洞交界处或肿瘤中部开始从后正中沟切开脊髓分离切除肿瘤；对Ⅱ型肿瘤从肿瘤中部脊髓后正中沟切开分离切除肿瘤；对III型肿瘤从最近肿瘤结节处从脊髓后正中沟切开，囊内切除肿瘤。术中电生理监测显示体感诱发电位（SEP）波幅下降50% 或者潜伏期延长10%；目标肌群运动诱发电位（MEP）波幅持续下降至20%，应暂停手术。术后所有病例病理报告均为室管膜瘤。术后MRI复查23例肿瘤完全切除，3例肿瘤部分切除。术后症状明显减轻23例，好转2例，加重1例，无死亡病例。结论　依据术前MRI进行分型并制定相应的手术策略可以达到完全切除肿瘤、减少脊髓损伤的目的。

关键词: 室管膜瘤, 脊髓肿瘤, 磁共振成像, 显微外科手术

Abstract:

Objective　To investigate the imaging anatomical characteristics of intramedullary ependymoma in cervical spinal cord and formulate appropriate surgical strategy.　Methods　Tumors in 26 patients with intramedullary ependymoma in the cervical spinal cord were categorized by analyzing the pre-operative magnetic resonance imaging (MRI) characteristics and the compressed alteration of the spinal cord,and removed with assistance from real time neuro-electrophysiological monitoring.　Results　The tumors were classified into three types based on their morphological changes and the anatomical relationship between the spinal cord and the tumor : Type I: Solid tumor with syringomyelia or cyst；Type II: Solid tumor；Type III: Tumor tubercle in the cyst. For type I, tumors were removedstarting from operating at the posteriormedian sulcus at the border of the poles of the tumor and the syringomyelia or cyst,or at the center of the tumors. For type II,tumors were resected starting from operating at the posterior median sulcus at the center of the tumors, and for type III, starting from operating at the posterior median sulcus at the point close to the tumor tubercles.When the introperative neuro-electrophysiological monitor indicated a 50% reduction of the amplitude or a 10% delay of the latency of somatosensory evoked potential (SEP), andor the amplitude of motor evoked potential (MEP) for the target muscles dropped to 20%, surgical procedures should be suspended for its recovery. The final pathological diagnosis of all the cases was intramedullary ependymoma. Post-operative MRI indicated of all the cases, 23 were total removed, 3 partially, without death during surgery. Post-operative symptoms were significantly improved in 23 patients, partially in 2 and deteriorated in 1.　Conclusion　Classification based on pre-operative MRI characteristics and formulation of appropriate surgical strategy may be helpful for total removal of intramedullary ependymomain the cervical spinal cord and reduction of injury of spinal cord.

Key words: Intramedullary ependymoma, Spinal Tumor, Magnetic resonance imaging, Microsurgical operation

陈克恩,王向宇,许典双,周孟,张柳,郭国庆. 颈髓髓内室管膜瘤的影像解剖学分型及手术策略[J]. 中国临床解剖学杂志, 2016, 34(5): 563-567.

CHEN Ke-en, WANG Xiang-yu, XU Dian-shuang, ZHOU Meng, ZHANG Liu, GUO Guo-qing. Categorization of intramedullary ependymoma in cervical spinal cord by imaging anatomy and surgical strategy[J]. Chinese Journal Of Clinical Anatomy, 2016, 34(5): 563-567.

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颈髓髓内室管膜瘤的影像解剖学分型及手术策略

Categorization of intramedullary ependymoma in cervical spinal cord by imaging anatomy and surgical strategy

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