椎管内髓外硬膜下转移瘤的诊治：附病例分析.pdfVIP

· 874 · · 诊 治 分 析 · 椎管内髓外硬膜下转移瘤的诊治：附病例分析 金 鑫，王 洪，方 川，史彦芳，董晓辉，李 炜，刘海建 【摘要】 目的 总结椎管内髓外硬膜下转移瘤的临床特点及诊治经验。方法 回顾性分析3例 (孤立性转移腺 瘤 2例，星形细胞瘤 1例)经手术及病理证实的椎管内髓外硬膜下转移瘤患者的临床资料。3例患者行椎管内肿瘤切 除术及椎板减压术，在显微镜下将脊神经根或马尾神经与肿瘤粘连紧密的部分予以切断，术后给予激素治疗及放化疗 等综合治疗。结果 椎管内髓外硬膜下转移瘤灶MRIT．、T2像的信号特点，均匀程度，与周围正常组织的分界及强化 后的影像学特征均与脊膜瘤或神经鞘瘤类似。经显微外科手术治疗，患者术后疼痛基本消失，脊髓功能较术前明显改 善。结论 诊断榷管内髓外硬膜下转移瘤时应仔细询问病史，并做全面的相关检查。确诊后早期手术治疗可取得 良好 的治疗效果。 【关键词】 脊椎；转移瘤；髓外硬膜下；显微外科手术 【中圈分类号】R651．2 【文献标识码】A 【文章编号】1007—9572(2011)03—0874—03 DiagnosisandTreatmentofSubduralExtramedullarySpinalMetastases：A CaseStudy JIN Xin．WANGHong。FANG Chuan，eta1．DepartmentofNeurosurgery，theAffiliatedHospitalofHebeiUniversity，Baoding071000，China A【bstract】 Objeetive Tosummarizetheclinicalfeaturesandtherapeuticexperiencesofthesubduralextramedullary spinalmetastases．Methods Theclinicaldataof3eases(2casesofsolitarymetastaticadenoearcinoma，1caseofastrocytoma) confirmedbysurgeryandpathologyassubduralextramedullaryspinalmetastasesandtreatedinourdepartmentwererespectively reviewed．Patientsunderwenttumorresectionandspinallaminectomysurgery．Underthemicroscope，wecutoffthepartwhere thespinalnerverootorcaudaequinahadcloseadhesionwiththetumor．Aftertheoperation，hormonetherapyandchemoradi- ationweregiventothepatientsinordertohaveacomprehensivetreatment．Results ThesignalanduniformityofMRIT1and T2ofsubdural extramedullaryspinalmetastasesanditsdividinglinewithperipheralnomr altissuesaswellastheimagingfeatures weresimilartothoseofmeningiomaandneurinoma．Aftermicrosurgical treatments，thepainofallpatientsdisappearedandspi· nalcordfunctionwasimprovedsignificantlycomparedwiththatbefore．Conclusion Throughthesurgical treatmentatearly stage，patientswithsubduralextramedullaryspinalmetastasescanachievefavorabletreatmenteffectiveness． 【Keywords】 Spine；Metastasis；Subduralextramedullarymetastases；Mierosurgery 椎管内转移瘤绝大多数发生在硬膜外 ，极少数发生在硬膜