脊髓髓内肿瘤手术治疗.pptx

脊髓髓内肿瘤的手术治疗复旦大学附属华山医院神经外科车晓明

脊髓髓内肿瘤约占椎管内肿瘤20%涉及重要的神经结构与生存质量关系重大操作精细，方法得当

ThePercentageofthe202CasesofIntrameduallaryTumorPathologyCasesPrecentageEpendymoma11456.4%Astrocytoma4220.8%Hemangioblastoma3416.8%Teratoma52.5%Neurinoma42.0%Lipoma31.5%Total202100%

TheRemovalExtentof202TumorsPathologyCasesTumorremovalextentTotallySubtotallyPartiallyorBiopsiedependymoma114108(94.7%)6astrocytoma428232hemangiblastoma3434(100%)teratoma514neurinoma44lipoma321total202155(76.7%)1433

TheMcCorMickGradingScaleofSpinalCordFunctionStatusClassificationDefinitionGradeⅠNeurologicallynormal;mildfocaldeficitnotsignificantlyaffectingthefunctionofinvolvedlimb;mildspasticityorreflexabnormality;normalgaitGradeⅡPresenceofsensorimotordeficitaffectingfunctionofinvolvedlimb,mildtomoderategaitdifficulty;severepainordysestheticsyndromeimpairingpatients’qualityoflife;stillfunctionsandambulatesindependentlyGradeⅢMoresevereneurologicaldeficit;requirescane/braceforambulationorsignificantbilateralupper-extremityimpairment;mayormaynotfunctionindependentlyGradeⅣSeveredeficit;requireswheelchairorcane/bracewithbilateralupper-extremityimpairment;usuallynotindependent

SpinalCordFunctionStatusof202PatientswhenDischargedPathologyCasesSpinalCordFunctionStatusImprovedUnchangedWorsenDiedEpendymoma114226626Astrocytoma4282391Hemangiblastoma3410195Teratoma541neurioma422Lipoma32120248112←(79.2%)411

Pre-andpostoperativeSpinalCordFunctionStatusMaCorMickGradingScaleCasesPreoperativePostoperative(7daysorso)Ⅰ1110Ⅱ6773Ⅲ2217Ⅳ1414

TheFollow-upStudyofSpinalCordFunctionStatusin93Patients(mean3.7years)PathologyCasesSpinalCordFunctionStatusImprovedUnchangedWorsenEpendymoma591836←(91.5%)5Astrocytoma1628←(62.5%)6Hemangiblastoma1476←(92.8%)1Teratoma312Neuriom(87.1%)12

髓内肿瘤的治疗原则保存脊髓功能的基础上，最大限度的切除肿瘤。早期手术，保留功能提倡根据病理类型因病施治，采用不同的手术策略和方法

室管膜瘤大多边界清楚，力争全切严格背正中切开识别并严格沿“瘤—髓”边界分