脊髓髓内肿瘤的手术治疗

脊髓髓内肿瘤相对少见,约占中枢神经系统肿瘤的4%～10%,占椎管内原发性肿瘤的25%.随着神经影像学和显微外科技术的发展,脊髓髓内肿瘤的外科治疗也逐渐广泛开展.现就我科5年间采用显微镜下手术治疗的12例脊髓髓内肿瘤报道如下.     

脊髓内肿瘤术后辅用甲泼尼龙的疗效观察

目的 观察甲泼尼龙对脊髓髓内肿瘤术后的疗效.方法 通过9例脊髓髓内肿瘤术后病人应用甲泼尼龙辅助治疗的临床观察与分析.结果 9例术后病人使用甲泼尼龙治疗后,病情恢复快,但5例出现副作用反应,经对症治疗均能恢复正常.结论 辅用甲泼尼龙治疗脊髓髓内肿瘤术后效果虽然不错,但应注意副作用的发生,并做到:正确配药,严密观察,及时处理.     

显微手术治疗脊髓髓内肿瘤38例临床分析

目的 探讨显微手术治疗脊髓髓内肿瘤的临床疗效.方法 对38例脊髓髓内肿瘤患者的临床资料进行回顾性分析,并对肿瘤的切除情况及术后患者功能改变情况进行总结.结果 38例中17例室管膜瘤均显微镜下全切除;13例星形细胞瘤全切除5例,近全切除4例,部分切除4例;5例脂肪瘤均大部分切除;3例血管母细胞瘤均全切除.32例术前有不同程度运动障碍的患者出院时29例有不同程度的改善,1例无变化,2例较术前减退;29例患者术前有不同程度感觉障碍,出院时21例患者有改善,5例无变化,3例加重;14例出现括约肌功能障碍的患者,12例较术前减轻或缓解,2例无变化.结论 早期诊断并采取显微手术治疗是脊髓髓内肿瘤首选的治疗方法,值得在临床推广应用.     

难治性脊髓肿瘤的诊断与治疗

本文将脊髓肿瘤中的颅脊管肿瘤、高颈髓肿瘤、脊髓腹侧面肿瘤、脊髓髓内肿瘤和椎管内外哑铃型肿瘤,这五种统称为难治性脊髓肿瘤,并对其早期诊断和误诊,辅助检查判定和手术治疗体会作以介绍。     

脊髓髓内肿瘤显微切除的临床研究

我科自1998年1月至2007年1月共收治脊髓髓内肿瘤病人27例,我们全部采取显微手术切除肿瘤,术前根据临床症状、体征,肿瘤的部位及类型,选择合适的手术时机,脊髓髓内肿瘤必须尽早明确诊断,定位准确,把握好手术时机,采取显微手术治疗,术中根据肿瘤性质决定术式,严格沿脊髓后正中切开,减少脊髓的损伤.尽可能切除肿瘤是最大程度减少神经功能障碍同时获得长期生存.先报告如下:     

脊髓肿瘤18例手术护理

脊髓肿瘤是指椎管内各种组织的原发性和继发性肿瘤,包括髓内肿瘤、髓外硬膜下肿瘤、硬膜外肿瘤.表现为肿瘤所在部位神经组织及其以下平面的感觉障碍,运动障碍,反射障碍,植物神经功能障碍等[1].手术治疗的目的是去除病因,缓解压迫症状.护理以密切观察呼吸,肢体活动防止脊髓损伤,恢复脊髓功能为重点.     

脊髓髓内结核瘤1例报告并文献复习

脊髓髓内结核瘤是一种少见的疾病,国内外文献罕见报道,其发病率仅约占全部结核病的2/10万和中枢神经系统结核的0.2%[1]。由于发病率低,在临床上易误诊、漏诊和延误治疗。笔者将经治的1例脊髓髓内结核瘤的诊治经验及文献复习情况总结如下。     

脊髓髓内肿瘤显微手术切除治疗体会

目的探讨应用显微外科手术切除脊髓髓内肿瘤的临床疗效,方法对15例脊髓髓内肿瘤施行显微手术治疗．采用McCormick临床神经功能分级方法及MRI检查,对患者术前、术后神经功能改变,以及肿瘤切除情况进行评估分析,结果肿瘤全切除11例,次全切除3例,部分切除1例,术后临床神经功能改善6例,保留术前神经功能6例,术后神经功能变差3例。结论显微外科能提高手术切除脊髓髓内肿瘤的临床疗效,改善患者症状;对髓内室管膜瘤及良性肿瘤全切除效果良好。     

脊髓髓内肿瘤显微神经外科治疗的临床研究

目的 探讨应用显微神经外科技术切除脊髓髓内肿瘤的方法、技巧和临床效果。方法 对我院16例脊髓髓内肿瘤患者行显微神经外科切除进行回顾性研究。结果 62.5％全切除，31.2％分切除，术后临床症状改善率61．5％。结论 对脊髓髓内肿瘤积极的应用显微外科手术技术分块切除肿瘤，同时注意保护脊髓组织，可取得良好的手术疗效。     

21例脊髓髓内肿瘤的显微手术治疗

<正>椎管内肿瘤是神经外科常见病,占神经系统肿瘤的10%～15%,而脊髓髓内肿瘤占椎管内肿瘤的10%～20%[1]。自20世纪70年代以后由于神经影像和显微手术技术的应用,髓内肿瘤的诊治水平和手术疗效得到很大提高,大多数学者主张积极手术切除髓内肿瘤[2,5]。本文回顾性分析21例脊髓髓内肿瘤患者临床特征、影像学资料及手术     

脊髓血管畸形影像学特点与栓塞治疗

目的：讨论８例脊髓血管畸形影像学特点和治疗。方法：经选择性脊髓血管造影证实髓内动静脉畸形４例，髓周动静脉瘘４例，全部患者表现为进行性脊髓损坏。采用血管内直接栓塞法治疗，栓塞 Ｉｖａｌｏｎ（栓塞粒）。结果：６例临床症状缓解，２例无明显改变。结论：血管造影是诊断脊髓篾管畸形的可靠方法，栓塞治疗效果良好。     

显微外科手术治疗椎管内肿瘤的临床效果分析

目的 评估显微外科手术治疗椎管内肿瘤的临床效果.方法 回顾分析46例采用显微外科技术切除的椎管内肿瘤病例,对肿瘤的部位、病例类型、切除程度及症状缓解情况进行总结.结果 46例椎管内肿瘤均成功切除,其中40例完全切除,6例部分切除,完全切除率达87.0％.术后症状改善率较高,仅1例出现疼痛较术前加重.没有1例复发,没有死亡病例.结论 应用显微外科技术进行椎管内肿瘤切除,可提高肿瘤切除率,降低脊髓损伤及并发症的发生率.     

Symptomatic spinal cord involvement in prostate cancer

The literature on spinal cord involvement in prostate cancer is reviewed by searching the Medline from 1965 to 1997 and references in publications on the subject. The objective was to identify the clinical characteristics and treatment modalities of the disease. Prostate cancer is the leading cause of metastatic spinal cord disease in men. The tumour reaches the spinal column mainly by the venous route. The frequency of involvement in decreasing order is thoracic spine, lumbar spine and cervical spine. The tumour usually exerts compression of the cord from the extradural space. However, intradural and intramedullary metastases have devastating effects. The patients have other neurological and urological symptoms prior to the onset of paraplegia. But in some, spinal cord compression may be the first symptom of prostate cancer. Plain X-rays may suffice in diagnosis but MRI is the single most valuable investigation for anatomic definition or localization of spinal cord secondaries. All forms of treatment are palliative. Treatment options, singly or in combination, include hormonal manipulation, radiotherapy and laminectomy each often with high dose corticosteroids. Recurrence of symptoms after an initial relief with hormonal manipulation signifies escape of the tumour from endocrine control and portends a poor prognosis.     

Intramedullary cavernous haemangioma of spinal cord: a case report and literature review

A 27-year-old female patient with progressive paraparesis and incontinence of urine of 9 months duration was managed at Tikur Anbessa Hospital, Neurosurgery unit, Department Of Surgery, Medical Faculty, Addis Ababa University, Addis Ababa. Thoracic myelography showed an intramedullary mass at T3-T5 levels of the spinal cord. Histopathology revealed cavernous haemangioma. Near total surgical removal of the haemangioma was done. and the patient put on intensive physiotherap. Cavernous haemangioma should be suspected in the differential diagnosis of patients with progressive deterioration of spinal cord function. Total surgical excision of the lesion is the current treatment modality.     

Intrathecal administration of roscovitine attenuates cancer pain and inhibits the expression of NMDA receptor 2B subunit mRNA

Cancer pain is one of the most severe chronic pains. The mechanisms underlying cancer pain are still unclear. Because of the pain-relieving effects of Cdk5 (Cyclin-dependent kinase 5) antagonist roscovitine in inflammation pain models, we tested whether roscovitine would induce antihyperalgesia in cancer pain. Our previous study showed that the NR2B (N-methyl-d-aspartate receptor 2B) in the spinal cord participates in bone cancer pain in mice. In this study, we used a mouse model of bone cancer pain to investigate whether roscovitine could attenuate bone cancer pain by regulating the expression level of NR2B mRNA in spinal cord. C3H/HeJ mice were inoculated into the intramedullary space of the right femur with Osteosarcoma cells to induce ongoing bone cancer pain behaviors. At day 14 after operation, inoculation of Osteosarcoma cells significantly enhanced mechanical allodynia and thermal hyperalgesia, which was attenuated by intrathecal administration of different doses of roscovitine. Correlated with the pain behaviors changes, RT-PCR experiments in our study revealed that there was a marked increase in the expression of NR2B mRNA in spinal cord after operation, which was attenuated by intrathecal administration of roscovitine. These results suggest that roscovitine may be a useful adjunct therapy for bone cancer pain, and NR2B in spinal cord may participate in this effect.     

脊髓粘连性蛛网膜炎：21例临床分析

本文报道21例经脊髓腔碘油造影或手术证实的脊髓粘连性蛛网膜炎。病变常以脊神经根刺激症状为首发症状,但由于蛛网膜的纤维粘连和/或囊肿直接压迫脊髓,或使供应脊髓的动脉受压及脊髓静脉回流困难,常致脊髓缺血、水肿甚至空洞形成,及至病人就诊时其临床表现多为髓内病征。脊髓腔碘油造影目前仍为主要的确诊手段,主要表现为蛛网膜下腔部分或完全梗阻,或造影剂呈“蜡泪”状,或造影剂梗阻平面与临床定位平面不尽相符等。磁共振成像(MRI)有助于局限性粘连与肿瘤的鉴别。     

激光治疗系统接触式激光显微手术治疗脊髓髓内肿瘤

目的　探讨应用接触式激光显微手术治疗髓内肿瘤的疗效。方法　 1995年 3月至 2 0 0 2年 1月应用美国 Medi- Therm公司生产的激光治疗系统 (SL T)接触式激光器配合显微技术共完成各类脊髓髓内肿瘤手术2 5例 ,包括室管膜瘤 8例 ;低恶度星形细胞瘤 7例 ;高恶度星形细胞瘤 1例 ;髓内脂肪瘤 3例 ;皮样或表皮样囊肿 3例 ;髓内畸胎瘤、神经鞘瘤和海绵状血管瘤各 1例。术中依据肿瘤性质和部位不同选用不同的激光刀头或联合使用。结果　肿瘤全切 15例 (6 0 % ) ;近全切除 8例 (32 % ) ,两者合计共 2 3例 (92 % )。大部切除 2例 (8% )。全部病例获得随访 ,随访期 4～ 79个月 ,按功能标准判断 :痊愈 13例 (5 2 % ) ,好转 7例 (2 8% ) ,两项合计 2 0例 (80 % )。而不变 3例(12 % ) ,加重 1例 (4% ) ,复发 1例 (4% )。结论　接触式激光可以精确地切除和汽化髓内肿瘤 ,减少副损伤 ,增加脊髓髓内肿瘤的切除率和术后功能好转率 ,术中显微手术技术的运用和激光刀头的正确选择至关重要。     

Low-dose zoledronic acid reduces spinal cord metastasis in pulmonary adenocarcinoma with neuroendocrine differentiation

Zoledronic acid (ZOL), a nitrogen-containing compound, is effective in the treatment of skeletal disorders, but its long-term use in high doses gives rise to complications such as osteonecrosis. We aimed to investigate the effect of low-dose ZOL on the expression of the neural cell adhesion molecule (NCAM), which may be correlated with tumor growth and spinal cord metastasis in lung adenocarcinoma with neuroendocrine differentiation. First, we used the small hairpin RNA technique to directly knock down NCAM expression in cells of a murine lung adenocarcinoma line, line 1 cells, and found that the tumor cells generated showed lower invasive capacity, slower tumor growth, and lesser tendency for spinal cord metastasis than control cells. Further, ZOL decreased NCAM expression and invasiveness in line 1 tumor cells in vitro. Line 1/lacZ cells, a stable clone tagged with the lacZ gene, were introduced into mice, followed by ZOL treatment (1 μg/kg/weekly). Low-dose ZOL significantly reduced spinal cord metastasis probably through reduced NCAM expression in vivo. These findings indicated that NCAM is involved in tumor growth and spinal cord metastasis of lung adenocarcinoma with neuroendocrine differentiation. Treatment with low-dose ZOL can reduce NCAM expression that may contribute toward reduced spinal cord metastasis, suggesting that NCAM is an alternative therapeutic target and that the low-dose ZOL treatment protocol is a reasonable approach for its treatment.