椎管内脊膜瘤的显微外科治疗——附70例临床报告

背景与目的：脊膜瘤是椎管内的常见良性肿瘤，随着影像学、显微外科学、神经电生理学等的发展．手术治愈率逐年提高，本研究旨在总结脊膜瘤的临床特点，显微外科治疗手术技巧，以期对提高其临床疗效起到一些作用。方法：对我院神经外科2000—2005年收治的70例经病理证实的脊膜瘤患者临床资料进行回顾性分析。结果：所有患者术前均行MRI、诱发电位检查，采取显微手术治疗，术中辅以电生理监测。肿瘤位于颈段21例（30％），胸段45例（64_3％），胸腰交界2例（2．9％），腰骶段2例（2．9％）。全切63例．近全切除5例．大部分切除2例，无手术死亡。术后症状均缓解，神经功能明显改善，随访3-6个月．无影像学上复发。结论：脊膜瘤是椎管内的良性肿瘤，胸段好发，娴熟的显微神经外科操作及合理的手术入路．可尽量避免脊髓及神经损伤．提高治疗效果。如能全切除肿瘤及受累硬脊膜，可降低肿瘤复发率，预后良好。

Surgical Treatment of Intraspinal Meningiomas:Report of 70 Cases

BACKGROUND & OBJECTIVE:Intraspinal meningioma is the second-most common intradaral,extramedullary spinal cord tumor. This study is to investigate clinical features,experience of microsurgery and operative skills of intraspinal meningiomas. METHODS: Seventy patients with intraspinal meningiomas,treated in the 3rd ward of department of neurosurgery,Beijing Tiantan Hospital from January of 2000 to April of 2005,were retrospectively analyzed. RESULTS: All the patients were examined by MRI scanning and evoked potential test preoperatively. Intraoperative electrophysiologic monitoring was applied. Twenty-one(30%) tumors located at cervical segment,45 tumors(64.3%)located in thoracic segment,2(2.9%) in thoracic-lumbar junction,2 (2.9%) in lumbar-sacral segment. Total resection was achieved in 63 patients,subtotal removal in 5 patients,and partial resection in 2 patients. There was no surgical death. No significant perioperative complications occurred. Symptomatic relief was attained in most of patients,no image recurrence at follow-up visits at least 3 months. CONCLUSIONS: Intraspinal meningioma is a benign tumor. Microsurgery treatment is optimal therapy. Microsurgical procecure and operative skills can avoid concomitant damage to spinal cord and nerves as far as possible. If the tumor and the involved dura were resected totally,recurrence rate would decrease,and patient would have a good prognosis.