后正中入路治疗胸椎管内脊膜瘤41例报告

摘要

Objective To investigate the follow-up outcomes of posterior midline approach treatment for patients with meningioma in thoracic spinal canal . Methods A total of 41 cases with meningioma in thoracic spinal canal from January 2004 to December 2013 in our hospital were studied , included 35 females and 6 males, aged from 24 to 84 years old ( mean, 56.3 ±13.6 years old).MRI showed tumors located in the dorsal side of spinal cord in 16 cases (39.0%), in ventral and lateral-ventral side in 13 cases (31.7%), and in lateral side in 12 cases (29.3%).According to the McCormick scores, there were 10 cases of grade Ⅰ, 17 cases of grade Ⅱ, 10 cases of grade Ⅲ, and 4 cases of grade Ⅳpreoperatively .The operation was performed through posterior median line incision to cut off the intraspinal tumor under microscope with laminectomy (34 cases) or lamiplasty (7 cases).A total of 22 cases of operation was under electrophysiologic monitoring .Postoperative follow-up of spinal cord functions was evaluated by McCormick scores. Results There were no operative deaths .According to the Simpson classification , there were 13 cases (31.7%) of classⅠresection and 28 cases (68.3%) of class Ⅱresection.Postoperative incisional infection occurred in 1 case, which was cured by debridement .At the second week after operation , there were 15 cases of grade Ⅰ, 15 cases of grade Ⅱ, 7 cases of grade Ⅲ, and 4 cases of grade Ⅳas the McCormick scores, without significant differences as compared with preoperation (Z=-1.445, P=0.149). A total of 41 patients were followed up for 4-73 months (mean, 24.9 ±18.3 months).Local recurrence was found in 1 case.At the last follow-up evaluation , there were 30 cases of grade Ⅰ, 8 cases of grade Ⅱ, and 3 cases of grade Ⅲ, with spinal cord functions significantly improved (Z=-4.135, P=0.000).Among 12 cases followed up for more than 36 months, there were 8 cases of gradeⅠ, 2 cases of grade Ⅱ, and 2 cases of grade Ⅲ. Conclusions The posterior thoracic midline approach treatment for meningioma is effective .Intraoperative elaborative microscopic performance and application of electrophysiologic monitoring can be helpful to get a better prognosis .%目的：探讨正中入路治疗胸椎管内脊膜瘤的随访结果。方法2004年1月～2013年12月，我院收治胸椎管内脊膜瘤41例，女35例，男6例，年龄24～84岁，（56．3±13．6）岁。肿瘤位于脊髓背侧16例（39．0％），腹侧及侧腹方13例（31．7％），侧方12例（29．3％）。 McCormick脊髓功能评分Ⅰ级10例，Ⅱ级17例，Ⅲ级10例，Ⅳ级4例。行标准后正中入路胸椎椎板切除（34例）或胸椎椎板回置（7例），显微镜下行肿瘤切除术。后22例在神经电生理监测下手术。术后随访McCormick脊髓功能评分。结果手术无死亡，手术Simpson分级Ⅰ级切除13例（31．7％），Ⅱ级切除28例（68．3％）。术后伤口感染1例，经清创后痊愈。术后2周脊髓功能评分Ⅰ级15例，Ⅱ级15例，Ⅲ级7例，Ⅳ级4例，较术前无显著差异（ Z＝-1．445，P＝0．149）。41例随访时间4～73个月，（24．9±18．3）月，局部复发1例。末次随访脊髓功能评分Ⅰ级30例，Ⅱ级8例，Ⅲ级3例，较术前明显改善（Z＝-4．135，P＝0．000）。其中12例随访＞36个月，脊髓功能评分Ⅰ级8例，Ⅱ级2例，Ⅲ级2例。结论后正中入路治疗胸椎管内脊膜瘤手术效果良好，术中精细操作及神经电生理监测的应用可以使患者获得良好的预后。