马尾神经鞘瘤的临床特点与外科治疗

摘要

Objective To investigate the clinical features and surgical treatment method of cauda equina schwannoma. Methods Clinical symptoms, imaging characteristics and functional outcomes after surgical treatment of 32 patients with cauda equina schwannoma from June 2007 to March 2009 were retrospectively reiewed. Results Most patients (30 cases) suffered lower extremity numbness/pain before operations and 18 of them suffered in both lower extremities. Physical examination showed bilateral nerve damage or unilateral multiple nerve damage in 25 cases. The initial symptom of 12 cases was simple lumbago. Ten cases were misdiagnosed as lumbar disc herniation. Six patients were scanned by computed tomography but none of them was diagnosed correctly. All the patients were definitely diagnosed by magnetic resonance imaging (MRI) , the typical appearance of the schwannoma was a round or ovoid mass with isointense or slightly hyperintense on T1-weighted images, while on T2-weighted images with heterogeneous hyperintense in 25 cases, slightly hyperintense in 2, and homogeneous hyperintense in 5. Gadolinium-enhanced MRI was performed in 13 patients, of whom 10 cases showed heterogeneous or annular enhancing. In all patients, the tumor was resected completely, the functional outcomes were satisfactory except one with a giant tumor, in whom the neurological symptom was aggravated, and no recurrence was found during a short-term follow-up.Conclusions The characteristic features of cauda equina schwannoma were lower extremities numbness/pain and bi- or unilateral polyradiculopathy in physical examination. MRI is helpful for early diagnosis and recommended as the first choice. Functional outcomes are satisfactory in patients with tumor completely resected.%目的 探讨马尾神经鞘瘤的临床特点与外科手术治疗方法.方法 回顾性分析2007年6月-2009年3月经手术治疗的32例马尾神经鞘瘤患者的临床症状、影像学改变和外科手术治疗效果.结果 多数患者术前出现下肢疼痛麻木的症状(30例),其中18例为双下肢疼痛麻木,体检时25例表现为双侧神经损害或单侧多根神经损害.12例患者首发症状为单纯腰痛.10例误诊为腰椎间盘突出症.6例行CT扫描,但均未能做出正确诊断.所有患者均经MRI确诊,神经鞘瘤表现为圆形或椭圆形病灶,T1加权像呈等或稍低于脊髓信号,T2加权像25例呈不均匀高信号,2例呈稍高信号,5例呈均匀高信号.13例行钆增强扫描,10例呈不均匀强化或环形强化.所有患者均完整切除肿瘤,除1例巨大马尾神经鞘瘤术后症状加重外,其他患者术后功能均改善,短期随访未见复发.结论 马尾神经鞘瘤的特征性表现为双下肢疼痛麻木;查体显示双侧或单侧多根神经损伤,但首发症状可不典型;MRI有助于早期诊断;外科手术完整切除肿瘤效果良好.