椎管内血管外皮细胞瘤1例

2018-04-25 谢涛 刘羽 毛峰 中国临床神经外科杂志

女,47岁,因背部持续性胀痛1个月、加重伴双下肢麻木、乏力10d入院。

【一般资料】

女,47岁

【主诉】

因背部持续性胀痛1个月、加重伴双下肢麻木、乏力10d入院。

【体格检查】

第7、8胸椎棘突及椎旁压痛、叩击痛,双下肢肌力Ⅲ级。

【辅助检查】

入院后胸椎MRI检查示:胸8椎体水平椎管内髓外硬脊膜下可见一大小约1.17cm×41px等T1、等T2信号影(图1A、1B),增强T1WI呈明显均匀强化,边界清楚,脊髓明显受压(图1C)。



【治疗】

全麻下行后正中入路椎管内占位切除术。磨钻及铣刀整块打开椎板后,见硬脊膜张力较高,剪开硬脊膜,见灰红色“鱼肉状”肿瘤。肿瘤质地中等,边界清,肿瘤基底附着于硬脊膜,脊髓明显受压。术中行神经电生理监测,仔细分离肿瘤与周边粘连的神经,显微镜下整块切除肿瘤及与之粘连的硬脊膜。术后病理示(胸8椎体水平椎管内)梭形细胞肿瘤,符合血管外皮细胞瘤(WHOⅡ级,图1F)。术后1周,双下肢肌张力恢复。术后10d拆线并出院,出院后两周行放疗。术后4个月,复查胸腰椎MRI增强扫描,见肿瘤全切,脊髓形态良好(图1D、1E)。半年后随访,术前背部、双下肢麻木、乏力症状消失,双下肢活动正常。



【讨论】

椎管内HPC在椎管内各段均可发生,无明显分布差异,与硬脊膜粘连,血供较丰富。根据病灶部位可分为硬脊膜外HPC、硬脊膜下髓外HPC及硬脊膜内外型HPC。椎管内硬脊膜下髓外HPC临床极为罕见。临床表现无特异性,表现为缓慢起病逐渐加重,与病灶的位置、大小和脊髓受压有关,而与组织病理学分型无关。多表现为上肢或下肢的乏力或感觉异常,有些表现为神经根的刺激症状,病变位于腰骶段椎管时常伴有大小便功能障碍。MRI检查具有定位及定性诊断意义,可直接观察肿瘤的形态、部位、大小以及与脊髓的关系等。T1WI呈低、等信号,T2WI呈等或稍高信号,有时亦可呈混杂信号,部分可见血管流空影;增强扫描明显均匀强化,有时可见硬脊膜尾征。目前,MRI仍然难以与椎管内其它良性肿瘤(如脊膜瘤、神经鞘瘤)鉴别,因此临床误诊率几乎高达100%。确诊依靠病理检查。椎管内HPC最佳治疗方法是手术。治疗难题是高复发率和高转移率。为了防止肿瘤远距转移和复发,术中必须尽可能整块切除肿瘤和粘连的硬脊膜。由于肿瘤血供较丰富,术中常因出血量大、止血困难而影响显微手术视野,使肿瘤难以全切。术中应尽可能仔细地锐性分离肿瘤周围结构,避免牵拉周围神经和组织,减少脊髓和周围神经的损伤,在安全的情况下使肿瘤组织暴露及切除的更彻底。术中神经电生理监测,有利于脊神经的保护。椎管内HPC宜采取手术切除,术后辅助放疗,减少术后转移和复发,而不提倡化疗,术后均应进行长期随访。

原始出处:

谢涛, 刘羽, 毛峰,等. 椎管内血管外皮细胞瘤1例[J]. 中国临床神经外科杂志, 2017(11).

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    2018-05-12 bugit
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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309296, encodeId=b80d309296da, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=12, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Thu Apr 26 05:30:51 CST 2018, time=2018-04-26, status=1, ipAttribution=)]
    2018-04-27 chunjianf

    学习了.谢谢分享

    0

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time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309379, encodeId=90d53093e965, content=学习了很有用不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Thu Apr 26 07:14:27 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309337, encodeId=2c4d30933e7a, content=shu背部胀痛双下肢麻木的 需警惕, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Thu Apr 26 06:15:23 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309296, encodeId=b80d309296da, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=12, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Thu Apr 26 05:30:51 CST 2018, time=2018-04-26, status=1, ipAttribution=)]
    2018-04-27 虈亣靌

    谢谢分享.学习了

    0

  7. 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time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309379, encodeId=90d53093e965, content=学习了很有用不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Thu Apr 26 07:14:27 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309337, encodeId=2c4d30933e7a, content=shu背部胀痛双下肢麻木的 需警惕, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Thu Apr 26 06:15:23 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309296, encodeId=b80d309296da, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=12, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Thu Apr 26 05:30:51 CST 2018, time=2018-04-26, status=1, ipAttribution=)]
    2018-04-26 易水河

    学习学习.赞赞赞赞赞赞

    0

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time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309379, encodeId=90d53093e965, content=学习了很有用不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Thu Apr 26 07:14:27 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309337, encodeId=2c4d30933e7a, content=shu背部胀痛双下肢麻木的 需警惕, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Thu Apr 26 06:15:23 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309296, encodeId=b80d309296da, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=12, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Thu Apr 26 05:30:51 CST 2018, time=2018-04-26, status=1, ipAttribution=)]
    2018-04-26 飛歌

    学习了很有用不错

    0

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    2018-04-26 871538379

    shu背部胀痛双下肢麻木的 需警惕

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    2018-04-26 秀红

    学习了

    0

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