摘要
目的探讨脊膜瘤老年患者的临床和病理特点及显微手术技巧。方法回顾性分析2001年3月至2011年10月显微手术治疗的56例经病理学检查证实的脊膜瘤老年患者（年龄60—84岁）的临床资料；按McCormick神经功能分级，56例患者中术前McCormickI级6例，Ⅱ级11例，Ⅲ级22例，Ⅳ级14例，V级3例。结果肿瘤位于硬膜下髓外55例（98．2％），完全位于硬膜外1例（1．8％）；56例患者中38例（67．9％）肿瘤位于胸段。55例（98．2％）肿瘤全切除，1例大部分切除。无手术死亡病例。术后、McC0rmick分级改善者31例（55．4％），不变者19例（33．9％），恶化者6例（10．7％）。术后随访3个月至7年，肿瘤无复发。结论老年脊膜瘤患者中女性发病率明显高于男性。老年患者术前脊膜瘤误诊率高，术前大多数患者有中、重度神经功能障碍。肿瘤多位于胸段及脊髓腹侧及腹外侧，且部分质地坚硬，显微手术应精细操作，尽量避免脊髓及神经损伤。
Objective To explore clinical and pathological characteristics of the intraspinal meningiomas and the skills of microsurgery for them in elderly patients. Methods The clinical data of 56 patients （age range, 60-84 years） with intraspinal meningiomas proved by pathological examination, who underwent microsurgery for the intraspinal meningiomas from March, 2001 to October, 2011, were analyzed retrospectively. Of 56 patients with intraspinal meningiomas, 6 belonged in McCormick grade Ⅰ , Ⅱ in grade Ⅱ, 22 in grade Ⅲ, 14 in grade Ⅳ and 3 in grade V according to the McCormick neurological dysfunction scale before the operation. Results The total resection of the meningiomas was achieved in 55 patients, and partial resection in 1. No patient died of the surgery. The meningiomas subdurally located extramedullary in 55 patients and epidurally in 1 patient. Of 56 meningiomas, 38 were in the thoracic segments and 18 in the other segments of the spinal cords. Postoperative McCormick grades were improved in 31 patients unchanged in 19, and deteriorated in 6. Following up from 3 months to 7 years showed that no tumors recurred in all the patients. Conclusions The incidence of intraspinal meningiomas is significantly higher in the elderly female than that in the elderly male. There are high rate of preoperative misdiagnosis and severe neurological dysfunction in the elderly patients with intraspinal meningiomas. Most of the spinal meningiomas locate in the thoracic segments of spinal cords and the regions ventral and ventrolateral to the spinal cords, and they are very hard. Microsurgical procedure should be carefully performed in order to avoid damage to the spinal cord and nerves in the elderly patients with intraspinal meningiomas.
出处
《中国临床神经外科杂志》
2012年第8期456-459,共4页
Chinese Journal of Clinical Neurosurgery
关键词
椎管内脊膜瘤
老年患者
显微手术
临床特点
疗效
Intraspinal meningiomas
Elderly patients
Microsurgery
Clinical characteristics
Curative effect
