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目的探讨脊髓髓内海绵状血管瘤的出血性损伤风险、临床特征以及经单侧半椎板切除髓内海绵状血管瘤的手术技巧。方法回顾性分析11例髓内海绵状血管瘤病人的病历资料。均经单侧半椎板切除肿瘤。采用统计学分析,在性别分布、平均年龄、年出血率等方面与同期颅内(145例)、脑干(61例)海绵状血管瘤进行比较。术前Frankel分级D级8例,C级2例,A级1例。结果本组女性7例,男性4例,女性与男性之比高于颅内(80∶65)和脑干(33∶28)海绵状血管瘤;年出血率为2.8%/病人,稍低于颅内(3.3%)和脑干(3.1%)海绵状血管瘤。病变均获全切;术后随访期内8例神经系统症状改善(Frankel分级D级升到E级6例,C级升到D级2例),3例临床症状无变化。结论脊髓髓内海绵状血管瘤应全切以防复发和再出血;选择微侵袭的半椎板入路,以及术中采用体感诱发电位监护,是取得满意结果、预防附加损伤的关键。
Objective To investigate the risk of hemorrhagic injury of spinal intramedullary cavernous hemangiomas, clinical features and surgical techniques of resection of intramedullary cavernous hemangiomas by unilateral hemi-laminectomy. Methods Retrospective analysis of 11 cases of intramedullary cavernous hemangioma patients medical records. Unilateral semi-lamina resection of the tumor. Statistical analysis was used to compare with the intracranial (145 cases) and the brainstem (61 cases) cavernous hemangiomas in terms of gender distribution, average age and annual bleeding rate. Preoperative Frankel grade D grade in 8 cases, C grade in 2 cases, A grade in 1 case. Results There were 7 female and 4 male patients. The ratio of female to male was higher than that of intracranial (80:65) and brain stem (33:28) cavernous hemangiomas. The annual bleeding rate was 2.8% / patient, slightly lower than Intracranial (3.3%) and brainstem (3.1%) cavernous hemangiomas. All the lesions were completely resected. During the follow-up period, the neurological symptoms were improved in 8 cases (Frankel grade D to E grade in 6 cases and C grade to D grade in 2 cases). No change was found in the clinical symptoms in 3 cases. Conclusions Spinal intramedullary cavernous hemangiomas should be fully resected to prevent recurrence and rebleeding. Selecting the minimally invasive half-lamina approach and monitoring of somatosensory evoked potentials during operation are the keys to satisfactory results and prevention of additional injuries.