探讨脊髓髓内肿瘤显微手术治疗方法和疗效。

回顾性分析海南省人民医院神经外科自2014年6月至2019年6月收治的17例经显微手术治疗的髓内肿瘤患者的病例资料，其中肢体麻木为首发症状13例，有肢体运动功能障碍9例，大小便功能障碍2例，腰背部疼痛2例，痛温觉分离者1例，呼吸困难1例，肌肉萎缩1例。所有患者在术前均行MRI平扫+增强扫描明确髓内占位性病变。全部病例采取全椎板切开术后复位固定。对患者术后病理以及术前、术后症状体征和随访复发情况进行总结，评价外科显微手术治疗髓内肿瘤的效果。

本组患者中，11例室管膜瘤10例全切，1例次全切除；2例星形细胞瘤1例全切除，1例次全切除；表皮样囊肿、血管母细胞瘤、胶质母细胞瘤术后转移各1例均全切除；1例炎性组织部分切除。术后症状改善11例，1例术前双下肢瘫和大小便失禁，术后无变化，5例术后症状加重，经康复治疗后2例完全恢复，2例留有轻度功能障碍，1例仅轻微改善，遗留有中度功能障碍，没有死亡病例。17例随访0.1~4.5年，2例肿瘤复发，1例再次手术，1例转放射治疗。

对于不同病理和性质的髓内肿瘤采取不同的显微手术方法和手术技巧，获得较好的成功率。术前症状较重者，预后较差。因此，显微外科手术是脊髓内肿瘤有效、安全的治疗方法。

To investigate the microsurgical treatment and efficacy of intramedullary spinal cord tumors.

The medical records of 17 patients with intramedullary tumors treated by microsurgery in neurosurgery Department of our hospital from June 2014 to June 2019 were retrospectively analyzed. Among the 17 patients, 13 patients had numbness of limbs as the first symptom, 9 patients had motor dysfunction of limbs, 2 patients had dysfunction of urine and stool, 2 patients had back pain and 1 had separation of pain and temperature. There were 1 case of dyspnea and 1 case of muscular atrophy. All patients underwent plain and enhanced MRI before operation to identify intramedullary space-occupying lesions. All cases were treated with reduction and fixation after total laminotomy. To summarize the postoperative pathology, preoperative and postoperative symptoms, signs and follow-up recurrence of the patients, and to evaluate the effect of surgical microsurgery in the treatment of intramedullary tumors.

Eleven cases of ependymoma were totally resected in 10 cases and subtotally resected in 1 case. Two cases of astrocytoma were totally resected in 1 case and subtotally resected in 1 case. Epidermoid cyst, hemangioblastoma and glioblastoma were totally resected in 1 case and inflammatory tissue was partially resected in 1 case. Postoperative symptoms improved in 11 cases, including 1 case of preoperative lower limb paralysis and urinary incontinence, no change after operation, 5 cases of postoperative symptoms aggravated, 2 cases recovered completely after rehabilitation treatment, 2 cases had mild dysfunction, 1 case only slightly improved, left with moderate dysfunction, no death cases. Seventeen cases were followed up for 0.1-4.5 years, 2 cases had recurrence, 1 case had reoperation, and 1 case received radiotherapy.

Different microsurgery methods and surgical techniques are adopted for intramedullary tumors of different pathological and nature, and the success rate is higher. Those with severe preoperative symptoms have poor prognosis. Therefore, microsurgery is an effective and safe treatment for intraspinal tumors.