总结术中超声（IOUS）在胸椎管髓内肿瘤手术中的应用经验。

回顾性分析南京大学医学院附属鼓楼医院神经外科自2020年1月至2021年5月应用IOUS引导下显微手术治疗的11例胸椎管髓内肿瘤患者的临床资料，包括性别、年龄、肿瘤所在节段、病理、术中IOUS影像、肿瘤是否全切等，归纳总结其临床特点及手术疗效。

11例患者中男性6例，女性5例；年龄范围18~63岁，病程时间0.5~24个月；肿瘤位于上胸段（T1~4）3例，中胸段（T5~8）3例，下胸段（T9~12）5例，均在IOUS引导及神经电生理监测下行髓内肿瘤切除术。所有患者术中使用IOUS均可探查到病灶位置及周围神经与血管结构，其中3例IOUS显示椎板暴露不够充分，因此于硬脊膜切开前进一步扩大椎板骨窗；11例髓内肿瘤切开软脊膜前再次使用IOUS探查精确调整切开范围。肿瘤全切除者9例（81.8%），次全切除者2例（18.2%）。术后病理检查示室管膜瘤5例、血管瘤3例、胶质瘤2例、囊肿1例；6例患者出院后随访超过1年，均未发现肿瘤复发。

IOUS是胸椎管髓内肿瘤切除手术的重要工具，可在硬脊膜切开前显示髓内肿瘤的影像，帮助术者确定椎板切除具体范围，硬脊膜打开范围，同时进一步指导软脊膜的切开范围，最大程度地减少术中对脊柱稳定性及脊髓神经的损伤，从而提高手术的安全性和有效性。

To summarize the experience gained from the use of intraoperative ultrasound (IOUS) in thoracic intramedullary spinal tumor surgery.

Clinical data of 11 patients with thoracic intramedullary tumor who treated by IOUS guided micro-surgery in our hospital from January 2020 to May 2021 were retrospectively analyzed, including gender, age, tumor segment, pathology, intraoperative IOUS image, and the amount of tumor resection. The clinical characteristics and surgical effects were summarized.

Among the 11 patients, 6 were male and 5 were female, the range of age was 18-63 years, the course of disease was from 0.5 to 24 months. The tumors were located in the upper thoracic region (T1-4) in 3 cases, in the middle thoracic region (T5-8) in 3 cases, and in the lower thoracic region (T9-12) in 5 cases. Intramedullary tumor resection was performed under IOUS guidance and neuroelectrophysiological monitoring. Intraoperative use of IOUS could detect the location of lesions and peripheral nerve and vascular structures in all cases. In 3 cases, IOUS showed inadequate lamina exposure, so the lamina bone window was further expanded before dural opening. In 11 cases of intramedullary tumors, IOUS was used to probe again and adjust the incision range accurately before myelotomy. Total resection was performed in 9 cases (81.8%) and subtotal resection in 2 cases (18.2%). Postoperative pathology showed ependymoma in 5 cases, hemangioma in 3 cases, glioma in 2 cases and cyst in 1 case. 6 patients were followed up for more than 1 year, and no tumor recurrence was found during the follow-up period.

IOUS is an important tool of thoracic intramedullary spinal tumor surgery, which can show the lesion before dural opening. This modality helps the surgeon to limit the laminectomy, duratomy and myelotomy, to minimize the intraoperative damage of spinal stability and spinal cord funciton, improving the safety and efficacy of surgery.