目的 探讨颈髓髓内多节段室管膜瘤的早期手术治疗及其预后。方法 选择北京大学第三医院2001年1月至2016年6月在电生理监测下显微手术治疗的20例McCormic分级Ⅰ级、长度在3个和3个节段以上的室管膜瘤病例进行回顾性分析,术后均未行放疗。所有病例术前均行核磁共振检查并采用McCormic分级法评估神经功能,术后随访3~48个月,平均32个月,并根据随访结果进行评价。结果 所有病例的肿瘤主体均位于颈髓髓内,肿瘤瘤体长度跨越3~8个椎体节段,平均4.2个椎体节段,肿瘤一期均得到了全部切除。术后病理诊断均为室管膜瘤,WHO分级Ⅰ~Ⅱ级。有18例病例术后得到了随访,2例因联系方式变更而失访,但病历记录术后出院时恢复良好。随访结果表明,所有获得随访的患者恢复良好,术前肢体麻木、疼痛等症状均有明显缓解,未留下明显运动功能障碍,大小便未出现功能障碍,磁共振检查结果表明未见肿瘤复发;主要并发症是留有不同程度的下肢深感觉障碍,可以认为手术未对患者的生活及工作带来明显影响。结论 对于早期多节段颈髓室管膜瘤采取积极的手术治疗能取得良好的疗效;全切除术后极少复发,术后不需要放疗。

Objective: To investigate the early clinical treatment and prognosis of multi-segment in-tramedullary cervical ependymoma. Methods: Twenty patients with multi-segment (more than 3 segments) intramedullary spinal ependymoma (McCormic grade Ⅰ) were microsurgically treated with assistance of intraoperative neuroelectrophysiological monitoring. None of them received postoperative radiotherapy. Preoperatively all the patients underwent MRI examination and their neurologically function was assessed by McCormic classification method. They were followed up for an average of 2.7 years (The follow-up ranged from 3 months to 4 years). All the patients underwent review of the MRI examination and their postoperative neurological function was assessed by McCormic classification method again. Evaluation was accomplished according to the results of the follow-up. Results: All tumors were intramedullary. The length of the tumor body varied from 3 to 8 vertebral segments with an average of 4.2 vertebral segments. Gross total removal was achieved in all the 20 patients through one-stage operation. The pathology of these patients was ependymoma (WHO grades Ⅰ to Ⅱ). Two cases were lost during the follow-up due to the change of contact, but the hospital records of them showed that they recovered well at discharge. Eighteen cases were followed up constantly after operation. A case which ran through the whole cervical spinal cord had short-term mild motor dysfunction after operation, which manifested as weakness of the left side muscle strength to grade Ⅳ (which recovered to grade V during the follow-up period). Resultsof the follow-up showed that these 18 patients recovered well. Preoperative symptoms, such as limb numbness and painness were significantly alleviated. There was no obvious motor dysfunction. The bowel and bladder function of these 18 patients were almost normal. The McCormic scores of these 18 patients remained in grade Ⅰ. No recurrence was found on review of the MRI examination. The main complications were a certain degree of deep sensory disturbance of lower extremities. The operation did not significantly affect the patient’s life and work. Conclusion: Aggressive surgical therapy is a good treatment strategy for early multi-segment intramedullary cervical ependymoma. There is nearly no recurrence after operation and no postoperative radiotherapy is needed after gross total removal of tumors.