髓内室管膜瘤2.ppt

Case discussion

epidural 硬膜外的
Intradural extramedullary 硬膜下、髓外的
Intramedullary 髓内的
conus 圆锥
terminal filum['faɪləm] 终丝
cauda equina 马尾
syringomyelia [si,riŋɡəumai'i:liə] 脊髓空洞症
Male,49 years old
plaint: presented with weakness of both lower limbs of two-year duration. It was insidious in onset and revealed gradual progression.
Case
T1WI
T2WI
CE TIWI
T12-LI
手术记录
Case1 :标记颈6-胸3水平后正中手术切口…..,棘突及椎板咬骨钳咬除棘突及椎板,进入椎管,打开硬膜囊,探查,可见实性肿物位于颈7-胸2、3水平脊髓内后正中,质软,灰红色,边界尚清,大小约1××4cm,显微镜下仔细分离,全切除肿物送病理,颈7水平以上髓内为淡黄色囊液
术后病理:室管膜瘤
手术记录
Case 2:取胸腰段后正中切口…咬除T11-L2全部棘突及椎板…..显露硬膜囊,以尖刀小心纵行切开硬膜,见长圆形囊实性肿物,大小约9××,包膜完整,肿物与马尾神经粘连并包裹数支马尾神经。小心钝性分离,完整切除肿物并送病理检查。
术后病理:神经鞘瘤
ponents determines the spectrum of tumor
Epidural space
Intradural extramedullary space
Intramedullary
Meninges
Nerve
Ependymal cells
Neuroepithelial cells
Fat
Lymphatic
Internal vertebral venous plexus
Loose connective tissue
Intraspinal mass
Intradural extramedullary mass
Intramedullary mass
Adult
Children
epidural mass
Metastasis
Reticuloendothelial tumors
Chordoma
a
+
Neuroblastoma
Chordoma
+
a
Neurogenic tumor
Meningioma
Ependymoma,60%
Astrocytoma ,30%
Hemangioblastoma ,5%
5%
40%
55%
Intramedullary mass
Ependymoma
mon intramedullary tumor in adults (60%)
Peak incidences in 4th and 5th decades
Location:  All segments may be involved, but filum is mon
T1 iso, T2 hyper,CE T1WI enhanced obviously
Two types:
Cellular – usually in cervical spine, F>M, 40-50 years old, circumscribed but unencapsulated, can be associated with cyst or hemorrhage
Myxopapillary – in conus or filum, M>F, 20-30 years old, encapsulated, 20% destroy bone
Myxopapillary is most frequent type and accounts for nearly all filum ependynomas