髓内室管膜瘤2课件.pptVIP

Case discussion 2013.5.9 epidural 硬膜外的 Intradural extramedullary 硬膜下、髓外的 Intramedullary 髓内的 conus 圆锥 terminal filum[fa?l?m] 终丝 cauda equina 马尾 syringomyelia [si,ri?ɡ?umaii:li?] 脊髓空洞症 Male，49 years old Chief complaint: presented with weakness of both lower limbs of two-year duration. It was insidious in onset and revealed gradual progression. 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1×1.5×4cm，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9×2.0×1.8cm，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 Histological components determines the spectrum of tumor Intraspinal mass Intramedullary mass Ependymoma Most common intramedullary tumor in adults (60%) Peak incidences in 4th?and 5th?decades Location:? All segments may be involved, but filum is most common T1 iso, T2 hyper,CE T1WI enhanced obviously Two types: Cellular – usually in cervical spine, FM, 40-50 years old, circumscribed but unencapsulated, can be associated with cyst or hemorrhage Myxopapillary – in conus or filum, MF, 20-30 years old, encapsulated, 20% destroy bone Myxopapillary is most frequent type and accounts for nearly all filum ependynomas 1.What’s the origin of the ependymoma? Ependymomas are a rare type of glioma that are thought to develop from the ependymal cells that line the ventricles (fluid-filled spaces in the brain) and the central canal of the spinal cord. 2.?Not all ependymomas are located in the intramedullary 3. How to explain the exist of extramedullary ependymoma? Although it’s still uncertain,they probably arise from heterotopic glial tissue pinched off from the neural tube during its closure 4. The intraoperative findings were consistent with multiple, isolated cystic lesions, without any attachment to the central nervous system or to the dura mater,which excludes the hypothesis of an exophytic ependymoma of the spinal cord extramedull