spinal tumors （soft tissue tumors）原发性脊柱肿瘤（软组织肿瘤）课件

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1、PrimarySpinalTumors(Softtissuetumors)H.LouisHarkeyDepartmentofNeurosurgeryUniversityofMississippiJackson,MSAnatomicalClassificationofSpinalCordTumorsExtradural:Benignandmalignantverteberaltumors,tumorsnearthespinalcord.IntraduraltumorsExtramedullary:nervesheathandmenengialIntramedullary:glialando

2、therMeningiomaSlowgrowingbenignmassesproducingindolentsymptoms~15%ofallmeningiomasarespinal5:1femaletomaleratioTypicallyintraduralextramedullarybutcanbeextaduralMostcommonlythoracicinlocation,CervicalsecondmostcommonMeningiomaClinicalpresentationisindistinguishablefromanyotherslowgrowingintraspinal

3、massDeficitsareoftendramaticallyreversibleTreatmentisresectionbysafestrouteTotalresectionincludingduralattachmentand/orcauterizationoftheadjacentdura=1%recurrencerateSubtotalresectionhasmuchhigherriskofrecurrenceSchwannomaAccountfor~25%ofintradural&~50%ofintradural,extramedullarytumors70%intradural

4、,15%dumbbell,5%extradural0.3-0.4cases/100,000peryearTypicallypresentin4thand5thdecadeNomale-femalepredilectionPresentwithradicularpain,weaknessinlumbartumors,longtractmotorsigns&urinaryretentionincervical&thoracicSchwannomaBenigntumorsArisefromSchwanncellsofthesensoryrootletsTumoronlycontainsSchwan

5、ncellsandcausessymptomsbycompressingneuralelementsCanberemovedviahemilaminectomyinmostcasesTotalresectioniscurativeResidualtumorshouldbefollowedlongtermLongtractsignstypicallyimproveafterresectionFewerAntoniBcellsNeurofibroma&NeurofibromatosisCommonlyseeninNF-1Occurmorefrequentlyinthecervicalspinei

6、nNF-1Maybeintradural,extraduralordumbellOftenmultipleSometimesplexiformNeurofibromaBenignFusiformexpansionofthenerve(Schwann,perineuralandneuralcells)Difficulttogetcompleteresectionbecauseoftheextra-foramenalextensionandriskoffunctionallossGanglioneuromaPathologyGanglioneuroma(extradural,dumbbell)G

7、angliocytomaGanglioglioma(intradural-intramedullary)MostarebenignthoughGangliogliomasmaybecomemalignantMoreoftenseeninpatients<30Male:female3:2Ganglioglioma10%ofgangliogliomasarespinal,restcranialMostarepar