作者：史良，阎涛，王科大，刘龙奇，王汉斌，乔京元，苏亦兵

单位：

100035北京市，北京积水潭医院神经外科 通信作者：史良，E-mail：shiliang111@sina.com.cn

Units：

Department of Neurosurgery, Beijing Jishuitan Hospital, Beijing 100035, ChinaCorresponding author: SHI Liang, E-mail: shiliang111@sina.com.cn

关键词：

血管瘤,海绵状; 脊髓; 显微外科手术; 临床特征; 预后;

Keywords：

Hemangioma, cavernous; Spinal cord; Microsurgery; Clinical manifestation; Prognosis

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.035

Funds：

北京市属医院科研培育项目（PX2020018）；北京积水潭医院学科骨干培养计划（XKGG202115）；北京积水潭医院医工企交叉培育项目（YGQ-201906）

摘要：

背景脊髓海绵状血管瘤(SCCH)较为罕见,约占髓内肿瘤的5%,其早期症状隐匿,但瘤体常反复出血,可导致严重的脊髓损伤甚至截瘫,极易误诊漏诊,延误手术时机并增加手术风险,故需早期识别。目的 探讨SCCH的临床特征及显微外科手术治疗预后。方法 回顾性选取2005年1月至2021年1月北京积水潭医院神经外科收治的17例SCCH患者,均采用显微外科手术治疗,分析其临床表现、影像学特征、手术及随访情况,分别于入院时、出院时及出院后6个月采用疼痛视觉模拟量表(VAS)评估疼痛程度,采用McCormick脊髓功能分级评估脊髓损伤情况,采用欧洲脊髓病评分(EMS)评估预后情况。结果 17例SCCH患者中,男7例,女10例;年龄26～67岁。首发症状表现为颈肩、腰背或肢体不适感;疾病分类:急性起病型2例(11.8%),缓解复发型10例(58.8%),进行性加重型5例(29.4%)。脊髓磁共振成像(MRI)平扫+增强扫描可见脊髓相应节段占位性病变。入院时17例患者VAS评分为0～6分,平均(3.2±1.2)分;McCormick脊髓功能分级:Ⅰ级2例,Ⅱ级7例,Ⅲ级5例,Ⅳ级3例;EMS为7～16分,平均(11.8±2.3)分。出院时患者VAS评分为0～4分,平均(1.8±1.1)分,低于入院时(t=3.55,P=0.001)。McCormick脊髓功能分级:Ⅰ级5例,Ⅱ级7例,Ⅲ级4例,Ⅳ级1例。EMS为7～17分,平均(12.8±2.7)分;所有患者术后EMS高于术前EMS。随访6个月时患者VAS评分为0～4分,平均(1.2±1.1)分,低于入院时(t=5.07,P<0.001)。McCormick脊髓功能分级:Ⅰ级12例,Ⅱ级4例,Ⅲ级1例,Ⅳ级0例。EMS为9～17分,平均(14.5±2.3)分;所有患者随访EMS高于术前EMS。每6～12个月定期复查脊髓MRI,未见复发或再次出血。结论 SCCH作为一类罕见的脊髓内病变,其症状多变,手术风险较高。对于有临床症状进展的SCCH患者,早期行显微外科手术是最佳治疗选择,但术前应制定个体化手术方案,术中精细操作,可获得较满意的预后。而对于症状轻微或处于缓解期的患者,如手术风险总体可控,可积极进行手术治疗。

Abstract：

【Abstract】　Background Spinal cord cavernous hemangioma (SCCH) is very rare, accounting for about 5% ofintramedullary lesions. Its early symptoms are variable, but the tumor body often bleeds repeatedly, which can lead to severe spinalcord injury and even paraplegia, and it is very easy to miss diagnosis and misdiagnose, delay the timing of surgery, and increase therisk of surgery. Therefore, early identification of SCCH is needed.Objective To investigate the clinical features and prognosisof microsurgery of SCCH.Methods A retrospective analysis was preformed in 17 patients with SCCH in the Department ofNeurosurgery, Beijing Jishuitan Hospital from January 2005 to January 2021. Patients were all treated by microsurgery. Theclinical manifestation, imaging features, operative findings, and prognosis were analyzed. At admission, discharge and 6 monthsafter discharge, Visual Analogue Scale (VAS) was used to assess the degree of pain, the McCormick spinal cord function gradewas used to assess the situation of spinal cord injury and European Myelopathy Score (EMS) was used to assess the prognosis.Results Among the 17 patients with SCCH, there were 7 males and 10 females; the age ranged from 26 to 67 years old. The firstsymptom was discomfort of neck, shoulder, waist and back or limbs; disease classification: 2 cases of acute onset type (11.8%) , 10cases of remission and relapse type (58.8%) , and 5 cases of progressive aggravation type (29.4%) . Spinal cord magnetic resonanceimaging (MRI) plain scan+enhanced scan showed space-occupying lesions in the corresponding segments of the spinal cord. TheVAS score of 17 patients at admission was 0-6, with an average of (3.2±1.2) ; McCormick spinal cord function classification: 2cases were grade Ⅰ, 7 cases were grade Ⅱ, 5 cases were grade Ⅲ, and 3 cases were grade Ⅳ; EMS ranged from 7 to 16 points,with an average of (11.8±2.3) points. The VAS score of the patients at discharge was 0-4, with an average of (1.8±1.1) , whichwas lower than that at admission (t=3.55, P=0.001) . McCormick spinal cord function classification: 5 cases were grade Ⅰ, 7 caseswere grade Ⅱ, 4 cases were grade Ⅲ, and 1 case was grade Ⅳ. EMS was 7-17 points, with an average of (12.8±2.7) points;postoperative EMS was higher than preoperative EMS in all patients. At the 6-month follow-up, the VAS score of the patients was0-4, with an average of (1.2±1.1) , which was lower than that at admission (t=5.07, P < 0.001) . McCormick spinal cord functionclassification: 12 cases were grade Ⅰ, 4 cases were grade Ⅱ, 1 case was grade Ⅲ, and 0 cases were grade Ⅳ. EMS was 9-17points, with an average of (14.5±2.3) points; the follow-up EMS of all patients was higher than that of preoperative EMS. MRIof spinal cord was rechecked regularly every 6-12 months, and there was no recurrence or rebleeding. Conclusion SCCH, asa rare intraspinal lesion, has variable symptoms and high surgical risk. For SCCH patients with progressive clinical symptoms,early microsurgery is the best treatment option, but an individualized surgical plan should be formulated before surgery, anda satisfactory prognosis can be obtained by fine-tuning intraoperative operations. While for patients with mild symptoms or inremission, if the risk of surgery is generally controllable, surgery can be actively performed.

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