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[目的]探讨椎管内髓外硬膜下肿瘤的手术治疗结果,分析影响髓外硬膜下肿瘤术前症状与预后及复发的因素。[方法]自2004年1月～2009年1月采用外科手术治疗髓外硬膜下肿瘤84例,男41例,女43例。年龄14～76岁,平均44.2岁。病程1周～15年,平均25.3个月。通过视觉模拟评分(VSA)评估疼痛,Nurick′s分级评估神经功能来探讨手术的疗效,同时调查肿瘤病理诊断类型,术前症状持续时间及肿瘤在髓外硬膜下的位置并分析这些因素对术前神经症状和预后的影响。[结果]随访1～5年,平均30个月。在所有病例中VSA评分从8.0±1.2减到1.2±0.8(P<0.005),Nurick’s分级从3.0±1.3减到1.0±0.0(P<0.001),患者的术前症状有明显改善。术前症状与肿瘤类型、症状持续时间和肿瘤位置无明显相关性,术后疗效与术前症状严重性及病程长短有关。5例髓外硬膜下肿瘤复发。[结论]髓外硬膜下肿瘤多可通过后路手术切除,大部分病例症状明显改善。积极手术切除是髓外硬膜下肿瘤治疗的有效途径。
[Objective] To investigate the surgical treatment outcome of subdural extramedullary subdural tumors and to analyze the preoperative symptoms, prognosis and recurrence of extramedullary subdural tumors. [Method] From January 2004 to January 2009, 84 cases of extramedullary subdural tumors were treated by surgery, including 41 males and 43 females. Aged 14 to 76 years old, with an average of 44.2 years old. Duration of 1 week ~ 15 years, an average of 25.3 months. Evaluate the pain through visual analogue scale (VSA), Nurick’s classification to assess neurological function to investigate the efficacy of surgery, and investigate the type of tumor pathology, the duration of preoperative symptoms and the location of the tumor in extramedullary extradural space and analyze these factors Preoperative neurological symptoms and prognosis. [Results] Follow-up 1-5 years, an average of 30 months. In all cases, the VSA score decreased from 8.0 ± 1.2 to 1.2 ± 0.8 (P <0.005) and the Nurick’s classification decreased from 3.0 ± 1.3 to 1.0 ± 0.0 (P <0.001). The preoperative symptoms were significantly improved. Preoperative symptoms and tumor type, the duration of symptoms and tumor location no significant correlation, postoperative efficacy and severity of preoperative symptoms and duration of the disease. 5 cases of extradural subdural tumor recurrence. [Conclusion] Most extramedullary subdural tumors can be resected by posterior approach, and the symptoms of most cases are obviously improved. Active surgical excision is an effective way to treat extramedullary subdural tumors.