摘要： 目的 分析脊髓髓内室管膜瘤的临床特点，探讨显微手术治疗原则。方法 回顾性分析51 例脊髓髓内室管膜瘤患者社会人口学特征，以及诊断与治疗经过。结果 首发症状以疼痛（28 例）、肢体麻木（16 例）或乏力（9 例）为主；术前McCormick 脊髓功能评分Ⅰ级3 例、Ⅱ级33 例、Ⅲ级11 例、Ⅳ级4 例。肿瘤位于延颈髓（3 例）、颈髓（24 例）、跨颈胸髓（7 例）、胸髓（13 例）、跨胸腰髓（2 例）和腰髓（2 例），其中手术全切除42 例（82.35%）、次全切除7 例（13.73%）、大部切除2 例（3.92%）。出院时临床症状改善者33 例、无明显改善14 例、加重3 例，1 例死于继发延颈髓水肿。29 例获平均41.83 个月随访，其中McCormick 脊髓功能评分Ⅰ级8 例、Ⅱ级14 例、Ⅲ级5 例、Ⅳ级2 例。结论 显微手术切除病灶是脊髓髓内室管膜瘤治疗的根本措施。患者术前神经功能缺损程度、肿瘤粘连程度，以及手术技巧是影响其预后的主要因素。

关键词: 室管膜瘤, 脊髓肿瘤, 显微外科手术

Abstract: Objective  To analyze the clinical features and microneurosurgical management of intramedullary spinal cord ependymomas.  Methods  Sociodemographic characteristics, diagnosis and treatment of 51 patients with intramedullary spinal cord ependymomas treated in Southwest Hospital between January 2003 to January 2013 were reviewed.  Results  Of the 51 patients, the ratio of male and female was 1.32∶1 (29 males, 22 females). The onset age ranged from 8 to 68 years old, with the average age of 39.21 years. The main symptoms included pain in 41 cases, numbness in 35 cases, hypodynamia in 22 cases, dyspnea in 6 cases and incontinence in 5 cases. The first symptom was pain in 28 cases, numbness in 16 cases and hypodynamia in 9 cases. According to McCormick spinal function scale, 3 cases of the 51 patients were gradeⅠ, 33 cases grade Ⅱ, 11 cases grade Ⅲ and 4 cases grade Ⅳ. Among all the tumors, 3 cases were located in medulla-cervical cord, 24 in cervical spinal cord, 7 in cervical-thoracic spinal cord, 13 in thoracic spinal cord, 2 in thoracic-lumbar spinal cord and 2 in lumbar spinal cord. All patients underwent microsurgical procedure and total excision was achieved in 42 cases (82.35%), subtotal in 7 cases (13.73% ) and partial resection in 2 cases (3.92% ). Postoperative neurological function was improved in 33 patients, while no changes occurred in 14 cases and became worsened in 3 cases. One case died of secondary edema in the upper part of cervical spinal cord. Twenty-nine patients were followed-up from 5 months to 10 years (mean 41.83 months). Eight cases of the 29 patients were McCormick gradeⅠ, 14 cases gradeⅡ, 5 cases gradeⅢ and 2 grade Ⅳ.  Conclusion  Microneurosurgical procedure was the fundamental measure in treatment of intramedullary spinal cord ependymomas. Preoperative neurological function, tumor adhesion and surgical technique were the major factors influencing prognosis.

Key words: Ependymoma, Spinal cord neoplasms, Microsurgery