完全囊变脊髓室管膜瘤1例报告并文献复习

目的探讨完全囊变脊髓室管膜瘤的临床特点、影像学特征以及治疗方法。方法回顾性分析南昌大学第二附属医院神经外科2021年4月收治的1例完全囊变脊髓室管膜瘤临床资料，并对相关文献进行复习。结果术中见肿瘤呈粉红色，柔软，有一定包膜，肿瘤几乎完全囊性，囊液暗红色，囊壁为肿瘤组织，厚度约2~3 mm。术后病理诊断为脊髓室管膜瘤（WHO Ⅱ级）。随访6个月，未见肿瘤复发。结论脊髓室管膜瘤常伴有肿瘤囊变，完全囊变的情况罕见，囊壁多为肿瘤细胞；磁共振平扫肿瘤表现为T1低信号，T2高信号，增强扫描肿瘤呈环形强化；临床表现多为相应阶段的神经功能损害；对于完全囊变的肿瘤，尽可能保留囊壁的完整性将肿瘤全切是其治疗的关键，避免肿瘤细胞随囊液播散转移。

Objective To explore the clinical features, imaging features and treatment of completely cystic spinal cord ependymoma. Methods The clinical data of 1 case of spinal cord ependymoma with complete cystic transformation admitted to Department of Neurosurgery, the Second Affiliated Hospital of Nanchang University in April 2021 were analyzed retrospectively, and the related literature were reviewed. Results Intraoperative findings showed that the tumor was pink and soft with a certain capsule. The tumor was almost completely cystic with dark red fluid. The cyst wall was tumor tissue with a thickness of about 2-3 mm. Postoperative pathological diagnosis was spinal cord ependymoma(WHO Grade Ⅱ). After 6 months of follow-up, no tumor recurrence was found. Conclusions Spinal cord ependymom is often accompanied by cystic changes. Complete cystic changes are rare and the cystic walls are mostly tumor cells. Plain MRI shows low signal on T1 and high signal on T2, while enhanced MRI shows ring enhancement. The clinical manifestations are mostly neurological impairment at corresponding stages. For completely cystic tumors, the key to the treatment is to preserve the integrity of the cyst wall as much as possible and remove the tumor completely, so as to avoid the dissemination and metastasis of tumor cells along with the cyst fluid.