髓内室管膜瘤

髓内室管膜瘤第一页，共二十页，编辑于2023年，星期六epidural硬膜外的Intraduralextramedullary硬膜下、髓外的Intramedullary髓内的conus圆锥terminalfilum['faɪləm]终丝caudaequina马尾syringomyelia[si,riŋɡəumai'i:liə]脊髓空洞症第二页，共二十页，编辑于2023年，星期六Male，49yearsoldChiefcomplaint:presentedwithweaknessofbothlowerlimbsoftwo-yearduration.Itwasinsidiousinonsetandrevealedgradualprogression.Case第三页，共二十页，编辑于2023年，星期六T1WIT2WICETIWIT12-LI第四页，共二十页，编辑于2023年，星期六手术记录Case1：标记颈6-胸3水平后正中手术切口…..,棘突及椎板咬骨钳咬除棘突及椎板，进入椎管，打开硬膜囊，探查，可见实性肿物位于颈7-胸2、3水平脊髓内后正中，质软，灰红色，边界尚清，大小约1×1.5×4cm，显微镜下仔细分离，全切除肿物送病理，颈7水平以上髓内为淡黄色囊液术后病理：室管膜瘤第五页，共二十页，编辑于2023年，星期六手术记录Case2：取胸腰段后正中切口…咬除T11-L2全部棘突及椎板…..显露硬膜囊，以尖刀小心纵行切开硬膜，见长圆形囊实性肿物，大小约9×2.0×1.8cm，包膜完整，肿物与马尾神经粘连并包裹数支马尾神经。小心钝性分离，完整切除肿物并送病理检查。术后病理:神经鞘瘤第六页，共二十页，编辑于2023年，星期六HistologicalcomponentsdeterminesthespectrumoftumorEpiduralspaceIntraduralextramedullaryspaceIntramedullaryMeningesNerveEpendymalcellsNeuroepithelialcellsFatLymphaticInternalvertebralvenousplexusLooseconnectivetissue第七页，共二十页，编辑于2023年，星期六第八页，共二十页，编辑于2023年，星期六IntraspinalmassIntraduralextramedullarymassIntramedullarymassAdultChildrenepiduralmassMetastasisReticuloendothelialtumorsChordomaSarcoma+NeuroblastomaChordoma+SarcomaNeurogenictumorMeningiomaEpendymoma,60%Astrocytoma

,30%Hemangioblastoma,5%5%40%55%第九页，共二十页，编辑于2023年，星期六IntramedullarymassEpendymomaMostcommonintramedullarytumorinadults(60%)Peakincidencesin4th

and5th

decadesLocation:

Allsegmentsmaybeinvolved,butfilumismostcommonT1iso,T2hyper,CET1WIenhancedobviouslyTwotypes:Cellular–usuallyincervicalspine,F>M,40-50yearsold,circumscribedbutunencapsulated,canbeassociatedwithcystorhemorrhageMyxopapillary–inconusorfilum,M>F,20-30yearsold,encapsulated,20%destroyboneMyxopapillaryismostfrequenttypeandaccountsfornearlyallfilumependynomas第十页，共二十页，编辑于2023年，星期六a–cT2-,T1-,andpost-gadoliniumT1-weightedsagittalimagesofgrade2ependymomaina3-year-oldboy.第十一页，共二十页，编辑于2023年，星期六d–fT2-,T1-,andpostgadoliniumT1-weightedimagesofamyxopapillary(grade1)ependymomaina14-year-oldboy第十二页，共二十页，编辑于2023年，星期六

1.What’stheoriginoftheependymoma?

Ependymomasareararetypeofgliomathatarethoughttodevelopfromtheependymalcellsthatlinetheventricles(fluid-filledspacesinthebrain)andthecentralcanalofthespinalcord.2.

NotallependymomasarelocatedintheintramedullaryExtramedullaryEpendymoma第十三页，共二十页，编辑于2023年，星期六SagittalT2-(B)andT1-weightedimagesbefore(C)andafter(D)gadoliniuminjection.Itisextremelydifficulttodeterminewhetherthislesionisintra-orextramedullary.Nocontrastenhancementisseen.AxialT2imagesbetterillustratetheextramedullarylocationofthelesionMacroscopicappearanceofthelesionatsurgeryafteropeningoftheduramater:acysticmassmimickinganarachnoidcyst第十四页，共二十页，编辑于2023年，星期六3.Howtoexplaintheexistofextramedullaryependymoma?Althoughit’sstilluncertain,theyprobablyarisefromheterotopicglialtissuepinchedofffromtheneuraltubeduringitsclosure4.

Theintraoperativefindingswereconsistentwithmultiple,isolatedcysticlesions,withoutanyattachmenttothecentralnervoussystemortotheduramater,whichexcludesthehypothesisofanexophyticependymomaofthespinalcord第十五页，共二十页，编辑于2023年，星期六HistologicexaminationrevealsanependymomaA,Low-powerviewillustratestumorproliferationlocatedaroundthearachnoid.B,Thickenedarachnoidislimitedbutnotinvadedbymonomorphoustumorcells.C,Perivascularcellulararrangementaroundhyalinizedbloodvesselsdenotesependymomadifferentiation第十六页，共二十页，编辑于2023年，星期六extramedullaryependymomamostcommoninthethirdtofifthdecadesoflifefemalepreponderantmainlylocatedatthe

thoracicspineImagingfindingsarenon-specific第十七页，共二十页，编辑于2023年，星期六IntramedullarymassAstrocytomaSecondmostcommoncordneoplasminadults,mostcommoncordneoplasminchildren(60%)MostcommonlylocatedinthecervicalandupperthoraciccordFusiformenlargement,infiltrativemargins,longsegmentofinvolvement;noorvariableenhancementUncommon/rareimagingfeatures:caudallocation,holocordinvolvement第十八页，共二十页，编辑于2023年，星期六IntramedullarymassHemangioblastomaM=F,20-40yearsoldIntenselyenhancing,hypervasculartumor;usuallylocateddorsallywithinthecordMultiplelesionscommon(checktheposteriorfossa!)Upto50%casesare