目的 对不合并脊柱裂的软膜下脂肪瘤进行临床回顾,根据临床特点提出一种基于影像学的新的亚组分类,并对其手术策略进行探讨.方法 回顾分析了2013年1月~2014年12月在北京积水潭医院神经外科接受手术治疗的5例软膜下脂肪瘤患者.所有病例均有完整的临床资料,常规进行术前的评估,定期门诊随访进行神经功能评估和影像学评估.基于磁共振影像特点将本组5例病例分为两组:单纯型组和侵袭型组,比较两种类型的术式及临床情况.结果 所有5例患者在术前的神经功能均有轻中度的损害,均行手术治疗,手术过程均较顺利,单纯型中1例达到了完全切除,1例大部分切除;侵袭型中3例均为部分切除;肿瘤切除情况在术后的MRI检查中得到证实,所有病例最终均经病理学证实为脂肪瘤.两者表现为不同的影像特点和不同的神经功能恢复过程.单纯型并发脊髓空洞,术中肿瘤边界较易探查;侵袭型肿瘤中有神经组织穿行,切除过程中即产生损伤,在术后病理中可得到证实.两种类型在术后均有短暂的神经功能下降,但单纯型在术后两年基本恢复到术前情况,预后较后者好.结论 单纯型和侵袭型的分类方法对认识不伴脊柱裂的脊髓软膜下脂肪瘤可能有一定帮助,单纯型一般手术中可发现肿瘤与脊髓的边界,可能完全切除;而侵袭型肿瘤呈浸润性生长,任何试图切除肿瘤的操作可能导致脊髓功能的进一步损伤,减压性手术可能是最佳的选择.%Objective To investigate the proper management of spinal subpial lipoma with-out dysraphisms. A new subset classification method was proposed for individual handling protocols. Methods We retrospectively reviewed five cases of patients diagnosed with subpial lipomas who received sur-gical treatment in Department of Neurosurgery,Beijing Jishuitan Hospital between January 2013 and December 2014. The patients'clinical histories and medical records were carefully examined,and radiological charac-teristics were periodically retrieved after surgery. The outcomes of these patients were also reviewed. The five patients were grouped into 2 groups based on MRI characteristics:simple type and invasive type. Results All five patients had mild to moderate neurological impairment and underwent surgical treatment. In two patients of simple type,one was underwent total removal while the other underwent partial removal. And three patients of invasive type all underwent partial removal. Tumor resection was confirmed in postoperative MRI. All patients were confirmed as lipoma by pathology. Patients of different types showed different imaging features and neuro-logical recovery. Patients of simple type were complicated with syringomyelia and were easy to probe intraoperative tumor border. Patients of invasive type had tumor with nerve tissue passing through and easy to be damaged during excision which could be comfirmed in postoperative pathology. All patients showed temporary neurological impairment after surgery. But patients of simple type had better prognosis and could return to preoperative neurological function in two years. Conclusions The classification of simple and invasive type may be helpful in understanding spinal subpial lipoma without dysraphisms. The boundary between tumor and spinal cord could be generaly found in patients of simple type,so the tumor may be completely removed. But invasive tumors are invasive growth. Any attempt to remove the tumor may lead to further damage to the spinal cord function. Decompression surgery may be the best choice for invasive tumors.
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