髓内室管膜瘤优秀PPT.ppt

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1、髓内室管膜瘤第一页，本课件共有20页nepidural硬膜外的nIntraduralextramedullary硬膜下、髓外的nIntramedullary髓内的nconus圆锥nterminalfilumfalm终丝ncaudaequina马尾nsyringomyeliasi,riumaii:li脊髓空洞症第二页，本课件共有20页Male，49yearsoldChiefcomplaint:presentedwithweaknessofbothlowerlimbsoftwo-yearduration.Itwasinsidiousinonsetandrevealedgradualprogress

2、ion.Case第三页，本课件共有20页T1WIT2WICETIWIT12-LI第四页，本课件共有20页手术记录nCase1：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11.54cm，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n术后病理：室管膜瘤第五页，本课件共有20页手术记录nCase2：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92.01.8cm，包膜完整，肿物与马尾神

3、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。n术后病理:神经鞘瘤第六页，本课件共有20页Histological components determines the spectrum of tumorEpiduralspaceIntraduralextramedullaryspaceIntramedullaryMeningesNerveEpendymalcellsNeuroepithelialcellsFatLymphaticInternalvertebralvenousplexusLooseconnectivetissue第七页，本课件共有20页第八页，本课件共有20页

4、IntraspinalmassIntraduralextramedullarymassIntramedullarymassAdultChildrenepiduralmassMetastasisReticuloendothelialtumorsChordomaSarcoma+NeuroblastomaChordoma+SarcomaNeurogenictumorMeningiomaEpendymoma,60%Astrocytoma,30%Hemangioblastoma,5%5%40%55%第九页，本课件共有20页IntramedullarymassEpendymomaMostcommonint

5、ramedullarytumorinadults(60%)Peakincidencesin4thand5thdecadesLocation:Allsegmentsmaybeinvolved,butfilumismostcommonT1iso,T2hyper,CET1WIenhancedobviouslyTwotypes:Cellularusuallyincervicalspine,FM,40-50yearsold,circumscribedbutunencapsulated,canbeassociatedwithcystorhemorrhageMyxopapillaryinconusorfil

6、um,MF,20-30yearsold,encapsulated,20%destroyboneMyxopapillaryismostfrequenttypeandaccountsfornearlyallfilumependynomas第十页，本课件共有20页acT2-,T1-,andpost-gadoliniumT1-weightedsagittalimagesofgrade2ependymomaina3-year-oldboy.第十一页，本课件共有20页dfT2-,T1-,andpostgadoliniumT1-weightedimagesofamyxopapillary(grade1)ep

7、endymomaina14-year-oldboy第十二页，本课件共有20页1.Whatstheoriginoftheependymoma?Ependymomasareararetypeofgliomathatarethoughttodevelopfromtheependymalcellsthatlinetheventricles(fluid-filledspacesinthebrain)andthecentralcanalofthespinalcord.2.NotallependymomasarelocatedintheintramedullaryExtramedullaryEpendymo

8、ma第十三页，本课件共有20页SagittalT2-(B)andT1-weightedimagesbefore(C)andafter(D)gadoliniuminjection.Itisextremelydifficulttodeterminewhetherthislesionisintra-orextramedullary.Nocontrastenhancementisseen.AxialT2imagesbetterillustratetheextramedullarylocationofthelesionMacroscopicappearanceofthelesionatsurgeryaf

9、teropeningoftheduramater:acysticmassmimickinganarachnoidcyst第十四页，本课件共有20页3.Howtoexplaintheexistofextramedullaryependymoma?Althoughitsstilluncertain,theyprobablyarisefromheterotopicglialtissuepinchedofffromtheneuraltubeduringitsclosure4.Theintraoperativefindingswereconsistentwithmultiple,isolatedcyst

10、iclesions,withoutanyattachmenttothecentralnervoussystemortotheduramater,whichexcludesthehypothesisofanexophyticependymomaofthespinalcord第十五页，本课件共有20页HistologicexaminationrevealsanependymomaA,Low-powerviewillustratestumorproliferationlocatedaroundthearachnoid.B,Thickenedarachnoidislimitedbutnotinvade

11、dbymonomorphoustumorcells.C,Perivascularcellulararrangementaroundhyalinizedbloodvesselsdenotesependymomadifferentiation第十六页，本课件共有20页extramedullaryependymomanmostcommoninthethirdtofifthdecadesoflifenfemalepreponderantnmainlylocatedatthethoracicspinenImagingfindingsarenon-specific第十七页，本课件共有20页Intramed

12、ullarymassAstrocytomaSecondmostcommoncordneoplasminadults,mostcommoncordneoplasminchildren(60%)MostcommonlylocatedinthecervicalandupperthoraciccordFusiformenlargement,infiltrativemargins,longsegmentofinvolvement;noorvariableenhancementUncommon/rareimagingfeatures:caudallocation,holocordinvolvement第十

13、八页，本课件共有20页IntramedullarymassHemangioblastomaM=F,20-40yearsoldIntenselyenhancing,hypervasculartumor;usuallylocateddorsallywithinthecordMultiplelesionscommon(checktheposteriorfossa!)Upto50%casesareassociatedwithsyrinxformationOftenwithsignsofpriorhemorrhageOftenwithprominentserpiginoussubarachnoidflowvoidsduetoenlargeddrainingveins第十九页，本课件共有20页Thanks for your attention!第二十页，本课件共有20页