Lee M, Epstein F J, Rezai A R, Zagzag D
Section of Neurosurgery, Medical College of Georgia, Augusta, USA.
Neurosurgery. 1998 Oct;43(4):788-94; discussion 794-5. doi: 10.1097/00006123-199810000-00034.
We report a group of nine patients with atypical, nonneoplastic intramedullary spinal cord lesions. By retrospectively reviewing these patients, we hoped to elucidate characteristics that would identify these patients as harboring nonneoplastic lesions before surgical intervention.
We reviewed the histological findings of 212 patients undergoing surgery for intramedullary spinal cord tumors between 1989 and 1994. We identified nine patients with nonneoplastic lesions (4%); case histories and radiographs were reviewed.
All patients were evaluated preoperatively using magnetic resonance imaging. The extent of enhancement with gadolinium varied from homogeneous enhancement to no enhancement. All lesions showed marked T2 changes. There was a lack of significant spinal cord expansion associated with the lesions in all cases. All patients underwent surgery. The histology of the surgical specimens showed demyelinating lesions in four patients, sarcoidosis in two patients, amyloid angiopathy in two patients, and a mass of nonneoplastic inflammatory cells of unknown origin in one patient.
Although it was difficult to antecedently distinguish these lesions from neoplastic spinal cord tumors by case history and physical examination, the most consistent clue was absent or minimal spinal cord expansion on the preoperative magnetic resonance images.
我们报告一组9例非典型、非肿瘤性脊髓髓内病变患者。通过回顾性分析这些患者，我们希望阐明在手术干预前可将这些患者识别为患有非肿瘤性病变的特征。
我们回顾了1989年至1994年间接受脊髓髓内肿瘤手术的212例患者的组织学检查结果。我们确定了9例非肿瘤性病变患者（4%）；回顾了病历和X线片。
所有患者术前均行磁共振成像检查。钆增强程度从均匀增强到无增强不等。所有病变均显示明显的T2改变。所有病例中均未发现与病变相关的明显脊髓扩张。所有患者均接受了手术。手术标本的组织学检查显示，4例患者为脱髓鞘病变，2例患者为结节病，2例患者为淀粉样血管病，1例患者为来源不明的非肿瘤性炎性细胞团块。
尽管通过病史和体格检查很难预先将这些病变与肿瘤性脊髓肿瘤区分开来，但最一致的线索是术前磁共振图像上脊髓无扩张或扩张极小。
