~ ~ % % 24 ~ ± ~ ± % % % Ⅲ

2014 11 14 11 Chin J Min Inv Surg November 2014 Vol. 14. No. 11 1011 41 * 刘彬王振宇 谢京诚马长城陈晓东李振东赵薇 100191 2004 1 ~ 2013 12 41 35 6 24 ~ 84 56. 3 ± 13. 6 16 39. 0% 13 31. 7% 12 29. 3% McCormick Ⅰ 10 Ⅱ 17 Ⅲ 10 Ⅳ 4 34 7 22 McCormick Simpson Ⅰ 13 31. 7% Ⅱ 28 68. 3% 1 2 Ⅰ 15 Ⅱ 15 Ⅲ 7 Ⅳ 4 Z = - 1. 445 P = 0. 149 41 4 ~ 73 24. 9 ± 18. 3 1 Ⅰ 30 Ⅱ 8 Ⅲ 3 Z = - 4. 135 P = 0. 000 12 > 36 Ⅰ 8 Ⅱ 2 Ⅲ 2 R739. 4 A doi 10. 3969 /j. issn. 1009-6604. 2014. 11. 013 1009-6604 2014 11-1011 - 05 Posterior Midline Approach Treatment for Meningioma in Thoracic Spinal Canal a Report of 41 Cases Liu Bin Wang Zhenyu Xie Jingcheng et al. Department of Neurosurgery Peking University Third Hospital Beijing 100191 China Corresponding author Wang Zhenyu E-mail wzy502@ hotmail. com Abstract Objective To investigate the follow-up outcomes of posterior midline approach treatment for patients with meningioma in thoracic spinal canal. Methods A total of 41 cases with meningioma in thoracic spinal canal from January 2004 to December 2013 in our hospital were studied included 35 females and 6 males aged from 24 to 84 years old mean 56. 3 ± 13. 6 years old. MRI showed tumors located in the dorsal side of spinal cord in 16 cases 39. 0% in ventral and lateral-ventral side in 13 cases 31. 7% and in lateral side in 12 cases 29. 3%. According to the McCormick scores there were 10 cases of grade Ⅰ 17 cases of grade Ⅱ 10 cases of grade Ⅲ and 4 cases of grade Ⅳ preoperatively. The operation was performed through posterior median line incision to cut off the intraspinal tumor under microscope with laminectomy 34 cases or lamiplasty 7 cases. A total of 22 cases of operation was under electrophysiologic monitoring. Postoperative follow-up of spinal cord functions was evaluated by McCormick scores. Results There were no operative deaths. According to the Simpson classification there were 13 cases 31. 7% of class Ⅰ resection and 28 cases 68. 3% of class Ⅱ resection. Postoperative incisional infection occurred in 1 case which was cured by debridement. At the second week after operation there were 15 cases of grade Ⅰ 15 cases of grade Ⅱ 7 cases of grade Ⅲ and 4 cases of grade Ⅳ as the McCormick scores without significant differences as compared with preoperation Z = - 1. 445 P = 0. 149. A total of 41 patients were followed up for 4-73 months mean 24. 9 ± 18. 3 months. Local recurrence was found in 1 case. At the last follow-up evaluation there were 30 cases of grade Ⅰ 8 cases of grade Ⅱ and 3 cases of grade Ⅲ with spinal cord functions significantly improved Z = - 4. 135 P = 0. 000. Among 12 cases followed up for more than 36 months there were 8 cases of grade Ⅰ 2 cases of grade Ⅱ and 2 cases of grade Ⅲ. Conclusions The posterior thoracic midline approach treatment for meningioma is effective. Intraoperative elaborative microscopic performance and application of electrophysiologic monitoring can be helpful to get a better prognosis. Key Words Meningioma Thoracic spinal canal Surgery Therapeutic effect * E-mail wzy502@ hotmail. com

1012 1 2 2004 1 ~ 2013 12 10 41 1 ~ 4 1 1. 1 41 35 85. 4% 6 14. 6% 24 ~ 84 56. 3 ± 13. 6 1 ~ 120 18. 2 ± 28. 2 26 63. 4% 6 14. 6% 9 22. 0% 17 15 35 Ⅲ ~ Ⅳ 32 25 McCormick 3 Ⅰ 10 Ⅱ 17 Ⅲ 10 Ⅳ 4 Ⅳ T 1 ~ T 4 17 T 5 ~ T 8 10 T 9 ~ T 12 14 < 1 cm 5 7 1 ~ 2 cm 20 2 ~ 3 cm 12 3 ~ 4 cm 4 16 39. 0% 13 31. 7% 12 29. 3% 1. 2 1. 2. 1 C X 0. 05 34 7 2014 11 14 11 Chin J Min Inv Surg November 2014 Vol. 14. No. 11 22 Cadwell Cascade Elite32 SEP motor evoked potential MEP electromyography EMG 5 MEP 6 SEP 70% MEP 1. 2. 2 McCormick 3 Ⅰ Ⅱ Ⅲ 1. 2. 3 2 3 1. 2. 4 SPSS18. 0 Wilcoxon P < 2 100 ~ 300 min 151. 8 ± 40. 6 min Simpson 1 Ⅰ 13 31. 7% Ⅱ 28 68. 3% 13 31. 7% 8 19. 5% somatosensory evoked potential SEP 21 51. 2% 20 48. 8% 4 18 43. 9% 25 61. 0% 2 McCormick Ⅰ Simpson Ⅰ 15 Ⅱ 15 Ⅲ 7 Ⅳ 4 1 28 68. 3% 8 19. 5% 5 12. 2% 2 1 41 4 ~ 73 24. 9 ± 18. 3 35 85. 4 % 4 9. 8 % 2

2014 11 14 11 Chin J Min Inv Surg November 2014 Vol. 14. No. 11 1013 1 2 3 4 1 41 McCormick 4. 9% 1 4 McCormick Ⅰ Ⅱ Ⅲ Ⅳ Ⅰ 30 Ⅱ 8 Ⅲ 3 1 10 17 10 4 2 2 15 15 7 4 3 30 8 3 0 Z 1-2 P - 1. 445 0. 149 Z 1-3 P - 4. 135 0. 000 1 12 > 36 Ⅰ 8 Ⅱ 2 Ⅲ 2 2 5 2 cm 2 1 69 8 2 ~ 3 2 Ⅳ Ⅳ 13 Ⅱ 2 72 2 6 ~ 7 2. 2 Ⅲ Ⅲ 6 Ⅰ 3 63 120 5 ~ 6 2. 5 Ⅱ Ⅳ 63 Ⅲ 4 58 1 4 ~ 5 3 Ⅱ Ⅳ 17 Ⅲ 5 24 5 4 ~ 5 3. 5 Ⅱ Ⅲ 21 Ⅱ 3 11 12 85. 4% 3. 1 13 18 Ⅱ Ⅲ Ⅳ 31 8 9 10 50 14

1014 MR 31. 7% Uchida 15 3. 2 3. 2. 1 Kim 16 18 5 2 2 17 63 2 2 36 31. 7% 23 1 ~ 3 13 3 Ⅱ 10 Ⅰ 95. 1% 39 /41 2 17 MEP CT 12 > 36 18 Lyons 19 Ⅰ 8 Ⅱ 2 Ⅲ 2 1 4 3. 2. 2 Yamamuro 20 Simpson Ⅱ 25 Simpson Ⅰ Ⅰ Ⅱ Ⅲ 60% 13 2 1 Ⅱ 1. 660. 21 2009 9 10 940-945. 7 3. 3 5 2 2014 11 14 11 Chin J Min Inv Surg November 2014 Vol. 14. No. 11 2 4 /5 T 4 ~ T 7 532. > 2 cm 3 4 2010 10 1 5 2 Zhu Q Qian M Xiao J et al. Myelopathy due to calcified meningiomas of the thoracic spine minimum 3-year follow-up after surgical treatment. J Neurosurg Spine 2013 18 5 436-442. 3 McCormick PC Torres R Post KD et al. Intramedullary ependymoma of the spinal cord. J Neurosurg 1990 72 4 523 -.. 13-15... 2012 44 5 776-779. 6 Voulgaris S Alexiou GA Mihos E et al. Posterior approach to ventrally located spinal meningiomas. Eur Spine J 2010 19 7 1027 1195-1199.

2014 11 14 11 Chin J Min Inv Surg November 2014 Vol. 14. No. 11 1027 10 11 2014 63 2 175-177. 5 PTRA 2002 36 2 111-113. 6. 2005 5 12 1055-1057. 1 Cooper CJ Murphy TP Cutlip DE et al. Stenting and medical therapy for atherosclerotic renal-artery stenosis. N Engl J Med 2014 370 1 13-22. 2 Bruno RM Daghini E Versari D et al. Predictive role of renal resistive index for clinical outcome after revascularization in hypertensive patients with atherosclerotic renal artery stenosis a monocentric observational study. Cardiovasc Ultrasound 2014 12 1 9. 3 Webb TN Ramratnam M Evans RW et al. Atherosclerotic renal artery stenosis as a cause for hypertension in an adolescent patient. Pediatr Nephrol 2014 29 8 1457-1460. 4 Textor SC Lerman LO. Reality and renovascular disease when does renal artery stenosis warrant revascularization Am J Kidney Dis... 7. 2010. 2011 39 7 579-616. 8 G.. 2013. 110-115. 9 Habibian MR Delbeke D Martin WH et al. Nuclear Medicine Imaging-A Teaching File. Philadelphia Lippincott Williams & Wilkins 1999. 366-367. 10 Grisk O Rettig R. Interactions between the sympathetic nervous system and the kidneys in arterial hypertension. Cardiovasc Res 2004 61 2 238-246. 11 Burke SL Evans RG Head GA. Effects of chronic sympathoinhibition on renal excretory function in renovascular hypertension. J Hypertens 2011 29 5 945-952. 2014-05 - 19 2014-09 - 12 ( 责任编辑 : 王惠群 ) 檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷檷 1014 7. 15 Uchida K Nakajima H Yayama T et al. Immunohistochemical Chiari. findings of multiple ossified en plaque meningiomas in the thoracic 2005 37 6 629-632. 8 Tuli J Drzymalski DM Lidov H et al. Extradural en-plaque spinal meningioma with intraneural invasion. World Neurosurg 2012 77 1 202. e5 - e13. 9 Tsai CY Tsai TH Lin CH et al. Unusual exophytic neurocytoma of thoracic spine mimicking meningioma a case report and review of the literature. Eur Spine J 2011 20 Suppl 2 S239 - S242. 10 Sahni D Harrop JS Kalfas IH et al. Exophytic intramedullary meningioma of the cervical spinal cord. J Clin Neurosci 2008 15 10 1176-1179. 11 Maiuri F De Caro ML de Divitiis O et al. Spinal meningiomas agerelated features. Clin Neurol Neurosurg 2011 113 1 34-38. 12 Mekitarian FE Horigoshi NK Carvalho WB et al. Primary spinal meningioma in a 10-year-old boy. Arquivos de Neuro-psiquiatria 2010 68 5 804-806. 13. 2012 17 8 456-459. 14 Knafo S Lonjon G Vassal M et al. Spinal cord compression due to undiagnosed thoracic meningioma following lumbar surgery in an elderly patient a case report. Orthop Traumatol Surg Res 2013 99 8 983-986. spine. J Clin Neurosci 2009 16 12 1660-1662. 16 Kim CH Chung CK. Surgical outcome of a posterior approach for large ventral intradural extramedullary spinal cord tumors. Spine Phila Pa 1976 2011 36 8 E531 - E537. 17 ZACKS A. Atlanto-occipital fusion basilar impression and block vertebrae associated with intraspinal neurofibroma meningocele and von Recklinghausen s disease. Radiology 1960 75 223-231. 18.. 2012 17 8 460-462. 19 Lyons M Windgassen E Kinney C et al. Thoracic meningioma masquerading as chronic abdominal pain. Turk Neurosurg 2012 22 3 365-367. 20 Yamamuro K Seichi A Kimura A et al. Histological investigation of resected dura mater attached to spinal meningioma. Spine Phila Pa 1976 2012 37 22 E1398 - E1401.. 21 Menku A Koc RK Oktem IS et al. Laminoplasty with miniplates for posterior approach in thoracic and lumbar intraspinal surgery. Turk Neurosurg 2010 20 1 27-32. 2014-08 - 20 2014-09 - 19 ( 责任编辑 : 王惠群 )