多模式神经电生理监测下的圆锥马尾区侵袭性肿瘤显微手术治疗体会

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【中图分类号】R651;R739.41 【文献标志码】 A 【文章编号】1672-7770（2025）04-0371-06

Experience in microsurgical treatment of invasive tumors in the conus and cauda equina region through multimodal intraoperative neurophysiological monitoring WU Weining，TIAN Wei，GU Shiqing，WANG Yiheng，WU Youzhi. Department of Neurosurgery，Nanjing First Hospital, Nanjing Medical University，Nanjing 210006， China

Corresponding author : WU Youzhi

Abstract: ObjectiveTo study the experience and effect of surgical treatment for invasive tumors in the conus and cauda equina of spinal cord under neurophysiological monitoring. Methods A total of 26 patients with invasive tumors in the conus cauda equina region admitted to Department ofNeurosurgery，Nanjing First Hospital，Nanjing Medical University from January 2O19 to June 2024 were selected，under SEP + MEP + EMG multimodal intraoperative neurophysiological monitoring，all tumors were surgically removed under the microscope.According to the follow-up time，McCormick spinal cord function rating and lumbar Japanese Orthopaedic Association( JOA) score of 26 patients were obtained at four time points such as before surgery，1O days after surgery, 1 month after surgery，and 3 months after surgery，with the results of intraoperative nerve electrophysiological monitoring were used for analysis. ResultsThere was no significant improvement in McCormick spinal cord function at1O days after surgery( P>0.05 ），but significant improvements at1 month after surgery and 3 months after surgery( P0.05) .The improvement rate of lumbar JOA score was similar to McCormick spinal cord function rating. There was a significant difference( P0.05 ）in the improvement rate between 1 month and 3 months after surgery. The results of neurophysiological monitoring indicated that patients with abnormal monitoring during surgery should be relieved or stopped from the operation，and all patients showed improvement after surgery. However，the neurological dysfunction of the remaining 3 patients with MEP abnormalities did not recover. ConclusionsThe operation of invasive tumors in cauda equina conus area should be performed under electrophysiological monitoring due to the tumor is tightly atached to the nerve.The extent of tumor resection should be as much or even complete as possble without further aggravating neurological dysfunction，but it should also be made according to the patient's condition and the extent of nerve damage.

Key words:conus and cauda equina region; invasive tumor; intraoperative neurophysiological monitoring；microsurgery

圆锥马尾区侵袭性肿瘤，指肿瘤生长在圆锥或马尾区的神经丛间隙，形成占据整个椎管的圆柱状病变。（剩余13064字）