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[目的]探讨马尾神经鞘瘤的临床特点、鉴别诊断与手术技巧。[方法]回顾性分析手术治疗的30例马尾神经鞘瘤患者的临床资料。[结果]本组中大多数患者首发症状为单下肢疼痛麻木(18例),其中6例伴腰背部疼痛,5例表现为双下肢疼痛麻木伴腰背部疼痛,6例表现为单纯腰背部疼痛,1例表现为蛛网膜下腔出血。所有患者均经胸腰椎MRI增强扫描确诊,单发神经鞘瘤27例,其中3例神经鞘瘤在椎管内外生长成哑铃型,多发神经鞘瘤3例。所有患者均完整切除肿瘤,术后除1例患者临床症状加重外,其余患者临床症状均明显改善,短期随访未见复发。[结论]马尾神经鞘瘤的主要表现为腰背部和下肢疼痛麻木,查体显示双侧或单侧多根神经损伤,但首发症状可不典型;MRI增强有助于早期诊断;外科手术完整切除肿瘤效果良好。
[Objective] To investigate the clinical features, differential diagnosis and surgical skills of cauda equina schwannomas. [Methods] The clinical data of 30 patients with cauda equina schwannoma treated by surgery were retrospectively analyzed. [Results] The first symptom of most of the patients in this group was numbness of single lower extremities (n = 18). Six of them had low back pain, five had numbness of both lower extremities with low back pain, and six had simple back pain , 1 case showed subarachnoid hemorrhage. All patients were confirmed by thoracic and lumbar MRI enhanced scan, single schwannoma in 27 cases, of which 3 cases of schwannomas grow dumbbell inside and outside the spinal canal, multiple schwannoma in 3 cases. All patients underwent complete resection of the tumor. All the patients except the one with clinical symptoms were significantly improved after operation, and no recurrence was found in short-term follow-up. [Conclusion] The main manifestations of cauda equina schwannomatosis are numbness of lower back and lower extremities. Physical examination showed bilateral or unilateral multiple nerve injury, but the first symptom may not be typical. Enhanced MRI may be helpful for early diagnosis. Surgical complete resection of tumor Good effect.