spinal meningioma
Introduction
Introduction to spinal canal tumor Meningioma originates from arachnoid endothelial cells or fibroblasts of the dura mater and is a benign spinal cord tumor. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: edema, dehydration, cerebrospinal fluid leakage
Cause
Cause of spinal canal tumor
(1) Causes of the disease
Meningioma usually occurs in the arachnoid cap-shaped cells around the nerve roots near the dura mater, which may explain why the meningioma is mostly lateral, and meningioma may also originate from fibroblasts of the soft or dura mater. , suggesting that it may originate from mesodermal tissue.
(two) pathogenesis
The meningioma grows in the spinal canal, the capsule is intact, and it is closely attached to the dura mater. It has a wide basement. The tumor tissue does not invade the spinal cord parenchyma, but only oppresses it. The tumor blood supply comes from the arachnoid or hard ridge. Membrane blood supply is relatively abundant, mostly single hair, rare in many cases, the tumor is generally small, mostly oblate or elliptical, the tumor tissue structure is dense and hard, the cut surface is grayish red, sometimes the tumor base There are calcified grit, hemorrhagic necrosis is rare in the tumor, meningioma is mostly located in the dura mater, a few are located outside the epidural, dumbbells are rare, 44 cases of meningioma have been reported, of which 42 are located in the dura mater Only one case was located outside the dura mater, and the other case was dumbbell-shaped, located in the dura mater. Outside, microscopic examination: the tissue structure of meningioma is roughly the same as that of intracranial meningioma. There are three types. :
1. Endothelial type: The tumor is composed of polygonal endothelial cells mosaic, sometimes with a swirling structure, and the tumor cells are well differentiated. This type of meningioma originates from arachnoid endothelial cells.
2. Fibrous type: The tumor is composed of staggered cells arranged in a staggered arrangement, rich in reticular fibers and collagen fibers, sometimes with a glassy change. This type of meningioma, which originates from the dural fibroblasts.
3. Sand type: Sand type meningioma, based on the endothelial type or fiber type, scattered in most sand bodies.
Prevention
Intraspinal meningioma prevention
A reasonable diet can take more high-fiber and fresh vegetables and fruits, balanced nutrition, including essential nutrients such as protein, sugar, fat, vitamins, trace elements and dietary fiber, with a combination of vegetarian and vegetarian foods. The complementary role of nutrients in food is also helpful in preventing this disease.
Complication
Intraspinal meningioma complications Complications edema dehydration cerebrospinal fluid leakage
If the meningioma is treated surgically, the following complications may occur:
1. Epidural hematoma: Paravertebral muscles, vertebrae and dural venous plexus are not completely hemostasis, hematoma can form after operation, resulting in limb paralysis, which occurs within 72 hours after surgery, even in the case of drainage tube Hematoma can also occur. If this phenomenon occurs, it should be actively explored to remove the hematoma and completely stop bleeding.
2. Spinal cord edema: often caused by surgical operation to damage the spinal cord, clinical manifestations similar to hematoma, treatment with dehydration, hormones, severe cases can be operated again, open dura.
3. Cerebrospinal fluid leakage: Due to the tightness of the dural and muscle layer suture, if there is drainage, the drainage tube should be removed in advance, the leakage is less, the dressing is observed, the leakage can not stop or the leakage is more, should be in the operating room Stitch the mouth.
4. Incision infection, rupture: general poor condition, poor wound healing ability or cerebrospinal fluid leakage is easy to occur, intraoperative should pay attention to aseptic operation, postoperative antibiotic treatment, should actively improve the general condition, pay special attention to protein and more A vitamin supplement.
Symptom
Symptoms of intraspinal meningioma Common symptoms Calcified spinal cord compression, limb numbness, slow growth, lumbar degeneration
The growth of meningioma is slow, and the early symptoms are not obvious. Therefore, the general history is long. The common first symptom is the corresponding limb numbness in the site where the tumor is located, followed by fatigue, the root pain is ranked third, and 44 cases are reported. The first symptom was limb numbness in 23 cases accounted for 49.9%; limb weakness in 11 cases, accounting for 27.3%, and root pain in 10 cases, accounting for 22.8%.
Symptoms of spinal cord compression and progression of the disease are similar to those of spinal cord neurofibromatosis.
1. The medical history is long, the early symptoms are not obvious, and the first symptom is more common in the corresponding limbs of the tumor.
2. More often occur in middle-aged women, children are less common.
3. X-ray examination, some can be seen with sand-like calcification.
4. Symptoms may be aggravated after lumbar puncture, and the protein in cerebrospinal fluid is moderately increased.
Examine
Examination of spinal canal tumors
1. Lumbar puncture and neck test, obstruction in the subarachnoid space, generally later than neurofibroma, the protein content of cerebrospinal fluid is generally moderate.
2. Meningioma and neurofibroma are the same as the spinal cord. The benign tumor in the dura mater is roughly the same in X-ray plain film and spinal cord lipiodol imaging. The difference is that the meningioma is examined by X-ray. Found grainy calcification.
3. CT and MRI findings: the tumor is substantial when the CT scan is normal, the density is often slightly higher than the normal spinal cord, and the tumor is mostly round or round, and calcification can be prominent in the tumor. The subarachnoid space of the tumor site was widened, the spinal cord was displaced to the contralateral side, and the contralateral subarachnoid space was narrowed or disappeared. MRI showed that the meningioma was superior to CT, and there was a soft tissue mass behind the chest pulp or in front of the cervical spinal cord. Existence, the spinal cord is displaced to the contralateral side, the spinal cord can be compressed or flattened, and the tumor is round or round in the transverse tangential position. The sagittal or coronal position of the tumor is often larger than the transverse diameter. Rectangular, long elliptical or long strips, T1 weighted tumors are mostly equal or slightly lower signals, edge smoothing, and there may be low signal loops between the spinal cord, but they can also be integrated into one, and the boundary is unclear. The signal is relatively homogeneous in the T1 weighted graph, and the signal can also be heterogeneous when the calcification is significant. The T2 weighted tumor signal is often slightly higher than the spinal cord, and there is a low signal in the calcification.
Diagnosis
Diagnosis and diagnosis of spinal canal tumor
It is difficult to distinguish meningioma from schwannomas and neurofibromas. The tumor is located in the dorsal aspect of the thoracic segment. The sagittal tumor has a large diameter. The calcification in the tumor should be considered more. The tumor should be considered in the occipital macropore. Considering the possibility of meningioma, if the tumor causes the enlargement of the intervertebral foramen and grows along the intervertebral foramen to the extraspinal canal, neurofibromatosis or schwannomas should be considered.
