Spinal cavernous malformation resection

Intramedullary spongy malformations (spontaneous hemangioma) are less common in spinal canal diseases. Ogilvy equalized 6 cases reported in 1992 and collected 30 cases from the literature. Since the clinical application of MRI, the incidence rate has increased significantly. In 1997, Vishteh et al reported 17 cases from 1985 to 1995. This disease occurs in women between the ages of 30 and 50. Diagnostic MRI is the preferred method, and it can be seen not only when there is a symptom but the CT is negative, and it can be determined as a diagnosis of spongiform malformation based on the characteristics seen. Some people have done dynamic imaging observation of this disease, and found that the lesions can gradually increase, the mechanism is the expansion of abnormal blood vessels, rather than the proliferation of tumor cells. In the treatment, because the spongy deformity has a layer of gelatinous band which can be used as a boundary between the normal spinal cord and no obvious blood supply artery, the surgery can often be completely removed, so surgical resection is preferred. Because the lesion often has multiple hemorrhages, the spinal cord damage gradually worsens, so surgery can not be too late. Treatment of diseases: spinal cord injury, spinal cavernous hemangioma Indication Spinal spongiform resection is suitable for: 1. Those with symptoms of spinal cord injury. 2, although the clinical symptoms are mild, but MRI examination can be clearly diagnosed as intramedullary spongy deformity. Contraindications 1, complete paraplegia has been a long time, no recovery is possible. 2, old, infirm, accompanied by chronic diseases such as diabetes, high blood pressure, can not tolerate the operator. Preoperative preparation 1. General preparation of the whole body According to the condition and examination, the patient's general condition is actively improved, and various necessary supplements and corrections are given. 2, those with constipation, pre-operative laxatives, enema during the night before surgery. Those with dysuria should be catheterized before surgery and indwelling catheter. 3, neck lesions affect the respiratory, preoperative should be deep breathing, cough and other training, a few days before surgery can start aerosol inhalation, if necessary, antibiotics. 4, postoperative need to prone, should be prone position training in advance, so that patients can adapt to this lying position. 5, sedatives before the operation, phenobarbital 0.1g. 6, fast within 6 ~ 8h before surgery. 7, the day before surgery to prepare the surgical skin, cleaning shaving, the range should be more than 15cm around the incision. Neck surgery should shave the occipital hair. 8. According to the needs of anesthesia, give medication before anesthesia. 9, preoperative positioning should be determined before the scheduled removal of the spine position of the lamina, the easiest way is to locate according to the body surface markers. Due to the difference in body shape, there may be 1 or 2 spinous process errors by marker positioning. In order to avoid the error, it can be positioned according to the body surface marker, and then a type of lead is glued on the body surface of the corresponding spinous process. After taking the X-ray film, the surgical site is verified from the position of the lead on the X-ray film. Surgical procedure 1. Surgical incision, laminectomy, and dural incision "laminectomy". 2. Lesion removal After the dura mater is cut, the lesion is often seen. Some lesions protrude from the surface of the spinal cord, dark purple, covered with soft meninges, but most of the lesions are located in the spinal cord, see local enlargement of the spinal cord, blue or less vascular whitish areas on the surface of the enlarged spinal cord, the former suggest The lesion is close to the surface of the spinal cord, and the latter suggests a deeper lesion. There are no blood supply arteries and drainage veins on the surface. A tiny blood supply artery can sometimes be seen under the operating microscope. After seeing the lesion, the spinal cord is cut at its superficial area according to the lesion in the spinal cord. The incision is mostly in the posterior midline, or the posterior root enters the spinal cord region to cut the spinal cord. After seeing the lesion, it gently separates between the colloidal interface and the spinal cord, and can be completely removed without damaging the spinal cord. Intraoperative hemorrhage is mostly capillary or venule. Except for the small aorta visible under the operating microscope, the bipolar electrocoagulation with weak current is used to stop bleeding. The rest of the bleeding can be stopped by itself after compression. The spinal cord tissue deposited with hemosiderin cannot be removed to avoid aggravating symptoms. 3. Suture the layers of the incision as usual. complication 1, damage to the normal spinal cord, aggravating neurological dysfunction, and more related to surgical operations. It is necessary to operate gently during operation, try to avoid excessive compression or pulling the spinal cord, and separate the lesions according to the gel interface, and apply the compression to the lesion side to protect the spinal cord. 2, postoperative hematoma, and intraoperative hemostasis is not complete, should be carefully observed before suturing the incision, when it is confirmed that hemostasis has been completed, then suture the incision.