1、髓內室管膜瘤第1頁，共20頁，2022年，5月20日，16點13分，星期四epidural 硬膜外的Intradural extramedullary 硬膜下、髓外的Intramedullary 髓內的conus 圓錐terminal filumfalm 終絲cauda equina 馬尾syringomyelia si,riumaii:li 脊髓空洞癥第2頁，共20頁，2022年，5月20日，16點13分，星期四Male，49 years old Chief complaint: presented with weakness of both lower limbs of two-year

2、duration. It was insidious in onset and revealed gradual progression. Case 第3頁，共20頁，2022年，5月20日，16點13分，星期四T1WIT2WICE TIWIT12-LI第4頁，共20頁，2022年，5月20日，16點13分，星期四手術記錄Case1 ：標記頸6-胸3水平后正中手術切口.,棘突及椎板咬骨鉗咬除棘突及椎板，進入椎管，打開硬膜囊，探查，可見實性腫物位于頸7-胸2、3水平脊髓內后正中，質軟，灰紅色，邊界尚清，大小約11.54cm，顯微鏡下仔細分離，全切除腫物送病理，頸7水平以上髓內為淡黃色囊液術后病理

3、：室管膜瘤第5頁，共20頁，2022年，5月20日，16點13分，星期四手術記錄Case 2：取胸腰段后正中切口咬除T11-L2全部棘突及椎板.顯露硬膜囊，以尖刀小心縱行切開硬膜，見長圓形囊實性腫物，大小約92.01.8cm，包膜完整，腫物與馬尾神經粘連并包裹數支馬尾神經。小心鈍性分離，完整切除腫物并送病理檢查。術后病理:神經鞘瘤第6頁，共20頁，2022年，5月20日，16點13分，星期四Histological components determines the spectrum of tumorEpidural spaceIntradural extramedullary spaceIn

4、tramedullaryMeningesNerve Ependymal cellsNeuroepithelial cellsFatLymphaticInternal vertebral venous plexusLoose connective tissue第7頁，共20頁，2022年，5月20日，16點13分，星期四第8頁，共20頁，2022年，5月20日，16點13分，星期四Intraspinal massIntradural extramedullary massIntramedullary massAdult Children epidural massMetastasis Retic

5、uloendothelial tumors Chordoma Sarcoma +Neuroblastoma Chordoma +SarcomaNeurogenic tumorMeningioma Ependymoma,60% Astrocytoma,30% Hemangioblastoma ,5%5%40%55%第9頁，共20頁，2022年，5月20日，16點13分，星期四Intramedullary massEpendymomaMost common intramedullary tumor in adults (60%) Peak incidences in 4thand 5thdecad

6、esLocation: All segments may be involved, but filum is most commonT1 iso, T2 hyper,CE T1WI enhanced obviouslyTwo types:Cellular usually in cervical spine, FM, 40-50 years old, circumscribed but unencapsulated, can be associated with cyst or hemorrhageMyxopapillary in conus or filum, MF, 20-30 years

7、old, encapsulated, 20% destroy boneMyxopapillary is most frequent type and accounts for nearly all filum ependynomas第10頁，共20頁，2022年，5月20日，16點13分，星期四ac T2-, T1-, and post-gadolinium T1-weighted sagittal images of grade 2 ependymoma in a 3-year-old boy.第11頁，共20頁，2022年，5月20日，16點13分，星期四df T2-,T1-, and p

8、ostgadolinium T1-weighted images of a myxopapillary (grade 1) ependymoma in a 14-year-old boy第12頁，共20頁，2022年，5月20日，16點13分，星期四 1.Whats the origin of the ependymoma? Ependymomas are a rare type of glioma that are thought to develop from the ependymal cells that line the ventricles (fluid-filled spaces

9、 in the brain) and the central canal of the spinal cord.2.Not all ependymomas are located in the intramedullary Extramedullary Ependymoma第13頁，共20頁，2022年，5月20日，16點13分，星期四Sagittal T2- (B) and T1-weighted images before (C) and after (D) gadolinium injection. It is extremely difficult to determine wheth

10、er this lesion is intra- or extramedullary. No contrast enhancement is seen. Axial T2 images better illustrate the extramedullary location of the lesionMacroscopic appearance of the lesion at surgery after opening of the dura mater: a cystic mass mimicking an arachnoid cyst第14頁，共20頁，2022年，5月20日，16點1

11、3分，星期四3. How to explain the exist of extramedullary ependymoma? Although its still uncertain,they probably arise from heterotopic glial tissue pinched off from the neural tube during its closure4. The intraoperative findings were consistent with multiple, isolated cystic lesions, without any attachm

12、ent to the central nervous system or to the dura mater,which excludes the hypothesis of an exophytic ependymoma of the spinal cord第15頁，共20頁，2022年，5月20日，16點13分，星期四Histologic examination reveals an ependymoma A, Low-power view illustrates tumor proliferation located around the arachnoid.B, Thickened a

13、rachnoid is limited but notinvaded by monomorphous tumor cells. C, Perivascular cellular arrangement around hyalinized blood vessels denotes ependymomadifferentiation第16頁，共20頁，2022年，5月20日，16點13分，星期四extramedullary ependymomamost common in the third to fifth decades of lifefemale preponderantmainly lo

14、cated at the thoracic spineImaging findings are non-specific第17頁，共20頁，2022年，5月20日，16點13分，星期四Intramedullary massAstrocytomaSecond most common cord neoplasm in adults, most common cord neoplasm in children (60%)Most commonly located in the cervical and upper thoracic cordFusiform enlargement, infiltra

15、tive margins,long segment of involvement; no or variable enhancementUncommon/rare imaging features: caudal location, holocord involvement第18頁，共20頁，2022年，5月20日，16點13分，星期四Intramedullary massHemangioblastoma M=F, 20-40 years old Intensely enhancing, hypervascular tumor; usually located dorsally within the cordMultiple lesions common (check the posterior fossa!)Up to 50% cases are asso