2014年 · 第94卷第19期

This issue of Chinese Medical Journal published 6 articles on the diagnosis and treatment of spinal cord tumors, including 3 intramedullary tumors and 3 extramedullary tumors. This reflects that in the field of spinal cord surgery, the diseases diagnosed and treated by neurosurgeons in China are still spinal cord tumors. Comments are given below.

With the development of medical science, the treatment of craniocerebral trauma in the acute phase has made great progress, and the mortality rate in the acute phase has decreased significantly. The subsequent problem is that the number of patients in the "vegetative state" is gradually increasing, and the disability rate of craniocerebral trauma has not decreased due to the advancement of treatment methods. How to improve the various neurological functions of persistent vegetative state (PVS) is still a worldwide treatment problem. Studies have shown that high cervical spinal cord electrical stimulation can promote wakefulness in patients with long-term coma. A case of coma after severe traumatic brain injury was recovered after high cervical spinal cord epidural stimulation (cSCS). cSCS have been used as a treatment to manage chronic pain and reduce the onset of hemiplegic spasticity.

With the development of functional imaging technology and the emergence of positron emission tomography (PET), it is of great significance for the differentiation of benign and malignant lymph node lesions, but it is limited in clinical application due to its shortcomings such as high price, large radiation and long time consumption. Magnetic resonance diffusion weighted imaging (DWI), as a completely non-invasive and radiation-free functional imaging technology, has achieved good clinical results in the application of tumor and lymph node lesions in recent years. The value of DWI and PET/CT in differentiating benign and malignant lymph nodes is reviewed.

A 61-year-old male, Han nationality, developed lower limb weakness with pigmentation and slow walking 5 years ago. Before 5 days before admission, he had sudden pain and weakness in his right lower limb, and was hospitalized in the Department of Vascular Surgery of Qiqihar No.1 Hospital with "lower limb arteriosclerosis obliterans". He denied the history of hypertension and coronary heart disease, cerebral thrombosis and cerebral hemorrhage, trauma, surgery and allergy. There was no history of exposure to the epidemic area, no history of smoking and alcoholism. A family genetic history is denied. Physical examination: General vital indications are stable, pigmentation is visible in the right lower limb, skin of the lower limb is hypothermic, femoral artery pulsation is palpable, and dorsal pedis artery pulsation disappears. The contralateral foot artery is palpable. There was no deformity in both lower limbs, muscle strength and muscle tone were normal, pain and temperature perception in both lower limbs decreased slightly, and no obvious positive signs were seen in the remaining nervous system. CT angiography of lower extremities showed no obvious occlusion of lower extremity arteries. Lumbar MRI was performed: intraspinal cyst, spinal cord compression (Figure 1)。 The patient was referred to neurosurgery for further treatment. Thoracic 12 lumbar 1 laminectomy of spinal conus enterogenic cyst was performed under general anesthesia. Postoperative pathological diagnosis: T12~ L1 spinal cord cavity occupying space, monolayer and stratified cubic epithelial cysts, consistent with spinal enterogenic cysts (Figure 2)。

The child was a 14-year-old girl. He came to the clinic because he found that his vision gradually declined for 2 years. The patient's parents are not intimate married, and there is no ethnic minority origin in the family. Physical examination: wide and flat nose bridge, maxillary dysplasia, tooth dysplasia, missing 2 teeth, and periumbilical neoplasia. Ocular examination: visual acuity: right eye visual acuity 0.15, correction 0.5, left eye visual acuity 0.25, correction 0.5, intraocular pressure 20 mmHg (1 mmHg =0.133 kPa) in right eye, 21 mmHg in left eye, no conjunctiva congestion in both eyes, transparent cornea, kp (–), shallow peripheral anterior chamber, peripheral anterior iris adhesion. The texture of the iris is loose, the iris matrix becomes thin and atrophic, holes form, the pupil is ectopic downward, the shape is irregular, and the pigment collar is everted (Figure 1，Figure 2), a small amount of pigmentation in the anterior capsule of the crystal, no obvious opacity in the vitreous body, fundus examination: the optic disc boundary is clear, orange-red, C/D is about 0.2, and the fovea reflectivity is clear. No obvious abnormalities were found in binocular visual field examination; Corneal endothelioscopy: corneal endothelial cell count right eye 2 141/mm²2 044/mm in left eye²There was no obvious abnormality in endothelial morphology. The ultrasound biomicroscopy of both eyes showed that the anterior chamber of both eyes was shallow, and the depth of the central anterior chamber was 1.90 mm in the right eye and 1.53 mm in the left eye. The iris root in all directions adhered to the corneal endothelial surface forward, the chamber angle was closed, the pupil shape was irregular and deviated, the lens position was acceptable, the suspensory ligament was visible, and the anterior vitreous body was mildly opaque (Figure 3，Figure 4)。 After asking for the medical history, her mother had undergone binocular anti-glaucoma surgery in an external hospital 2 years ago. Based on the clinical manifestations and eye examination, the diagnosis was "Axenfeld-Rieger syndrome". Eyewear was given to correct vision, and regular follow-up visits were instructed to observe the changes of intraocular pressure.