目的:探讨脊髓室管膜瘤显微手术治疗中的相关问题,并评估其手术疗效及预后。方法:2005年10月至2007年10月我院收治36例脊髓室管膜瘤患者,男性27例,女性9例;年龄16～59岁,平均41.2岁。运动异常28例,感觉障碍20例,神经根性痛和局部疼痛16例,括约肌功能障碍6例。MRI检查病灶呈等信号或略高信号,多无明显强化,边界较清楚,部分伴有空洞。术前McCormick临床功能分级:Ⅰ级16例,Ⅱ级11例,Ⅲ级9例。肿瘤主体位于颈段23例,颈胸交界区6例,胸段4例,腰段3例。均在显微镜下分离切除肿瘤实质部分。结果:肿瘤全切除32例,次全切除4例,次全切患者术后接受放射治疗,无手术死亡。术后发生肺炎5例,脑脊液漏3例,手术切口感染1例,经对症治疗后痊愈。术后病理证实均为室管膜瘤。31例获得为期1年的随访,3例肿瘤次全切除患者1年内复发,再次行手术治疗;肿瘤全切除者无复发。术后McCormick临床功能分级:Ⅰ级23例,Ⅱ级6例,Ⅲ级2例。结论:显微手术是治疗脊髓髓内肿瘤的有效手段。肿瘤能否全切主要取决于肿瘤与脊髓的粘连程度和手术技巧。 Objective: To investigate the related problems of microsurgical treatment of spinal ependymoma and evaluate its curative effect and prognosis. Methods: From October 2005 to October 2007, 36 patients with spinal ependymoma were treated in our hospital. There were 27 males and 9 females. The patients aged 16-59 years (mean 41.2 years). 28 cases of abnormal motion, sensory disturbance in 20 cases, nerve root pain and local pain in 16 cases, sphincter dysfunction in 6 cases. MRI showed lesion was equal signal or slightly higher signal, no significant enhancement, the border is clearer, some accompanied by holes. Preoperative McCormick clinical function grading: Ⅰ grade 16 cases, Ⅱ grade 11 cases, Ⅲ grade 9 cases. The main tumor located in 23 cases of cervical, neck and chest junction area in 6 cases, 4 cases of thoracic and 3 cases of lumbar. All were separated by microscopic resection of tumor parenchyma. Results: Tumor resection in 32 cases, subtotal resection in 4 cases, subtotal patients underwent radiotherapy after surgery, no operative death. Postoperative pneumonia in 5 cases, 3 cases of cerebrospinal fluid leakage, surgical incision infection in 1 case, cured by symptomatic treatment. Postoperative pathology confirmed as ependymoma. Thirty-one patients were followed up for one year. Three patients underwent subtotal resection within one year and again underwent surgical treatment. There was no recurrence after tumor resection. Postoperative McCormick clinical classification: Ⅰ grade 23 cases, Ⅱ grade 6 cases, Ⅲ grade 2 cases. Conclusion: Microsurgery is an effective method for the treatment of spinal intramedullary tumors. Tumor can be completely cut mainly depends on the tumor and spinal cord adhesion and surgical skills.