ppt spinal meningioma .ppt2.ppt

1、Spinal meningioma （脊膜瘤）,Zhang shui hua,Number : P519199 Gender: F Age: 73 years old Symptom: back pain with double lower extremities more than 10 days,T1 +C,T1+C,T2 FS,Spinal meningioma,The spinal cord is surrounded by a protective membrane called the meninges, which is made up of three layers, the

2、dura mater, the arachnoid membrane, and the pia mater. Tumors that arise from this tissue, especially the cells that make up the arachnoid membrane (arachnoid cap cells), are called meningiomas.,Risk Factors The only proven risk factor in the development of meningioma is exposure to ionising radiati

3、on - with tumours commonly developing following a 10 to 20 year lag time from exposure. Patients with neurofibromatosis type 2 (genetic defect on chromosome 22) are at increased risk of developing meningioma.,Symptoms,The symptoms of a meningioma are caused by the pressure the growing tumor exerts o

4、n surrounding tissue. These tumors can occur in a variety of places and therefore cause a wide range of symptoms. Depending on the location of the mass, meningiomas may cause headaches, nausea, seizures, weakness or numbness(麻木) in the limbs or face, visual problems, and gradual changes in mood or p

5、ersonality. The symptoms tend to increase in severity as the tumor grows in size.,Primary sites and primary people,Meningiomas account for approximately 25% of spinal canal lesions. They can occur at any location throughout the spine, but predominate in the thoracic region (probably because this is

6、the largest segment). Spinal Meningiomas occur approximately four times as often in women as in men, and the average age is 45 years.,Progression,This type of tumour spreads by local invasion and erosion of surrounding bony structures through pressure effects. Meningiomas are very rarely malignant b

7、ut occasionally tumours may show a tendency to recur.,Summary of the 2007 WHO Grading Scheme for Meningiomas,Grade I: Meningothelial, fibroblastic, transitional, angiomatous, microcystic, secretory, lymphoplasmacytic, metaplastic, psammomatous; does not fulfill criteria for grade II or III. Grade II

8、 (Atypical): Chordoid, clear cell; 4 or more mitotic cells per 10 hpf and/or 3 or more of the following: increased cellularity, small cells, necrosis, prominent nucleoli, sheeting, and/or brain invasion in an otherwise grade I tumor. Grade III (Anaplastic):Papillary, rhabdoid; 20 or more mitoses per

9、 10 hpf and/or obviously malignant cytologic characteristics such that tumor cell resembles carcinoma, sarcoma, or melanoma,Imaging diagnosis,Magnetic resonance imaging is the best imaging technique for diagnosing spinal meningiomas. It clearly delineates the level of the tumor and its relation to t

10、he cord, which is useful in planning surgery. spinal meningiomas were isointense to the normal spinal cord on T1- and T2-weighted images, and they displayed intense enhancement after gadolinium injection,Itscharacteristic,The pulp intradural（髓外硬膜内） tumor : flat shape or elliptic, obtuse Angle, the s

11、pinal cord surface obtuse, tumor size than the diameter, visible “subdural” (硬膜下征),After injection Gd-DTPA ， “hard film tail”（硬膜尾征） emerges and the part of spinal close to tumor with severe strengthening.; The pulp epidural（髓外硬膜外） tumor ： “dumbbell” shape （哑铃状）to the spinal canal invasion, make vertebra hole expansion, of the subarachnoid narrowed. Some mergers calcification,Differentials diagnosis,Neurogenic Tumour 20 to 50 years old, in any part of the spinal canal, and present a more hard for acute Angle, easy capsule change, T1WI lo