脊髓髓内肿瘤(IMSCTs): 35例手术切除后的结果及文献复习

G. Sharma, Sumit Joshi, P. Poudel, Prassana Karki, D. B. Shah, Baburam Pokharel
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引用次数: 0

摘要

脊髓髓内肿瘤(IMSCTs)是罕见的,仅占所有脊髓肿瘤的5%。室管膜瘤和星形细胞瘤是两种最常见的imsct。由于近年来显微仪器、影像和技术的进步,积极的手术切除已经成为一种更安全、效果更好的可能性。本研究的目的是分析imsct手术切除后患者的功能结局并复习文献。在2017年5月至2021年1月的4年时间里,35例患者在全身麻醉下接受了imsct手术。神经生理监测(NPM)是最近才出现的,仅在少数病例中使用。在这些显微外科手术中,只要需要,就使用CUSA。本回顾性研究从门诊挂号、住院档案、门诊记录中检索数据,并使用SPSS软件(版本18)进行统计分析。功能结局采用McCormick评分法评定,平均随访时间2.5年。结果35例患者中,男性17例,女性18例。平均年龄分布为27.57岁(±17.68岁)。入院时,30例患者有运动障碍,18例有颈部或背部疼痛,10例有括约肌功能障碍,7例有脊柱后凸,2例神经正常。这35例患者的MRI与IV对比显示髓内病变位于颈椎(11)、颈髓(4)、胸(8)、颈胸(2)、胸腰椎(3)、圆锥(6)和腰椎(1)区域。22例全部切除,13例次全切除。组织学检查证实神经胶质瘤(室管膜瘤和星形细胞瘤)30例,皮样/表皮样2例,神经肠囊肿2例,继发性1例。术后并发症为17%,无手术相关30天死亡率。显微手术切除前后以McCormick评分法测定功能结局。术前3例(8.5%)患者分级低或独立,32例(91.4%)患者分级高或依赖。术后和出院时14例(40%)患者为低分级或独立级,21例(60%)患者为依赖级或高分级。末次随访(4年)低分级15例(48.3%),高分级或依赖16例(51.6%)。在我们的研究中,随访4年,复发率为5例(14.2%),其中2例为星形细胞瘤,1例为继发性,2例为黏液乳头状室管膜瘤。2例黏液乳头状室管膜瘤手术两次,不主张放疗。局部放疗8例(22.6%),复发率17.2%。结论在现代神经外科工具的帮助下,髓内病变的安全切除是可能的,但功能预后取决于患者术前神经系统状况、切除程度和肿瘤组织学。IMSCTS复发的危险因素是肿瘤的切除程度和组织学行为。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Intramedullary Spinal Cord Tumors (IMSCTs): Outcome after surgical resection in 35 cases and review of literature
BACKGROUND Intramedullary Spinal Cord Tumors (IMSCTs) are rare and they represent only 5% of all spinal tumors. Ependymoma and astrocytoma are two most common IMSCTs. Due to recent advances in micro instruments, imaging and technology, aggressive surgical excision has become a safer possibility with better outcome. Aim of this study is to analyze functional outcome of patients after surgical resection of IMSCTs and review of literature. METHODOLOGY Over a period of 4 years, between May 2017 and January 2021, 35 patients were operated for IMSCTs under general anesthesia. Neurophysiological monitoring (NPM) was recently available and used only in last few cases. CUSA was used whenever required in these microsurgical procedures. This retrospective study was carried out after retrieving data from OT registers, inpatient files, OPD records, and statistical analysis was executed using SPSS software (version 18). Functional outcome was assessed by McCormick grading scale and mean follow up period was 2.5 years. RESULTS Out of 35 patients, 17 were male and 18 female. Mean age distribution was 27.57(+/-17.68). On admission, 30 patients had motor deficits, 18 had neck or back pain, 10 had sphincter dysfunction, 7 had kyphoscoliosis and 2 patients had normal neurology. MRI with IV contrast of these 35 patients revealed intramedullary lesions at cervical (11), cervicomedullary (4), thoracic (8), cervicothoracic (2), thoracolumbar (3), conus (6) and lumbar (1) regions. 22 patients had gross total and 13 had subtotal resection. Histological examination confirmed 30 glial tumors (ependymoma & astrocytoma), 2 dermoid/epidermoid, 2 neurenteric cysts and 1 secondary. Postoperative complication was 17% and there was no surgery related 30 days’ mortality. Functional outcome was measured by McCormick grade before and after microsurgical resection. Preoperatively 3(8.5%) patients had low grade or independent and 32 (91.4%) had high grade or dependent. Postoperatively and at the time of discharge 14 (40%) of patients had low grade or independent and 21 (60%) were dependent or high grade. On last followed up (4 years) 15 (48.3%) had low grade and 16 (51.6%) had high grade or dependent. In our series, on followed up of 4 years, recurrence rate was 5(14.2%), They were 2 astrocytoma, 1 secondary, and 2 myxopapillary ependymomas. Two patients with myxopapillary ependymoma were operated twice and no radiotherapy was advocated. 8 (22.6%) patients received local radiation and recurrence rate was 17.2%. CONCLUSION  Safe resection of intramedullary lesion is possible with the aid of modern neurosurgical tools, however, functional outcome relies on preoperative neurological status of the patients, extent of excision and histology of tumor. Risk factors for recurrence of IMSCTS are extent of resection and histological behavior of tumor.
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