成人非异常硬膜内髓外脊柱脂肪瘤的综合研究：系统回顾和单臂荟萃分析

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-08-28 DOI:10.1016/j.jocn.2025.111591

Áquila Matos Soares , Yan Gondim de Sousa , Daniel Salmito Chaves , José Italo da Silva Damasceno Gomes , George Pessoa Amorim Neto , Thiago Luís Marques Lopes , Júlio Farias Rangel , Mateus Dutra Balsells , Isabela Fernandes de Melo Pereira , Camilly Ramos Sales , Miguel Vieira de Almeida , Andressa Gabriella Duarte de Queiroz , Ana Karla Benigno Dantas , Leonardo de Macedo Filho , Lucas Alverne Freitas de Albuquerque

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引用次数: 0

摘要

背景：脊髓脂肪瘤是指神经外胚层与皮肤外胚层在初级神经发育过程中过早分离。非异常性髓外硬膜内脊柱脂肪瘤（N-DEISL）占脊柱肿瘤的不到1%。本研究旨在分析成人N-DEISL的解剖、临床表现及治疗策略。方法：我们按照PRISMA指南对N-DEISL的研究进行了系统回顾和荟萃分析。使用EMBASE和PubMed等数据库进行文献检索。这些研究包括病例报告、队列研究和专注于硬膜内-髓外脂肪瘤的临床试验。数据的提取和分析由多位审稿人完成，使用GraphPad Prism、R、Python等工具进行统计分析和图形化表示。结果共纳入36项研究，55例患者。患者以男性为主，平均年龄34.60岁。常见症状包括运动障碍（80.00 %）和感觉障碍（94.54%）。诊断主要通过磁共振成像（MRI）（72.72%）。94.54%的病例接受手术治疗，67.27%的患者报告症状改善。14.54%的患者采用神经生理术中监测（NIOM），症状明显改善，无明显复发。三次样条回归分析显示术中监测与术后恢复时间呈非线性关系。结论我们的系统回顾和荟萃分析表明，NIOM的使用可以作为成人髓外硬膜内脂肪瘤患者康复的预测因素。此外，我们发现这些脂肪瘤主要影响脊髓的胸段，主要通过MRI进行明确诊断。还证实，出现症状和寻求医疗援助之间的时间是一个需要解决的关键因素。最后，可以推断，虽然部分切除取得了显著的效果，但在未来的随机研究中，进一步研究术中监测的作用是必要的。

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A comprehensive study of non-dysraphic intradural extramedullary spinal lipoma in adults: A systematic review and single-arm meta-analysis

Background

Spinal lipomas are defined by the premature separation of the neural ectoderm from the cutaneous ectoderm during primary neurulation. Non-dysraphic extramedullary intradural spinal lipoma (N-DEISL) represents less than 1% of spinal tumors. This study aims to analyze the anatomical and clinical presentations, and treatment strategies of N-DEISL in adults.

Methods

We conducted a systematic review and meta-analysis of studies on N-DEISL, following PRISMA guidelines. Literature searches were performed using databases including EMBASE and PubMed. The studies included case reports, cohort studies, and clinical trials focusing on intradural-extramedullary lipoma. Data extraction and analysis were conducted by multiple reviewers, employing tools such as GraphPad Prism, R, and Python for statistical analysis and graphical representations.

Results

A total of 36 studies encompassing 55 patients were included. Most patients were male, with a mean age of 34.60 years. Common symptoms included motor disturbances (80.00 %) and sensory disturbances (94.54 %). Diagnosis was predominantly through Magnetic Resonance Imaging (MRI) (72.72 %). Surgical treatment was applied in 94.54 % of cases, with 67.27 % reporting symptom improvement. Neurophysiological Intraoperative Monitoring (NIOM) was used in 14.54 % of patients, showing significant symptom improvement without significant recurrence. Cubic spline regression analysis revealed a non-linear relationship between intraoperative monitoring and post-surgical recovery time.

Conclusion

Our systematic review and meta-analysis indicate that the use of NIOM can be a predictive factor in the recovery of patients with extramedullary intradural lipoma in adults. Moreover, it was found that these lipomas predominantly affect the thoracic level of the spinal cord, with definitive diagnosis primarily achieved through MRI. It was also verified that the time between the onset of symptoms and seeking medical assistance is a critical factor to be addressed. Finally, it can be inferred that, although partial resection presents remarkable results, further investigation into the role of intraoperative monitoring in future randomized studies is essential.

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.