Hoover M, Bowman L C, Crawford S E, Stack C, Donaldson J S, Grayhack J J, Tomita T, Cohn S L
Department of Pediatrics, Children's Memorial Hospital, Chicago, IL 60614, USA.
Med Pediatr Oncol. 1999 May;32(5):353-9. doi: 10.1002/(sici)1096-911x(199905)32:5<353::aid-mpo8>3.0.co;2-2.
Chemotherapy, radiotherapy, and surgical decompression with laminectomy are effective therapeutic options in the treatment of cord compression from neuroblastoma (NB). We report the long-term outcome of patients with intraspinal NB treated with or without laminectomy at two large pediatric oncology centers.
We reviewed the medical records and radiographs of 26 children with intraspinal NB treated at Children's Memorial Hospital in Chicago, Illinois, between 1985 and 1994 or at St. Jude Children's Research Hospital in Memphis, Tennessee, between 1967 and 1992.
Twenty-four of the 26 patients are alive and disease-free (follow-up of 2-29 years; median, 10 years 2 months). Fifteen of the 23 patients with neurologic impairment underwent initial laminectomy. Nine of these 15 patients recovered neurologic function, including 3 patients who presented with paraplegia. Eleven of the 15 patients who underwent laminectomy have developed mild to severe spinal deformities. Eight patients with neurologic symptoms consequent to cord compression were treated with initial chemotherapy and/or surgery, but did not undergo laminectomy. Three patients with mild to moderate deficits recovered neurologic function. Four of 11 patients with intraspinal NB who did not undergo laminectomy have mild to severe scoliosis.
A low incidence of neurologic recovery was seen in patients with long-standing severe cord compression regardless of treatment modality. For patients with partial neurologic deficits, recovery was seen in most patients following chemotherapy or surgical decompression with laminectomy. A higher incidence of spinal deformities was seen in the patients treated with initial laminectomy.
化疗、放疗以及椎板切除术减压手术是治疗神经母细胞瘤（NB）所致脊髓压迫症的有效治疗选择。我们报告了在两家大型儿科肿瘤中心接受或未接受椎板切除术治疗的脊髓内NB患者的长期预后情况。
我们回顾了1985年至1994年期间在伊利诺伊州芝加哥市儿童纪念医院或1967年至1992年期间在田纳西州孟菲斯市圣裘德儿童研究医院接受治疗的26例脊髓内NB患儿的病历和X光片。
26例患者中有24例存活且无疾病（随访2至29年；中位随访时间为10年2个月）。23例有神经功能障碍的患者中有15例接受了初次椎板切除术。这15例患者中有9例恢复了神经功能，其中包括3例截瘫患者。接受椎板切除术的15例患者中有11例出现了轻度至重度脊柱畸形。8例因脊髓压迫出现神经症状的患者接受了初次化疗和/或手术，但未进行椎板切除术。3例轻度至中度神经功能缺损患者恢复了神经功能。11例未接受椎板切除术的脊髓内NB患者中有4例出现了轻度至重度脊柱侧弯。
无论采用何种治疗方式，长期存在严重脊髓压迫的患者神经功能恢复的发生率都较低。对于部分神经功能缺损的患者，大多数患者在接受化疗或椎板切除术减压手术后神经功能得到恢复。初次接受椎板切除术治疗的患者脊柱畸形的发生率较高。
