Schick U, Marquardt G, Lorenz R
Clinic of Neurological Surgery, University of Leipzig, Germany.
Neurosurg Rev. 2001 Mar;24(1):1-5; discussion 6-7. doi: 10.1007/pl00011959.
Intradural spinal metastases are uncommon. The outcome of surgical treatment of intra- and extramedullary intradural metastases is considered to be poor, with rapid clinical deterioration. The question of optimal treatment remains controversial. We present an overview of the clinical outcome and surgical treatment of 220 spinal metastases carried out in our centre from 1980 to 1999, with particular emphasis on 11 intradural metastases. Clinical history, signs, surgical approach, outcome, and radiological reports were obtained by review of patient charts. Secondary spinal tumours most often originated from carcinomas of the breast, lung, kidney, gastrointestinal tract, and prostate. In 12% of cases, no primary tumour could be found. Drop metastases of intracranial pathology appeared in 3%. Intradural metastases were seen in 11 patients and formed a very heterogeneous group with predominance of melanoma, lymphoma, and medulloblastoma. Functional recovery and survival time were worse in intradural metastases than in extradural metastases, and the patients were younger. Treatment of metastases is designed to relieve pain and preserve or restore neurological function palliatively. Intradural metastases are a devastating condition with usually fatal outcome. Selected patients who undergo aggressive surgical treatment may have substantially increased survival.
硬脊膜内脊髓转移瘤并不常见。髓内和髓外硬脊膜内转移瘤的手术治疗效果被认为较差，临床会迅速恶化。最佳治疗方案的问题仍存在争议。我们概述了1980年至1999年在我们中心进行的220例脊柱转移瘤的临床结果和手术治疗情况，特别强调了11例硬脊膜内转移瘤。通过查阅患者病历获取临床病史、体征、手术方式、结果及影像学报告。继发性脊柱肿瘤最常起源于乳腺癌、肺癌、肾癌、胃肠道癌和前列腺癌。12%的病例中未发现原发肿瘤。3%出现颅内病变的播散性转移。11例患者出现硬脊膜内转移瘤，形成了一个非常异质性的群体，以黑色素瘤、淋巴瘤和髓母细胞瘤为主。硬脊膜内转移瘤患者的功能恢复和生存时间比硬脊膜外转移瘤患者更差，且患者更年轻。转移瘤的治疗旨在缓解疼痛并姑息性地保留或恢复神经功能。硬脊膜内转移瘤是一种严重的疾病，通常预后致命。接受积极手术治疗的特定患者可能会显著提高生存率。
