Friedman Jonathan A, Wetjen Nicholas M, Atkinson John L D
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Spine (Phila Pa 1976). 2003 Feb 1;28(3):288-90; discussion 291. doi: 10.1097/01.BRS.0000042271.75392.E4.
A retrospective chart review of patients with tumors of the cauda equina was performed.
To assess the role of intraoperative ultrasound for detecting tumor migration and modifying the approach to cauda equina tumors.
Rostral migration of cauda equina tumors relative to preoperative imaging is well described. The utility of intraoperative ultrasound to identify tumor migration and to modify the surgical approach was analyzed.
The medical records of nine consecutive patients undergoing biopsy or resection of a cauda equina tumor diagnosed by magnetic resonance imaging at the authors' institution from January 1994 through December 2000 were reviewed. Four patients with tumors of the cauda equina underwent transdural sonography of the intraspinal compartment after initial laminectomy and before durotomy.
In three patients, the findings on intraoperative ultrasound showed rostral migration of the lesion with respect to the preoperative magnetic resonance imaging, necessitating additional laminectomy and modifying the site of durotomy. One tumor had migrated rostrally one full bony vertebral segment, whereas two tumors each had migrated one half of a bony vertebral segment. Pathology examination in the three patients whose lesions had migrated rostrally demonstrated a schwannoma in every case. In one patient, intraoperative ultrasound showed no lesion migration with respect to the preoperative magnetic resonance imaging, and no modifications to the surgical approach were needed. Pathology examination of this patient demonstrated an ependymoma.
Intraoperative ultrasound was useful in documenting rostral migration of cauda equina tumors, and facilitated appropriate laminectomy and durotomy. The technique may be particularly valuable for schwannomas of the cauda equina, which seem to have a greater potential for rostral migration.
对马尾肿瘤患者进行回顾性病历审查。
评估术中超声在检测肿瘤移位及调整马尾肿瘤手术入路方面的作用。
马尾肿瘤相对于术前影像学检查向头侧移位的情况已有详细描述。分析了术中超声识别肿瘤移位及调整手术入路的效用。
回顾了1994年1月至2000年12月在作者所在机构接受磁共振成像诊断为马尾肿瘤并进行活检或切除的9例连续患者的病历。其中4例马尾肿瘤患者在初次椎板切除术后、硬脊膜切开术前接受了椎管内超声检查。
3例患者术中超声检查结果显示病变相对于术前磁共振成像向头侧移位，需要额外行椎板切除术并调整硬脊膜切开部位。1例肿瘤向头侧移位了一整个椎体节段，另外2例肿瘤各移位了半个椎体节段。对病变向头侧移位的3例患者进行病理检查，结果显示每例均为神经鞘瘤。1例患者术中超声检查显示病变相对于术前磁共振成像无移位，无需调整手术入路。该患者病理检查显示为室管膜瘤。
术中超声有助于记录马尾肿瘤的头侧移位，并便于进行适当的椎板切除术和硬脊膜切开术。该技术对于马尾神经鞘瘤可能特别有价值，因为这类肿瘤似乎有更大的向头侧移位的可能性。
