Kim Louis J, Klopfenstein Jeffrey D, Zabramski Joseph M, Sonntag Volker K H, Spetzler Robert F
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Neurosurgery. 2006 Jan;58(1):106-11; discussion 106-11. doi: 10.1227/01.neu.0000192161.95893.d7.
To determine the short- and long-term effects of surgical resection of intramedullary spinal cavernous malformations on preoperative pain.
Between 1988 and 2003, 53 intramedullary spinal cavernous malformations were surgically managed. A retrospective analysis of this cohort revealed 23 (43%) patients who presented with pain as a clinically relevant feature. Long-term evaluation of pain outcomes was available in 21 patients. Pain outcomes were characterized as improved, unchanged, or worse compared with preoperative and immediate postoperative status.
Seven patients presented with radiculopathy, 12 with central pain, and four with both. Immediately after surgery, pain symptoms improved in 18 (78%) patients, were unchanged in 5 (22%), and were worse in none compared with the patients' preoperative status (n = 23). During the follow-up period, 11 (52%) patients improved, nine (43%) remained at their preoperative baseline, and one (5%) was worse compared with their preoperative levels of pain. The difference in postoperative and long-term pain status was statistically significant (P = 0.031).
The surgical efficacy for improving pain related to intramedullary spinal cavernous malformations may be worse than implied in the literature. Although pain relief immediately after surgery is good, we found that recurrence is common and that only approximately 50% of patients report long-term benefit. Despite the significant limitations of this retrospective study, these data may serve as a guide when counseling patients preoperatively to help them to maintain realistic expectations about outcomes.
确定手术切除脊髓髓内海绵状血管畸形对术前疼痛的短期和长期影响。
1988年至2003年间，对53例脊髓髓内海绵状血管畸形进行了手术治疗。对该队列进行回顾性分析发现，23例（43%）患者将疼痛作为临床相关特征。对21例患者进行了疼痛结局的长期评估。与术前和术后即刻状态相比，疼痛结局分为改善、不变或恶化。
7例患者出现神经根病，12例出现中枢性疼痛，4例两者均有。与术前状态相比（n = 23），术后即刻18例（78%）患者疼痛症状改善，5例（22%）不变，无患者疼痛症状恶化。在随访期间，与术前疼痛水平相比，11例（52%）患者改善，9例（43%）维持在术前基线水平，1例（5%）恶化。术后和长期疼痛状态的差异具有统计学意义（P = 0.031）。
手术改善脊髓髓内海绵状血管畸形相关疼痛的疗效可能比文献中暗示的要差。虽然术后即刻疼痛缓解良好，但我们发现复发很常见，只有约50%的患者报告有长期获益。尽管这项回顾性研究有显著局限性，但这些数据可为术前咨询患者提供指导，帮助他们对手术结果保持现实的期望。
