Bagley Carlos A, Kothbauer Karl F, Wilson Sean, Bookland Markus J, Epstein Fred J, Jallo George I
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-7713, USA.
J Neurosurg. 2007 Apr;106(4 Suppl):261-7. doi: 10.3171/ped.2007.106.4.261.
Currently, the optimal treatment of children harboring myxopapillary ependymomas of the spinal cord remains somewhat debatable. The authors present a retrospective study in which they evaluated the records of patients in whom resection of these lesions had been performed.
Fourteen pediatric patients who had undergone resection of a spinal cord tumor between September 1982 and July 2004 were identified from the database as having histologically classified myxopapillary ependymomas. There were 10 boys and four girls ranging in age from 7 to 18 years (mean age 12.6 years); 71% of the patients were boys. The clinical presentation of the tumor's course was slow and indolent, and the patients had a mean symptom duration of 19.6 months. Twelve patients, who underwent a total of 16 operations, were available for long-term follow-up review. Thirteen gross-total resections and three subtotal resections were performed. There were no deaths due to surgery. Postoperatively, patients initially remained at their preoperative level of function or improved. Patients who had undergone previous surgery and radiotherapy were treated more conservatively than patients who were undergoing surgery for the first time. Four children experienced significant complications following treatment.
As the authors demonstrate in this study, excellent outcomes may be obtained with the use of aggressive surgical techniques with the goal being that of gross-total resection. Despite the best of resections, however, the risk of recurrence remains. Therefore, periodic neuroimaging surveillance of the neuraxis and close clinical follow up are warranted throughout the patient's life. The role for adjunctive chemo- and radiotherapy remains to be defined in the management of myxopapillary ependymomas.
目前，脊髓黏液乳头型室管膜瘤患儿的最佳治疗方案仍存在一定争议。作者开展了一项回顾性研究，评估了已对这些病变进行切除的患者记录。
从数据库中确定了1982年9月至2004年7月期间接受脊髓肿瘤切除术的14例儿科患者，其组织学分类为黏液乳头型室管膜瘤。其中有10名男孩和4名女孩，年龄在7至18岁之间（平均年龄12.6岁）；71%的患者为男孩。肿瘤病程的临床表现缓慢且隐匿，患者症状持续时间平均为19.6个月。12例患者共接受了16次手术，可进行长期随访复查。进行了13次全切除和3次次全切除。无手术相关死亡。术后，患者最初保持术前功能水平或有所改善。曾接受过手术和放疗的患者比首次接受手术的患者治疗更为保守。4名儿童在治疗后出现了严重并发症。
正如作者在本研究中所证明的，采用积极的手术技术以实现全切除的目标，可能会获得良好的结果。然而，尽管进行了最佳切除，复发风险仍然存在。因此，在患者的一生中，有必要定期对神经轴进行神经影像学监测并密切进行临床随访。辅助化疗和放疗在黏液乳头型室管膜瘤治疗中的作用仍有待确定。
