Saraceni Christine, Harrop James S
Midwestern University, Glendale, AZ, USA.
Clin Neurol Neurosurg. 2009 Apr;111(3):221-6. doi: 10.1016/j.clineuro.2008.10.018. Epub 2008 Dec 19.
Spinal meningiomas are uncommon entities that fortunately burden only a small minority of patients. Notwithstanding their overwhelmingly benign propensity, the occurrence of extramedullary meningioma may nonetheless cause significant morbidity and possible mortality. The consideration therefore, of spinal meningioma in the differential of patients presenting with radiculopathy or complaints of chronic back or neck pain should not be disregarded. The rapidity of diagnosis and the first neurosurgical encounter are cornerstones in patient longevity and neurological preservation. The advent of microsurgical techniques and magnetic resonance imaging and surgical techniques has notably improved clinical outcomes over the past two decades. However, surgical candidacy may be limited, particularly in those patients with significant preexisting medical comorbidities, aggressive or recurring tumors, or multiple lesions. Alternative management strategies such as stereotactic radiosurgery or less invasive surgical techniques are currently underway in clinical practice. A review on neurosurgical diagnosis and treatment modalities in the management of spinal meningioma is therefore pertinent.
脊髓脑膜瘤较为罕见,幸运的是仅累及少数患者。尽管其绝大多数呈良性倾向,但髓外脑膜瘤的发生仍可能导致严重的发病率甚至可能危及生命。因此,在对出现神经根病或慢性背痛或颈痛症状的患者进行鉴别诊断时,不应忽视脊髓脑膜瘤。快速诊断以及首次神经外科会诊是患者生存期和神经功能保留的基石。在过去二十年中,显微外科技术、磁共振成像及手术技术的出现显著改善了临床疗效。然而,手术候选资格可能受限,尤其是对于那些存在严重基础疾病、肿瘤侵袭性强或复发、或有多个病灶的患者。目前临床实践中正在探索如立体定向放射外科或侵入性较小的手术技术等替代治疗策略。因此,对脊髓脑膜瘤治疗中的神经外科诊断和治疗方式进行综述是很有必要的。