Neurosurgical Department, University Clinic Munich, Klinikum Grosshadern, 81377 Munich, Germany.
Acta Neurochir (Wien). 2010 Apr;152(4):611-8. doi: 10.1007/s00701-009-0577-x. Epub 2010 Feb 1.
The optimal time point for surgery of intramedullary spinal astrocytomas and ependymomas is often debated on, as predicting factors are poorly defined. The current single-institutional study was conducted to retrospectively analyze prognostic factors for postoperative functional outcome in these patients.
All consecutive adult patients with intramedullary astrocytomas or ependymomas (except filum terminale ependymomas) were included. Imaging data, McCormick score (MCS), and detailed neurological evaluation were stringently applied preoperatively, 1 week, and 6 months postoperatively for functional evaluation of all patients. End points were early and late functional outcome. Prognostic factors were obtained from univariate and multivariate logistic regression analysis.
Forty-four patients were included (29 ependymomas World Health Organization (WHO) grades I or II, 8 astrocytomas WHO grade I, and 7 astrocytomas WHO grade II). Overall perioperative morbidity was 34%, and there was no mortality. Complete tumor resection was achieved in 79% of ependymomas, 50% of astrocytomas WHO grade I, and 14% of astrocytomas WHO grade II (significantly more often in ependymomas than in astrocytomas, p < 0.05). Early and late functional outcome were highly intercorrelated (p < 0.01), but not correlated to histology. Preoperative MCS <3 and extent of tumor <5 levels were significantly (p = 0.01 and p < 0.05) associated with a favorable outcome (MCS <3) in early and late follow-up.
An MCS of less than 3 and a tumor extent of less than 5 levels are the most important factors for a favorable postoperative functional outcome. Therefore, surgery should be initiated before significant clinical symptomatology or substantial tumor growth occurs.
对于脊髓内星形细胞瘤和室管膜瘤的手术最佳时机，目前仍存在争议，因为预测因素尚未明确。本单中心回顾性研究旨在分析影响此类患者术后功能预后的相关因素。
本研究纳入所有连续的脊髓内星形细胞瘤或室管膜瘤（终丝室管膜瘤除外）成年患者。所有患者均严格进行术前、术后 1 周和 6 个月的影像学资料、McCormick 分级（MCS）和详细的神经功能评估，以进行术后功能评估。终点为早期和晚期功能预后。预后因素采用单因素和多因素逻辑回归分析。
共纳入 44 例患者（29 例为 World Health Organization（WHO）分级 I 或 II 级室管膜瘤，8 例为 WHO 分级 I 级星形细胞瘤，7 例为 WHO 分级 II 级星形细胞瘤）。围手术期总并发症发生率为 34%，无死亡病例。79%的室管膜瘤、50%的 WHO 分级 I 级星形细胞瘤和 14%的 WHO 分级 II 级星形细胞瘤实现了肿瘤全切除（室管膜瘤明显多于星形细胞瘤，p < 0.05）。早期和晚期功能预后高度相关（p < 0.01），但与组织学无关。术前 MCS <3 分和肿瘤范围 <5 个节段与早期和晚期随访时的良好结局（MCS <3 分）显著相关（p = 0.01 和 p < 0.05）。
MCS 评分 <3 分和肿瘤范围 <5 个节段是术后功能预后良好的最重要因素。因此，应在出现明显临床症状或肿瘤明显生长之前进行手术。
