Department of Neurological Surgery, University of California Los Angeles, CA 90095-1761, USA.
Neurosurg Focus. 2011 Oct;31(4):E13. doi: 10.3171/2011.7.FOCUS11158.
Spinal cord ependymomas are rare neoplasms, comprising approximately 5% of all CNS tumors and 15% of all spinal cord tumors. Although surgery was once reserved for diagnosis alone, the evolution of surgical practices has elevated resection to the treatment of choice for these lesions. While technological advances continue to improve the capacity for gross-total resections and thus decrease the risk of recurrence, ependymoma spinal surgery still contains a variety of potential complications. The presence of neurological deficits and deterioration are not uncommonly associated with spinal cord ependymoma surgery, including sensory loss, dorsal column dysfunction, dysesthetic syndrome, and bowel and bladder dysfunction, particularly in the immediate postoperative period. Surgical treatment may also lead to wound complications and CSF leaks, with increased risk when radiotherapy has been involved. Radiation therapy may also predispose patients to radiation myelopathy and ultimately result in neurological damage. Additionally, resections of spinal ependymomas have been associated with postoperative spinal instability and deformities, particularly in the pediatric population. Despite the advances in microsurgical techniques and intraoperative cord monitoring modalities, there remain a number of serious complications related to the treatment of spinal ependymoma tumors. Identification and acknowledgment of these potential problems may assist in their prevention, early detection, and increased quality of life for patients afflicted with this disease.
脊髓室管膜瘤是一种罕见的肿瘤，约占所有中枢神经系统肿瘤的 5%，占所有脊髓肿瘤的 15%。尽管手术曾经仅用于诊断，但手术实践的发展已将切除术提升为这些病变的首选治疗方法。虽然技术进步不断提高全切除的能力，从而降低复发的风险，但脊髓室管膜瘤手术仍然存在多种潜在的并发症。神经功能缺损和恶化的存在与脊髓室管膜瘤手术并不罕见，包括感觉丧失、后柱功能障碍、感觉异常综合征以及肠和膀胱功能障碍，尤其是在术后即刻期。手术治疗也可能导致伤口并发症和 CSF 漏，当涉及放射治疗时风险增加。放射治疗也可能使患者易患放射性脊髓病，最终导致神经损伤。此外，脊髓室管膜瘤的切除与术后脊髓不稳定和畸形有关，尤其是在儿科人群中。尽管显微外科技术和术中脊髓监测模式取得了进展，但与治疗脊髓室管膜瘤仍存在许多严重的并发症。识别和承认这些潜在问题可能有助于预防、早期发现，并提高患有这种疾病的患者的生活质量。
