Konovalov N A, Golanov A V, Shevelev I N, Nazarenko A G, Asyutin D S, Korolishin V A, Тimonin S Yu, Zakirov B A, Onoprienko R A
Burdenko Neurosurgical Institute, Moscow, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2015;79(1):58-67. doi: 10.17116/neiro201579158-67.
Ependymoma is a rare tumor that accounts for about 4% of all central nervous system tumors. Ependymomas typically have intramedullary localization; however, sometimes the tumor is located outside of the spinal cord and affects the cauda equina nerve roots.
To study the outcomes of treatment in patients diagnosed with extramedullary ependymoma.
Fifty patients (23 males and 27 females) aged 38.7 years (range: 18-76 years) with ependymoma of the cauda equina region were operated on at the 10th Department of the N.N. Burdenko Neurosurgical Institute between January 2009 and December 2013. Thirty-six patients were newly diagnosed with tumors. Fourteen patients were admitted to the N.N. Burdenko Neurosurgical Institute with recurrent or continued tumor growth. The patients were subdivided into two groups according to this criterion. The outcomes of treatment were evaluated using the Frankel, the Karnofsky, and the VAS scales. The criteria proposed by Kawabata et al. were used to assess the long-term outcomes of surgical treatment. Tumor growth was monitored by contrast-enhanced MRI.
Tumors were divided into two subtypes: the encapsulated vs. infiltrative forms. Ependymomas were resected subtotally in 5 patients; continued growth of ependymoma was observed in 3 patients. Positive results were obtained for both groups according to the evaluation performed using the scales. According to the criteria of Kawabata et al., the patients were distributed in a following way: in group 1 patients, the good outcome (class 1) was observed in 26 (72%); the fair outcome (class 2), in 8 (22.5%) patients; while the results were equivocal in 2 (5.5%) patients. A number of patients received radiotherapy as a component of combination treatment. Tumor growth stabilization was achieved.
Microsurgical intervention is obligatory, since it has a positive effect on the outcomes of surgical treatment of extramedullary intradural tumors, including ependymomas of the cauda equina region. Treatment effectiveness decreases for the infiltrative subtype of tumor growth. Radiation therapy should be used if continued tumor growth is detected or degree of tumor resection was subtotal.
室管膜瘤是一种罕见肿瘤，约占所有中枢神经系统肿瘤的4%。室管膜瘤通常位于髓内；然而，有时肿瘤位于脊髓外并影响马尾神经根。
研究诊断为髓外室管膜瘤患者的治疗结果。
2009年1月至2013年12月期间，在N.N.布尔坚科神经外科研究所第十科室，对50例（23例男性和27例女性）年龄为38.7岁（范围：18 - 76岁）的马尾区室管膜瘤患者进行了手术。36例患者为新诊断肿瘤。14例患者因肿瘤复发或持续生长入住N.N.布尔坚科神经外科研究所。根据该标准将患者分为两组。使用Frankel、Karnofsky和VAS量表评估治疗结果。采用川端等人提出的标准评估手术治疗的长期结果。通过增强MRI监测肿瘤生长。
肿瘤分为两种亚型：包膜型与浸润型。5例患者室管膜瘤次全切除；3例患者观察到室管膜瘤持续生长。根据量表评估，两组均取得阳性结果。根据川端等人的标准，患者分布如下：在第1组患者中，26例（72%）观察到良好结果（1级）；8例（22.5%）患者观察到中等结果（2级）；2例（5.5%）患者结果不明确。一些患者接受放疗作为联合治疗的一部分。实现了肿瘤生长稳定。
显微手术干预是必要的，因为它对髓外硬膜内肿瘤（包括马尾区室管膜瘤）的手术治疗结果有积极影响。对于浸润型肿瘤生长亚型，治疗效果会降低。如果检测到肿瘤持续生长或肿瘤切除为次全切除，则应使用放射治疗。
