Hernández-Durán Silvia, Hanft Simon, Komotar Ricardo J, Manzano Glen R
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Department of Neuroanatomy, University of Costa Rica School of Medicine, San José, Costa Rica.
Neurosurg Rev. 2016 Apr;39(2):175-83; discussion 183. doi: 10.1007/s10143-015-0654-y. Epub 2015 Jul 30.
Advances in imaging technology and microsurgical techniques have made microsurgical resection the treatment of choice in cases of symptomatic intramedullary tumors. The use of stereotactic radiosurgery (SRS) for spinal tumors is a recent development, and its application to intramedullary lesions is debated. We conducted a literature search through PubMed's MeSH system, compiling information regarding intramedullary neoplasms treated by SRS. We compiled histology, tumor location and size, treatment modality, radiation dose, fractionation, radiation-induced complications, follow-up, and survival. Ten papers reporting on 52 patients with 70 tumors were identified. Metastatic lesions accounted for 33%, while 67% were primary ones. Tumor location was predominantly cervical (53%), followed by thoracic (33%). Mean volume was 0.55 cm(3) (95% confidence interval (CI), 0.26-0.83). Preferred treatment modality was CyberKnife® (87%), followed by Novalis® (7%) and linear particle accelerator (LINAC) (6%). Mean radiation dose was 22.14 Gy (95% CI, 20.75-23.53), with mean fractionation of 4 (95% CI, 3-5). Three hemangioblastomas showed cyst enlargement. Symptom improvement or stabilization was seen in all but two cases. Radionecrotic spots adjacent to treated areas were seen at autopsy in four lesions, without clinical manifestations. Overall, clinical and radiological outcomes were favorable. Although surgery remains the treatment of choice for symptomatic intramedullary lesions, SRS can be a safe and effective option in selected cases. While this review suggests the overall safety and efficacy of SRS in the management of intramedullary tumors, future studies need randomized, homogeneous patient populations followed over a longer period to provide more robust evidence in its favor.
成像技术和显微外科技术的进步使显微外科切除术成为有症状的髓内肿瘤的首选治疗方法。立体定向放射外科（SRS）用于脊柱肿瘤是最近的发展，其在髓内病变中的应用存在争议。我们通过PubMed的医学主题词（MeSH）系统进行文献检索，汇编有关经SRS治疗的髓内肿瘤的信息。我们汇编了组织学、肿瘤位置和大小、治疗方式、辐射剂量、分割、辐射引起的并发症、随访和生存率。确定了10篇报告，涉及52例患者的70个肿瘤。转移性病变占33%，而原发性病变占67%。肿瘤位置主要在颈部（53%），其次是胸部（33%）。平均体积为0.55 cm³（95%置信区间（CI），0.26 - 0.83）。首选治疗方式是射波刀（CyberKnife®）（87%），其次是诺力刀（Novalis®）（7%）和直线加速器（LINAC）（6%）。平均辐射剂量为22.14 Gy（95% CI，20.75 - 23.53），平均分割次数为4次（95% CI，3 - 5）。3例血管母细胞瘤出现囊肿增大。除2例病例外，其余所有病例均有症状改善或稳定。在4个病变的尸检中发现治疗区域附近有放射性坏死灶，但无临床表现。总体而言，临床和放射学结果良好。虽然手术仍然是有症状的髓内病变的首选治疗方法，但在某些选定病例中，SRS可以是一种安全有效的选择。虽然本综述表明SRS在髓内肿瘤管理中的总体安全性和有效性，但未来的研究需要随机、同质的患者群体，并进行更长时间的随访，以提供更有力的支持证据。
