Abdullah Kalil G, Lubelski Daniel, Miller Jacob, Steinmetz Michael P, Shin John H, Krishnaney Ajit, Mroz Thomas E, Benzel Edward C
Department of Neurosurgery, Hospital of the University of Pennsylvania, Third Floor Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Department of Neurological Surgery, Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA.
J Clin Neurosci. 2015 Dec;22(12):1933-7. doi: 10.1016/j.jocn.2015.06.017. Epub 2015 Jul 30.
We present a 15 year institutional analysis of the factors affecting progression free survival (PFS) and overall survival (OS) in patients undergoing attempted resection of adult intramedullary spinal cord ependymomas. Intramedullary spinal cord tumors are rare but important clinical entities, and ependymomas are the most commonly encountered intramedullary tumor. In total, 53 adult patients over the span of 15 years were analyzed for OS, PFS, and the effects of plane of dissection (POD) and gross total resection (GTR) on functional and long term outcomes. The mean age was 45 years and median follow-up was 54 months. The follow-up neurological outcome and modified McCormick scale were used to determine the functional outcome. Kaplan-Meier curves were used to calculate progression and survival. The overall ability to achieve GTR was significantly correlated to identification of an intraoperative POD (p<0.001). There was a trend towards increased PFS with the ability to achieve a GTR. There was no significant difference in the pre- and postoperative functional outcome scores. The ability to achieve a GTR is strongly correlated to the identification of a POD in ependymomas. There is a trend towards an increased probability of PFS in intramedullary spinal cord tumors when GTR is achieved. The resection of these tumors is likely to halt, but not reverse, neurological deterioration.
我们对成年髓内脊髓室管膜瘤患者行手术切除术后影响无进展生存期（PFS）和总生存期（OS）的因素进行了一项为期15年的机构分析。髓内脊髓肿瘤虽罕见但为重要的临床实体，室管膜瘤是最常见的髓内肿瘤。总共对15年间的53例成年患者进行了OS、PFS分析，以及对解剖平面（POD）和全切除（GTR）对功能和长期预后的影响进行了分析。平均年龄为45岁，中位随访时间为54个月。采用随访神经学结果和改良的麦考密克量表来确定功能结果。采用Kaplan-Meier曲线计算进展和生存期。实现GTR的总体能力与术中POD的识别显著相关（p<0.001）。实现GTR的能力有使PFS增加的趋势。术前和术后功能结果评分无显著差异。在室管膜瘤中，实现GTR的能力与POD的识别密切相关。当实现GTR时，髓内脊髓肿瘤的PFS概率有增加的趋势。这些肿瘤的切除可能会阻止但不能逆转神经功能恶化。
