Bakhshi Saqib K, Waqas Muhammad, Shakaib Baila, Enam Syed A
Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
Surg Neurol Int. 2016 Sep 1;7(Suppl 23):S617-22. doi: 10.4103/2152-7806.189733. eCollection 2016.
Intraoperative neurophysiology, high magnification microscopes, and ultrasonic aspirators are considered essential aid for the safe resection of intramedullary spinal cord tumors (IMSCTs). Most centers in developing countries such as Pakistan still lack these facilities. The purpose of this study was to review the management of IMSCTs at our hospital and to determine factors associated with the outcomes of surgery.
This was a retrospective review of medical records of adult patients undergoing surgery for IMSCT over 12 years. The institutional ethical review committee approved this study. Data were collected regarding demographics, clinical and radiological features, and surgical details. Modified McCormick Scale was used to grade patients' neurological status at admission, discharge, and follow-up. Statistical analysis was performed using the Statistical Package for Social Sciences version 22.
Forty three cases were reviewed. Mean age was 33.8 ± 15.1 years whereas median follow-up was 5 months (range: 0.25-96 months). Most patients had ependymoma (n = 16; 73%). Cervical region was the most commonly involved (n = 15; 34.9%). Gross total resection (GTR) was achieved in 30 cases (69.8%). The preoperative McCormick grade was significantly associated with follow-up McCormick grade (P value = 0.002). Eight patients (18.6%) underwent intraoperative electrophysiological monitoring, out of which GTR was achieved in all cases, and none had disease progression or recurrence. Ten patients received postoperative radiotherapy. Thirty five patients (81.4%) had progression free survival at last follow-up.
We achieved a GTR rate of 68.9% for IMSCTs with limited resources. In few cases, where intraoperative electrophysiology was used, the rate of GTR was 100%. Preoperative neurological status was associated with better postoperative McCormick score.
术中神经生理学、高倍显微镜和超声吸引器被认为是安全切除髓内脊髓肿瘤（IMSCTs）必不可少的辅助手段。在巴基斯坦等发展中国家的大多数中心仍然缺乏这些设施。本研究的目的是回顾我院对IMSCTs的治疗情况，并确定与手术结果相关的因素。
这是一项对12年间接受IMSCTs手术的成年患者病历的回顾性研究。该研究获得了机构伦理审查委员会的批准。收集了有关人口统计学、临床和放射学特征以及手术细节的数据。采用改良的麦考密克量表对患者入院时、出院时和随访时的神经状态进行分级。使用社会科学统计软件包第22版进行统计分析。
共回顾了43例病例。平均年龄为33.8±15.1岁，中位随访时间为5个月（范围：0.25 - 96个月）。大多数患者患有室管膜瘤（n = 16；73%）。颈部是最常受累的部位（n = 15；34.9%）。30例（69.8%）实现了全切除（GTR）。术前麦考密克分级与随访时的麦考密克分级显著相关（P值 = 0.002）。8例患者（18.6%）接受了术中电生理监测，其中所有病例均实现了GTR，且无一例出现疾病进展或复发。10例患者接受了术后放疗。35例患者（81.4%）在最后一次随访时无进展生存。
我们在资源有限的情况下，IMSCTs的GTR率达到了68.9%。在少数使用术中电生理的病例中，GTR率为100%。术前神经状态与术后更好的麦考密克评分相关。
