Imagama Shiro, Ito Zenya, Ando Kei, Kobayashi Kazuyoshi, Hida Tetsuro, Ito Kenyu, Tsushima Mikito, Ishikawa Yoshimoto, Matsumoto Akiyuki, Morozumi Masayoshi, Tanaka Satoshi, Machino Masaaki, Ota Kyotaro, Nakashima Hiroaki, Wakao Norimitsu, Sakai Yoshihito, Matsuyama Yukihiro, Ishiguro Naoki
Department of Orthopaedic Surgery, Nagoya University, Nagoya, Aichi, Japan.
Department of Orthopaedic Surgery, Aichi Medical University, Aichigun, Aichi-ken, Japan.
Global Spine J. 2017 May;7(3):246-253. doi: 10.1177/2192568217707938. Epub 2017 Jun 16.
Prospective study.
Investigate factors associated with preoperative motor paresis, recovery, ambulatory status, and intraoperative neurophysiological monitoring (IONM) among patients with no preoperative paresis (N group), complete preoperative motor recovery (CR group), and no complete recovery (NCR group) in patients with intramedullary spinal cavernous hemangioma to determine the optimal timing of surgery.
The study evaluated 41 surgical cases in our institute. Disease duration, tumor lesion, manual muscle testing (MMT), and gait at onset, just before surgery, and final follow-up (FU), tumor and lesion volume, IONM, extent of tumor resection, and tumor recurrence were evaluated among N, CR, and NCR groups.
Motor paresis at onset was found in 26 patients (63%), with 42% of those in CR group. Disease duration from onset negatively affected stable gait just before surgery and FU as well as lower preoperative MMT ( < .05). Thoracic tumors were associated with patients with unstable gait before surgery ( < .05). Tumor volume was larger in NCR group ( < .05). IONM significantly decreased in NCR and CR groups than in N group ( < .05). The NCR group had residual mild motor paresis at FU ( < .05). Stable gait at FU was similar in N group and CR group, though lower in NCR group ( < .05).
Early surgery is generally recommended for thoracic tumors and large tumors during stable gait without motor paresis before long disease duration. Surgery may be postponed until patients recover from preoperative motor paresis to allow optimal surgical outcome. IONM should be carefully monitored in patients with a history of preoperative paresis even with preoperative complete motor recovery.
前瞻性研究。
调查髓内脊髓海绵状血管瘤患者中，术前无运动性轻瘫患者（N组）、术前运动功能完全恢复患者（CR组）和术前未完全恢复患者（NCR组）的术前运动性轻瘫、恢复情况、步行状态及术中神经电生理监测（IONM）相关因素，以确定最佳手术时机。
本研究评估了我院41例手术病例。在N组、CR组和NCR组中，评估疾病持续时间、肿瘤病变、徒手肌力测试（MMT）以及发病时、术前及末次随访（FU）时的步态、肿瘤及病变体积、IONM、肿瘤切除范围和肿瘤复发情况。
26例患者（63%）发病时存在运动性轻瘫，CR组中这一比例为42%。发病后的疾病持续时间对术前及FU时的稳定步态以及术前较低的MMT有负面影响（P<0.05）。胸段肿瘤与术前步态不稳的患者相关（P<0.05）。NCR组的肿瘤体积更大（P<0.05）。NCR组和CR组的IONM明显低于N组（P<0.05）。NCR组在FU时仍有残留轻度运动性轻瘫（P<0.05）。N组和CR组FU时的稳定步态相似，但NCR组较低（P<0.05）。
对于胸段肿瘤和病程较长且步态稳定、无运动性轻瘫的大肿瘤，一般建议早期手术。手术可推迟至患者从术前运动性轻瘫中恢复，以获得最佳手术效果。即使术前运动功能完全恢复，有术前轻瘫病史的患者也应仔细监测IONM。
