Division of Neurosurgery, Department of General Surgery, National University Hospital, National University Health Systems, Singapore.
Division of Neurosurgery, Department of General Surgery, National University Hospital, National University Health Systems, Singapore.
World Neurosurg. 2018 Jan;109:e229-e232. doi: 10.1016/j.wneu.2017.09.143. Epub 2017 Sep 30.
Intradural spinal tumors are rare and can be classified into extramedullary or intramedullary. They commonly present with symptoms such as intractable back pain or neurologic deficits. We retrospectively reviewed 91 cases of intradural spinal tumors that underwent surgery in our institution from 2011 to 2016 and assessed their clinical outcomes. The majority of intradural tumors were extramedullary (89%), and the most common pathology was schwannoma (38.5%) followed by meningioma (29.7%). Comparing extramedullary versus intramedullary tumors, both groups experienced similar improvement in neurologic status post surgery (92.6% vs. 90%, P = 0.77). We achieved gross total resection in the majority of patients with both extramedullary and intramedullary tumors (65.4% vs. 70%, P = 0.91). Patients younger than 65 years (odds ratio [OR] 4.40, confidence interval [CI] 0.72-26.9, P = 0.11) and those who had complete resection of tumor (OR 2.92, CI 0.61-14.0, P = 0.18) were associated with higher odds of improved clinical outcomes, but the results were not statistically significant. The use of intraoperative neurophysiologic monitoring was not associated with improved neurologic outcomes compared with cases where it was not used (OR 0.56, CI 0.10-3.05, P = 0.50).
椎管内脊髓肿瘤较为罕见,可分为髓外或髓内肿瘤。它们常表现为顽固性背痛或神经功能缺损等症状。我们回顾性分析了 2011 年至 2016 年在我院接受手术治疗的 91 例椎管内脊髓肿瘤患者的临床资料,并评估了他们的临床转归。大多数椎管内肿瘤为髓外肿瘤(89%),最常见的病理类型为神经鞘瘤(38.5%),其次为脑膜瘤(29.7%)。髓外肿瘤组与髓内肿瘤组术后神经功能状态均有相似程度的改善(92.6% vs. 90%,P=0.77)。大多数髓外和髓内肿瘤患者均达到大体全切除(65.4% vs. 70%,P=0.91)。年龄<65 岁的患者(优势比 [OR] 4.40,置信区间 [CI] 0.72-26.9,P=0.11)和肿瘤全切的患者(OR 2.92,CI 0.61-14.0,P=0.18)术后获得更好临床转归的可能性更高,但结果无统计学意义。与未使用术中神经生理监测的病例相比,使用术中神经生理监测并不能改善神经功能预后(OR 0.56,CI 0.10-3.05,P=0.50)。