Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, Beijing, China.
Spine (Phila Pa 1976). 2018 Sep 1;43(17):E1024-E1032. doi: 10.1097/BRS.0000000000002607.
A retrospective review of prospectively collected data.
To confirm the feasibility of using anterior to dorsal root entry zone myelotomy (ADREZotomy), a new surgical approach, for the treatment of ventrolateral deep intramedullary spinal cord cavernous malformation (ISCCMs).
Surgical removal of ventrolateral deep ISCCMs is highly risky and remains problematic.
The authors performed a retrospective study exploring the surgical removal of ventrolateral intrinsic ISCCMs using ADREZotomy in 10 patients. The Frankel grading system was used to evaluate the patients' neurological function at the preoperative, postoperative and follow-up stages. American Spinal Injury Association Scale scores at the preoperative and postoperative were also obtained. The patient characteristics and surgical outcomes were analyzed. The indication, operative steps, complications, and anatomical basis of the myelotomies were described and discussed.
In total, nine (90%) patients presented with mild symptoms before surgery. Gross total resections were performed in all 10 patients. Immediately after surgery, the neurological function of eight (80.0%) patients remained the same. One patient improved and one (10%) patient worsened. There were no other immediate or delayed complications related to the surgical procedure. No decrease of total American Spinal Injury Association sensory scores was observed. The follow-up neurological function evaluation showed that two (20%) patients improved from a Frankel grade of D to E and eight (80.0%) patients were stable. No recurrences or other additional neurological deterioration was observed.
Surgical removal of ventrolateral deep ISCCMs can be feasible using proper surgical techniques. ADREZotomy is a minimally invasive technique for the removal of cervical and thoracic ventrolateral deep ISCCMs, without disrupting the important spinal cord tracts or the need to broadly expose bone.
前瞻性数据回顾性分析。
确认使用前到背根进入区脊髓切开术（ADREZotomy）治疗腹外侧深部脊髓海绵状畸形（ISCCMs）的可行性，这是一种新的手术方法。
腹外侧深部 ISCCMs 的手术切除风险很高，仍然存在问题。
作者对 10 例采用 ADREZotomy 切除腹外侧固有 ISCCMs 的患者进行了回顾性研究。采用 Frankel 分级系统评估患者术前、术后和随访阶段的神经功能。还获得了术前和术后美国脊髓损伤协会量表评分。分析了患者的特征和手术结果。描述和讨论了切开术的适应证、手术步骤、并发症和解剖学基础。
共有 9 例（90%）患者术前症状较轻。10 例患者均行大体全切除。术后即刻，8 例（80.0%）患者的神经功能保持不变。1 例患者改善，1 例（10%）患者恶化。无与手术相关的其他即刻或迟发性并发症。总感觉美国脊髓损伤协会评分无下降。随访时的神经功能评估显示，2 例（20%）患者从 Frankel 分级 D 级改善至 E 级，8 例（80.0%）患者稳定。未观察到复发或其他额外的神经恶化。
使用适当的手术技术，腹外侧深部 ISCCMs 的手术切除是可行的。ADREZotomy 是一种微创技术，用于切除颈胸段腹外侧深部 ISCCMs，不会破坏重要的脊髓束，也不需要广泛暴露骨骼。
4 级。
