Yuh Woon Tak, Chung Chun Kee, Park Sung-Hye, Kim Ki-Jeong, Lee Sun-Ho, Kim Kyoung-Tae
Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
J Korean Neurosurg Soc. 2018 Mar;61(2):233-242. doi: 10.3340/jkns.2017.0405.001. Epub 2018 Feb 28.
A spinal cord subependymoma is an uncommon, indolent, benign spinal cord tumor. It is radiologically similar to a spinal cord ependymoma, but surgical findings and outcomes differ. Gross total resection of the tumor is not always feasible. The present study was done to determine the clinical, radiological and pathological characteristics of spinal cord subependymomas.
We retrospectively reviewed the medical records of ten spinal cord subependymoma patients (M : F=4 : 6; median 38 years; range, 21-77) from four institutions.
The most common symptoms were sensory changes and/or pain in eight patients, followed by motor weakness in six. The median duration of symptoms was 9.5 months. Preoperative radiological diagnosis was ependymoma in seven and astrocytoma in three. The tumors were located eccentrically in six and were not enhanced in six. Gross total resection of the tumor was achieved in five patients, whereas subtotal or partial resection was inevitable in the other five patients due to a poor dissection plane. Adjuvant radiotherapy was performed in two patients. Neurological deterioration occurred in two patients; transient weakness in one after subtotal resection and permanent weakness after gross total resection in the other. Recurrence or regrowth of the tumor was not observed during the median 31.5 months follow-up period (range, 8-89).
Spinal cord subependymoma should be considered when the tumor is located eccentrically and is not dissected easily from the spinal cord. Considering the rather indolent nature of spinal cord subependymomas, subtotal removal without the risk of neurological deficit is another option.
脊髓室管膜下瘤是一种罕见、生长缓慢的良性脊髓肿瘤。其影像学表现与脊髓室管膜瘤相似，但手术所见及结果有所不同。肿瘤全切并不总是可行的。本研究旨在确定脊髓室管膜下瘤的临床、影像学及病理特征。
我们回顾性分析了来自四个机构的10例脊髓室管膜下瘤患者的病历（男∶女 = 4∶6；中位年龄38岁；范围21 - 77岁）。
最常见的症状是8例患者出现感觉改变和/或疼痛，其次是6例患者出现运动无力。症状的中位持续时间为9.5个月。术前影像学诊断为室管膜瘤7例，星形细胞瘤3例。6例肿瘤位于脊髓偏心位置，6例无强化。5例患者实现了肿瘤全切，而另外5例患者由于分离平面不佳，不得不进行次全或部分切除。2例患者接受了辅助放疗。2例患者出现神经功能恶化；1例次全切除后出现短暂性无力，另1例全切后出现永久性无力。在中位31.5个月的随访期（范围8 - 89个月）内未观察到肿瘤复发或再生长。
当肿瘤位于脊髓偏心位置且不易从脊髓分离时，应考虑脊髓室管膜下瘤。鉴于脊髓室管膜下瘤生长相对缓慢的特性，在不伴有神经功能缺损风险的情况下进行次全切除是另一种选择。
