Krüger Marie T, Steiert Christine, Gläsker Sven, Klingler Jan-Helge
1Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
2Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada; and.
J Neurosurg Spine. 2019 Aug 9;31(6):880-889. doi: 10.3171/2019.5.SPINE1975. Print 2019 Dec 1.
Hemangioblastomas are benign, highly vascularized tumors that can occur sporadically or as part of von Hippel-Lindau (VHL) disease. Traditionally, spinal hemangioblastomas have been surgically treated via an open approach. In recent years, however, minimally invasive techniques using tubular retractors have been increasingly applied in spine surgery. Such procedures involve less tissue trauma but are also particularly demanding for the surgeon, especially in cases of highly vascular tumors such as hemangioblastomas. The object of this study was to evaluate the safety and efficacy of minimally invasive resection of selected spinal hemangioblastomas.
The authors conducted a retrospective single-center study of all patients who, between January 2010 and January 2018, had been operated on for spinal hemangioblastoma via a minimally invasive approach performed at the surgeon's discretion. The surgical technique is described and the pre- and postoperative neurological and imaging results were analyzed descriptively. The primary outcome was the postoperative compared to preoperative neurological condition (McCormick grade). The secondary outcomes were the extent of tumor resection and postoperative complications.
Eighteen patients, 12 female and 6 male, harboring a total of 19 spinal hemangioblastomas underwent surgery in the study period. Seventeen patients had stable neurological findings with stable or improved McCormick grades (94.5%) at a mean of 4.3 months after surgery. One (5.5%) of the 18 patients developed progressive neurological symptoms with a worsened McCormick grade that did not improve in the long-term follow-up. Sixteen of the 18 patients had VHL disease, whereas 2 patients had sporadic spinal hemangioblastomas. In all patients, postoperative MRI showed complete resection of the tumors. No other surgery-related perioperative or postoperative complications were recorded.
A minimally invasive approach for the resection of selected spinal hemangioblastomas is safe and allows complete tumor resection with good clinical results in experienced hands.
血管母细胞瘤是一种良性、血管高度丰富的肿瘤，可散发出现或作为冯·希佩尔-林道（VHL）病的一部分。传统上，脊髓血管母细胞瘤通过开放手术进行治疗。然而，近年来，使用管状牵开器的微创技术在脊柱手术中得到了越来越多的应用。此类手术对组织的创伤较小，但对外科医生的要求也特别高，尤其是在处理像血管母细胞瘤这样的高血管肿瘤时。本研究的目的是评估选择性脊髓血管母细胞瘤微创切除的安全性和有效性。
作者对2010年1月至2018年1月期间所有经外科医生酌情采用微创方法进行脊髓血管母细胞瘤手术的患者进行了一项回顾性单中心研究。描述了手术技术，并对术前和术后的神经学及影像学结果进行了描述性分析。主要结局是术后与术前神经学状况（麦考密克分级）的比较。次要结局是肿瘤切除范围和术后并发症。
在研究期间，18例患者（12例女性和6例男性）共患有19个脊髓血管母细胞瘤接受了手术。17例患者在术后平均4.3个月时神经学检查结果稳定，麦考密克分级稳定或改善（94.5%）。18例患者中有1例（5.5%）出现进行性神经症状，麦考密克分级恶化，在长期随访中未改善。18例患者中有16例患有VHL病，而2例患者患有散发性脊髓血管母细胞瘤。所有患者术后MRI显示肿瘤完全切除。未记录其他与手术相关的围手术期或术后并发症。
对于选择性脊髓血管母细胞瘤的切除，微创方法是安全的，在经验丰富的医生手中能够实现肿瘤的完全切除并取得良好的临床效果。
