Hohenberger Christoph, Gugg Christine, Schmidt Nils Ole, Zeman Florian, Schebesch Karl-Michael
Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany.
Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany.
J Clin Neurosci. 2020 Jul;77:62-66. doi: 10.1016/j.jocn.2020.05.042. Epub 2020 May 12.
Space-occupying spinal meningiomas (SM), commonly diagnosed due to gradual neurological deterioration, are treated surgically by decompression and tumor resection. In this series of patients with surgically treated SM, we determined individual predictors of functional outcome in the context of intraoperative neuromonitoring (IOM).
This retrospective study included 45 patients (39 women, 6 men; mean age 63 years). We reviewed pre- and postoperative charts, surgical reports, radiographic data for demographics, use of IOM, duration of symptoms, histopathology, co-morbidities, radiographic extension, surgical strategy, neurological performance (Japanese Orthopedic Association Score [JOA score]. Median follow-up was 34 months (12-190 months).
Most frequent surgical approaches were laminectomy (71.1%, n = 32) and hemi-laminectomy (28.9%, n = 13). Predominant SM site was the thoracic spine (55.6%, n = 25). Most common symptoms were sensory deficits (77.8%, n = 35), gait disorders (55.6%, n = 25), motor deficits (42.2%, n = 19), and radiating pain (37.8%, n = 17). Simpson grade 1 resection was achieved in 6 patients, most common type of resection was Simpson grade 2 in 36 patients. During follow-up, 80.0% of patients had fully recovered sensory deficits (p < 0.001), 76.0% of patients with preoperative gait disorders had been asymptomatic (p < 0.001), and motor deficits in 12/19 (63.1%). Pain had decreased significantly from admission to follow-up (p = 0.001). IOM was used in 20 (44.4%) patients. Postoperatively, 6(13.3%) patients had developed a new neurological deficit, 4 of them operated without IOM.
Resection of SM with IOM showed good recovery, excellent functional results with low surgical morbidity.
占据空间的脊髓脑膜瘤（SM）通常因神经功能逐渐恶化而被诊断出来，通过减压和肿瘤切除进行手术治疗。在这组接受手术治疗的SM患者中，我们在术中神经监测（IOM）的背景下确定了功能结果的个体预测因素。
这项回顾性研究纳入了45例患者（39名女性，6名男性；平均年龄63岁）。我们查阅了术前和术后病历、手术报告、关于人口统计学的影像学数据、IOM的使用情况、症状持续时间、组织病理学、合并症、影像学扩展、手术策略、神经功能表现（日本骨科协会评分[JOA评分]）。中位随访时间为34个月（12 - 190个月）。
最常用的手术入路是椎板切除术（71.1%，n = 32）和半椎板切除术（28.9%，n = 13）。SM的主要部位是胸椎（55.6%，n = 25）。最常见的症状是感觉障碍（77.8%，n = 35）、步态障碍（55.6%，n = 25）、运动障碍（42.2%，n = 19）和放射性疼痛（37.8%，n = 17）。6例患者实现了辛普森1级切除，最常见的切除类型是36例患者的辛普森2级切除。在随访期间，80.0%的患者感觉障碍完全恢复（p < 0.001），76.0%术前有步态障碍的患者无症状（p < 0.001），19例中有12例（63.1%）运动障碍恢复。从入院到随访疼痛明显减轻（p = 0.001）。20例（44.4%）患者使用了IOM。术后，6例（13.3%）患者出现了新的神经功能缺损，其中4例在未使用IOM的情况下进行了手术。
使用IOM切除SM显示出良好的恢复情况，功能结果优异，手术发病率低。
