Strong Michael J, Yee Timothy J, Khalsa Siri Sahib S, Saadeh Yamaan S, North Robert, Oppenlander Mark E
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Oper Neurosurg (Hagerstown). 2021 Apr 15;20(5):E352. doi: 10.1093/ons/opab038.
Myxopapillary ependymomas are slow-growing tumors that are located almost exclusively in the region of the conus medullaris, cauda equina, and filum terminale of the spinal cord. Surgical intervention achieving a gross total resection is the main treatment modality. If, however, a gross total resection cannot be achieved, surgery is augmented with radiation therapy. In this video, we present the case of a 27-yr-old male with persistent back pain and radiculopathy who was found to have a myxopapillary ependymoma that was adherent to the conus. Preoperative imaging demonstrated that the tumor was displacing the conus and nerve roots ventrally. A laminoplasty at L1-L2 was performed with near-total resection because of the intimate involvement of neural tissue. The key features of the video include performing laminoplasty and rationale, and performing maximum safe tumor resection with a combination of bipolar cautery, suction, and ultrasonic aspiration augmented with frequent stimulation, gel foam pledgets intradurally, and achieving a watertight closure of the dura and fascia. The patient tolerated the surgery well without any complications. Given his gross residual disease along the conus and young age, he was at a high risk for continued tumor growth without adjuvant therapy, with a recurrence rate of roughly 33% to 45% in patients who underwent subtotal resection. With the addition of adjuvant radiation therapy, the recurrence rate is 20% to 29%.1,2 He was discharged to home with a plan for conventional fractionated external beam radiation. At the most recent follow-up, he reported decreased back pain and radiculopathy. Appropriate patient consent was obtained.
黏液乳头型室管膜瘤是生长缓慢的肿瘤，几乎只位于脊髓圆锥、马尾和终丝区域。实现全切除的手术干预是主要治疗方式。然而，如果无法实现全切除，则手术联合放射治疗。在本视频中，我们展示了一名27岁男性的病例，该患者持续背痛和神经根病，被发现患有一个与圆锥粘连的黏液乳头型室管膜瘤。术前影像学显示肿瘤将圆锥和神经根向前移位。由于神经组织紧密受累，在L1-L2行椎板成形术并近全切除肿瘤。该视频的关键特征包括进行椎板成形术及其原理，以及使用双极电凝、吸引和超声吸引联合频繁刺激、硬膜内明胶海绵小块进行最大程度安全的肿瘤切除，并实现硬膜和筋膜的水密缝合。患者手术耐受性良好，无任何并发症。鉴于其圆锥处有大量残留病灶且年龄较轻，若无辅助治疗，肿瘤持续生长的风险很高，接受次全切除的患者复发率约为33%至45%。加上辅助放射治疗后，复发率为20%至29%。1,2他出院回家，并制定了常规分割外照射放疗计划。在最近的随访中，他报告背痛和神经根病有所减轻。已获得患者的适当知情同意。
