Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Polo Chirurgico "P. Confortini", P.le Stefani 1, 37126, Verona, Italy.
Unit of Neurosurgery, Department of Biomedicine, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy.
Neurosurg Rev. 2022 Apr;45(2):1645-1661. doi: 10.1007/s10143-021-01696-x. Epub 2021 Nov 25.
The prognostic factors for surgically removed spinal hemangioblastomas, the impact of VHL disease on outcome, and the role of intraoperative neuromonitoring are still not completely clear. The aim of this study was to review our experience with spinal hemangioblastomas in order to assess potential predictors of neurological outcome after surgery. All cases of spinal hemangioblastomas removed at two Italian academic institutions from 1985 to 2020 were reviewed. Data about clinical presentation and symptom duration, diagnosis of VHL, surgical approach, use of IONM, duration of hospital stay, follow-up, and modified McCormick grade before and after surgery were extracted. Sixty-one patients (31 F, 30 M) underwent 69 surgeries to remove 74 spinal hemangioblastomas (37 cervical, 32 thoracic, 5 lumbar). Improvement was found in 32.3% of cases, neurological condition remained stable in 51.6% of cases, and deteriorated in 16.1% of patients. A worsening trend in VHL patients and an improvement trend in non-VHL patients were detected, despite the lack of statistical significance. Laminotomy and use of IONM were found to be associated with better outcome, although no association was found between surgery without IONM and worse outcome. In most cases, patients affected by spinal hemangioblastomas can expect a good long-term outcome. In our experience, laminotomy seems to be associated with better outcome compared to laminectomy. While its absence is not associated with worse outcome, IONM seems to be associated with a better neurological outcome. Our study suggests that the more impaired the preoperative neurological condition, the worse the outcome.
手术切除的脊髓血管母细胞瘤的预后因素、VHL 疾病对结果的影响以及术中神经监测的作用尚不完全清楚。本研究旨在回顾我们在脊髓血管母细胞瘤方面的经验，以评估手术后神经功能结局的潜在预测因素。回顾了 1985 年至 2020 年在意大利两个学术机构切除的所有脊髓血管母细胞瘤病例。提取了与临床表现和症状持续时间、VHL 诊断、手术入路、IONM 使用、住院时间、随访以及手术前后改良 McCormick 分级相关的数据。61 例患者（31 例女性，30 例男性）接受了 69 次手术以切除 74 个脊髓血管母细胞瘤（37 个颈椎，32 个胸椎，5 个腰椎）。32.3%的病例发现改善，51.6%的病例神经状况保持稳定，16.1%的病例恶化。尽管没有统计学意义，但检测到 VHL 患者的恶化趋势和非 VHL 患者的改善趋势。发现椎板切开术和使用 IONM 与更好的结果相关，尽管没有发现无 IONM 手术与更差的结果之间的关联。在大多数情况下，患有脊髓血管母细胞瘤的患者可以期待良好的长期预后。根据我们的经验，与椎板切除术相比，椎板切开术似乎与更好的结果相关。虽然其缺失与更差的结果无关，但 IONM 似乎与更好的神经功能结果相关。我们的研究表明，术前神经功能障碍越严重，预后越差。
