Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy.
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
World Neurosurg. 2022 May;161:190-197.e20. doi: 10.1016/j.wneu.2022.01.110. Epub 2022 Feb 3.
Primary spine paragangliomas are rare tumors. Surgical resection plays a role, but aggressive lesions are challenging. We reviewed the literature on primary spine paragangliomas.
PubMed, Scopus, Web of Science, and Cochrane were searched following the PRISMA guidelines to include studies on primary spine paragangliomas. Clinical-radiologic features, treatments, and outcomes were analyzed and compared between cauda equina versus non-cauda equina tumors.
We included 143 studies comprising 334 patients. Median age was 46 years (range, 6-85 years). The most frequent symptoms were lower back (64.1%) and radicular (53.9%) pain, and sympathetic in 18 patients (5.4%). Cauda equina paragangliomas (84.1%) had frequently lumbar (49.1%) or lumbosacral (29%) locations. Non-cauda equina tumors were mostly in the thoracic (11.4%), thoracolumbar (5.1%), and cervical (3.6%) spine. Median tumor diameter was 2.5 cm (range, 0.5-13.0 cm). Surgical resection (98.5%) was preferred over biopsy (1.5%). Decompressive laminectomy (53%) and spine fusion (6.9%) were also performed. Adjuvant radiotherapy was delivered in 39 patients (11.7%) with aggressive tumors. Posttreatment symptomatic improvement was described in 86.2% cases. Median follow-up was 19.5 months (range, 0.1-468.0 months), and 23 patients (3.9%) had tumor recurrences. No significant differences were found between cauda equina versus non-cauda equina tumors.
Surgical resection is effective and safe in treating primary spine paragangliomas; however, adjuvant treatments may be needed for aggressive lesions.
原发性脊柱副神经节瘤是一种罕见的肿瘤。手术切除可发挥一定作用，但侵袭性病变极具挑战性。我们对原发性脊柱副神经节瘤的文献进行了回顾。
我们按照 PRISMA 指南检索了 PubMed、Scopus、Web of Science 和 Cochrane，以纳入关于原发性脊柱副神经节瘤的研究。分析并比较了马尾神经与非马尾神经肿瘤的临床-影像学特征、治疗方法和结局。
我们纳入了 143 项研究，共计 334 例患者。中位年龄为 46 岁（范围 6-85 岁）。最常见的症状是下背部（64.1%）和神经根性（53.9%）疼痛，18 例（5.4%）有交感神经症状。马尾神经副神经节瘤（84.1%）常位于腰椎（49.1%）或腰骶部（29%）。非马尾神经肿瘤多位于胸椎（11.4%）、胸腰椎（5.1%）和颈椎（3.6%）。肿瘤直径中位数为 2.5cm（范围 0.5-13.0cm）。手术切除（98.5%）优于活检（1.5%）。减压性椎板切除术（53%）和脊柱融合术（6.9%）也被实施。对侵袭性肿瘤患者中 39 例（11.7%）进行了辅助放疗。86.2%的病例治疗后症状得到改善。中位随访时间为 19.5 个月（范围 0.1-468.0 个月），23 例（3.9%）患者肿瘤复发。马尾神经与非马尾神经肿瘤之间无显著差异。
手术切除治疗原发性脊柱副神经节瘤有效且安全；但对侵袭性病变可能需要辅助治疗。
