Hersh Andrew M, Patel Jaimin, Pennington Zach, Porras Jose L, Goldsborough Earl, Antar Albert, Elsamadicy Aladine A, Lubelski Daniel, Wolinsky Jean-Paul, Jallo George, Gokaslan Ziya L, Lo Sheng-Fu Larry, Sciubba Daniel M
1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
J Neurosurg Spine. 2022 Feb 25;37(2):252-262. doi: 10.3171/2022.1.SPINE211235. Print 2022 Aug 1.
Intramedullary spinal cord tumors (IMSCTs) are rare neoplasms whose treatment is often technically challenging. Given the low volume seen at most centers, perioperative outcomes have been reported infrequently. Here, the authors present the largest single-institution series of IMSCTs, focusing on the clinical presentation, histological makeup, perioperative outcomes, and long-term survival of surgically treated patients.
A cohort of patients operated on for primary IMSCTs at a comprehensive cancer center between June 2002 and May 2020 was retrospectively identified. Data on patient demographics, tumor histology, neuraxial location, baseline neurological status, functional deficits, and operative characteristics were collected. Perioperative outcomes of interest included length of stay, postoperative complications, readmission, reoperation, and discharge disposition. Data were compared across tumor histologies using the Kruskal-Wallis H test, chi-square test, and Fisher exact test. Pairwise comparisons were conducted using Tukey's honest significant difference test, chi-square test, and Fisher exact test. Long-term survival was assessed across tumor categories and histological subtype using the log-rank test.
Three hundred two patients were included in the study (mean age 34.9 ± 19 years, 77% white, 57% male). The most common tumors were ependymomas (47%), astrocytomas (31%), and hemangioblastomas (11%). Ependymomas and hemangioblastomas disproportionately localized to the cervical cord (54% and 59%, respectively), whereas astrocytomas were distributed almost equally between the cervical cord (36%) and thoracic cord (38%). Clinical presentation, extent of functional dependence, and postoperative 30-day outcomes were largely independent of underlying tumor pathology, although tumors of the thoracic cord had worse American Spinal Injury Association (ASIA) grades than cervical tumors. Rates of gross-total resection were lower for astrocytomas than for ependymomas (54% vs 84%, p < 0.01) and hemangioblastomas (54% vs 100%, p < 0.01). Additionally, 30-day readmission rates were significantly higher for astrocytomas than ependymomas (14% vs 6%, p = 0.02). Overall survival was significantly affected by the underlying pathology, with astrocytomas having poorer associated prognoses (40% at 15 years) than ependymomas (81%) and hemangioblastomas (66%; p < 0.01) and patients with high-grade ependymomas and astrocytomas having poorer long-term survival than those with low-grade lesions (p < 0.01).
The neuraxial location of IMSCTs, extent of resection, and postoperative survival differed significantly across tumor pathologies. However, perioperative outcomes did not vary significantly across tumor cohorts, suggesting that operative details, rather than pathology, may have a stronger influence on the short-term clinical course, whereas pathology appears to have a stronger impact on long-term survival.
脊髓髓内肿瘤（IMSCTs）是罕见肿瘤，其治疗在技术上通常具有挑战性。鉴于大多数中心所见病例数量较少，围手术期结果的报道并不多见。在此，作者呈现了最大的单机构脊髓髓内肿瘤系列研究，重点关注手术治疗患者的临床表现、组织学构成、围手术期结果及长期生存情况。
回顾性确定2002年6月至2020年5月期间在一家综合癌症中心接受原发性脊髓髓内肿瘤手术的一组患者。收集患者人口统计学数据、肿瘤组织学、神经轴位置、基线神经状态、功能缺陷及手术特征等信息。感兴趣的围手术期结果包括住院时间、术后并发症、再次入院、再次手术及出院处置情况。使用Kruskal-Wallis H检验、卡方检验和Fisher精确检验对不同肿瘤组织学的数据进行比较。采用Tukey真实显著差异检验、卡方检验和Fisher精确检验进行两两比较。使用对数秩检验评估不同肿瘤类别和组织学亚型的长期生存情况。
302例患者纳入本研究（平均年龄34.9±19岁，77%为白人，57%为男性）。最常见的肿瘤为室管膜瘤（47%）、星形细胞瘤（31%）和血管母细胞瘤（11%）。室管膜瘤和血管母细胞瘤不成比例地集中于颈髓（分别为54%和59%），而星形细胞瘤在颈髓（36%）和胸髓（38%）之间分布几乎相等。临床表现、功能依赖程度及术后30天结果在很大程度上与潜在肿瘤病理无关，尽管胸段脊髓肿瘤的美国脊髓损伤协会（ASIA）分级比颈段肿瘤差。星形细胞瘤的全切除率低于室管膜瘤（54%对84%，p<0.01）和血管母细胞瘤（54%对100%，p<0.01）。此外，星形细胞瘤的30天再次入院率显著高于室管膜瘤（14%对6%，p=0.02）。总体生存受潜在病理显著影响，星形细胞瘤的相关预后较差（15年时为40%），低于室管膜瘤（81%）和血管母细胞瘤（66%；p<0.01），高级别室管膜瘤和星形细胞瘤患者的长期生存比低级别病变患者差（p<0.01）。
脊髓髓内肿瘤的神经轴位置、切除范围及术后生存情况在不同肿瘤病理类型间存在显著差异。然而，围手术期结果在不同肿瘤队列中差异不显著，这表明手术细节而非病理可能对短期临床过程影响更大，而病理似乎对长期生存影响更大。
