Duan Yu, Mao Renling, Qin Xuanfeng, Liao Yujun, Li Jian, Chen Gong
Department of Neurosurgery, Huadong Hospital, Fudan University, Shanghai, China.
Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
Front Med (Lausanne). 2022 Apr 25;9:872824. doi: 10.3389/fmed.2022.872824. eCollection 2022.
Surgery is the mainstay treatment for patients with symptomatic intramedullary spinal cavernous hemangioma (ISCH), however the time of surgical intervention remains controversial. In this study, we proposed emergency rescue surgery (ERS) for patients in deteriorative type. The prognostic factors of patients with ISCH after microsurgery and the clinical effect of ERS were analyzed.
From January 2013 to November 2019, 52 patients with symptomatic ISCH treated by microsurgical treatment were collected, ranging in age from 17 to 66 years old (mean: 45.8 ± 13.5 years). The course of the disease ranged from 2 days to 20 years. Of 52 lesions, 17 lesions were in the cervical segment, 25 in the thoracic segment, and 10 in the lumbosacral segment; while seven cases were at the ventral surface, 25 cases at the dorsal surface, and 20 cases at the central spinal cord. The sagittal diameter ranged from 1 to 58 mm (median: 17.3 mm). The transverse diameter ratio ranged from 20 to 80% (median: 50.7%). Thirty-two patients were diagnosed as deteriorative type and 22 were treated by ERS.
At 12 months after surgery, all patients were followed up, and no residual or recurrence was found in all patients. Twenty-five patients (48.1%) showed spinal cord functional improvement after surgery; 25 (48.1%) had no functional change; 2 (3.8%) got worse. For deteriorative patients, ERS group had a significantly higher improvement rate than the non-ERS group (χ = 5.393, = 0.02); For all 52 patients, the factors as a lesion at the ventral surface (Z = 10.453, = 0.015), or lumbosacral segment (χ = 9.259, = 0.010) and longer course of disease (Z = -2.021, = 0.043) were potential risks in functional recovery in univariate analysis; and in multiple-factor analysis, the lesion at the lumbosacral segment (OR = 4.004, 95% CI: 1.341~11.961, = 0.013) was the independent risk factors for the functional recovery.
Microsurgical resection is safe and effective for symptomatic ISCH. The ERS is an effective way to improve deteriorative patients' spinal cord function at long-term follow-up. The lesion at the lumbosacral segment is one of the poor prognostic factors.
手术是有症状的脊髓海绵状血管瘤（ISCH）患者的主要治疗方法，然而手术干预的时机仍存在争议。在本研究中，我们提出对病情恶化型患者进行急诊抢救手术（ERS）。分析了ISCH患者显微手术后的预后因素及ERS的临床效果。
收集2013年1月至2019年11月接受显微手术治疗的52例有症状的ISCH患者，年龄17至66岁（平均：45.8±13.5岁）。病程2天至20年。52个病灶中，颈段17个，胸段25个，腰骶段10个；腹侧7例，背侧25例，脊髓中央20例。矢状径1至58mm（中位数：17.3mm）。横径比20%至80%（中位数：50.7%）。32例患者被诊断为病情恶化型，22例接受ERS治疗。
术后12个月对所有患者进行随访，所有患者均未发现残留或复发。25例（48.1%）患者术后脊髓功能改善；25例（48.1%）功能无变化；2例（3.8%）恶化。对于病情恶化的患者，ERS组的改善率显著高于非ERS组（χ = 5.393， = 0.02）；对于所有52例患者，单因素分析中腹侧病灶（Z = 10.453， = 0.015）、腰骶段病灶（χ = 9.259， = 0.010）及病程较长（Z = -2.021， = 0.043）是功能恢复的潜在风险因素；多因素分析中，腰骶段病灶（OR = 4.004，95%CI：1.341~11.961， = 0.013）是功能恢复的独立风险因素。
显微手术切除对有症状的ISCH安全有效。ERS是长期随访中改善病情恶化患者脊髓功能 的有效方法。腰骶段病灶是预后不良因素之一。
