多节段颈髓室管膜瘤的治疗策略：病例说明
Treatment strategy for multisegmental cervicomedullary ependymoma: illustrative case.
作者信息
Zrelov Andrei A, Tastanbekov Malik M, Alexandrov Mikhail V, Nechaeva Anastasiia S, Toporkova Olga A, Vorobeva Olga M, Samochernykh Konstantin A
机构信息
Departments of Fourth Neurosurgery.
Clinical Neurophysiology, and.
出版信息
J Neurosurg Case Lessons. 2021 Dec 20;2(25):CASE21608. doi: 10.3171/CASE21608.
BACKGROUND
Сervicomedullary ependymoma (CME) is a rare tumor of the central nervous system. The CME treatment strategy is insufficiently represented in the literature and is a complex task for neurosurgeons.
OBSERVATIONS
The authors describe an infrequent case of a large multisegmental CME that extended from the medulla oblongata to the cervical spinal cord at the level of the sixth cervical vertebra in a 21-year-old female. Neurological disorders presented with headache, dysphagia, hypophonia, and weakness in the limbs. Subtotal removal of the tumor was performed according to intraoperative neurophysiological monitoring (IONM) results. A wait-and-see approach with patient follow-up was chosen.
LESSONS
Total tumor removal of the CME is the most important favorable prognostic factor. Subtotal resection can be considered if the borders of the tumor are unclear and the result of IONM is unfavorable. The role of postoperative radiation therapy in the case of subtotal removal of the tumor remains controversial.
背景
延髓脊髓室管膜瘤（CME）是一种罕见的中枢神经系统肿瘤。CME的治疗策略在文献中报道不足，对神经外科医生来说是一项复杂的任务。
观察结果
作者描述了一例罕见的大型多节段CME病例，该病例发生在一名21岁女性身上，肿瘤从延髓延伸至第六颈椎水平的颈脊髓。神经功能障碍表现为头痛、吞咽困难、声音嘶哑和肢体无力。根据术中神经生理监测（IONM）结果进行了肿瘤次全切除。选择了观察等待并对患者进行随访的方法。
经验教训
CME肿瘤全切除是最重要的有利预后因素。如果肿瘤边界不清且IONM结果不佳，可以考虑次全切除。肿瘤次全切除术后放射治疗的作用仍存在争议。
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