Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
World Neurosurg. 2023 Jun;174:197-204.e1. doi: 10.1016/j.wneu.2023.02.131. Epub 2023 Mar 4.
Nondysraphic intramedullary lipomas of the cervical spine are extremely rare, and only a few cases have been reported. We aimed to provide a thorough review of the literature regarding patient characteristics, treatment options, and outcomes in these patients. We also provided an illustrative case from our institution, which we added to the pool of patients identified by our review.
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature in PubMed/Medline, Web of Science, and Scopus databases was searched. Nineteen studies were included in the final quantitative analysis. The Joanna Briggs Institute critical appraisal tool was used to assess the risk of bias.
We identified 24 patients with nondysraphic cervical intradural intramedullary lipoma of the spinal cord. The patients were predominantly male (70.8%) with a mean age of 30.3 years. Quadriparesis was observed in 33.3% of the cases, while paraparesis occurred in 25% of the patients. Sensory disturbances were observed in 8.3% of the cases. In some patients, the presenting symptoms were neck pain (4.2%) and headache (4.2%). Surgical treatment was performed in 22 cases (91.7%). In 13 cases (54.2%) a subtotal removal was reached, and in 8 cases (33.3%) partial tumor removal was feasible. In 1 case (4.2%) a simple laminectomy was performed. Fourteen patients (58.3%) improved, 6 (25%) were unvaried, and 2 (8.3%) worsened. The mean follow-up was 30.8 months.
Overall, surgical treatment can provide substantial spinal cord decompression improving or stabilizing the neurologic deficits. Experience from our case, along with analysis of reports from the literature, suggests that careful and controlled resection may provide benefits and avoid serious complications otherwise that result from aggressive resection.
颈椎非典型脊髓内脂肪瘤极为罕见，仅有少数病例报道。我们旨在对这些患者的患者特征、治疗选择和结局进行全面的文献回顾。我们还提供了来自我们机构的一个案例，该案例加入了我们从文献回顾中确定的患者群体。
使用系统评价和荟萃分析的首选报告项目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，PRISMA）指南，对 PubMed/Medline、Web of Science 和 Scopus 数据库中的文献进行搜索。最终的定量分析纳入了 19 项研究。使用 Joanna Briggs 研究所的批判性评估工具评估偏倚风险。
我们共确定了 24 例颈椎非典型脊髓内硬脊膜内髓内脂肪瘤患者。患者以男性为主（70.8%），平均年龄为 30.3 岁。33.3%的病例表现为四肢瘫痪，25%的患者出现截瘫。8.3%的病例存在感觉障碍。一些患者的首发症状为颈痛（4.2%）和头痛（4.2%）。22 例（91.7%）患者接受了手术治疗。在 13 例（54.2%）中达到了次全切除，8 例（33.3%）可行部分肿瘤切除，1 例（4.2%）仅行单纯椎板切除术。14 例（58.3%）患者改善，6 例（25%）无变化，2 例（8.3%）恶化。平均随访时间为 30.8 个月。
总体而言，手术治疗可以提供显著的脊髓减压，改善或稳定神经功能缺损。结合我们的病例分析和文献报告，提示仔细和控制性切除可能带来益处，并避免因激进切除而导致的严重并发症。
