Zhang Dongao, Fan Tao, Fan Wayne, Zhao Xingang, Liang Cong, Wang Yinqian, Wu Kun
Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
Faculty of Science, University of British Columbia, Vancouver, BC, Canada.
Neurospine. 2023 Mar;20(1):231-239. doi: 10.14245/ns.2244648.324. Epub 2023 Mar 31.
Long-level intramedullary spinal cord tumors (LIMSCTs) cause complex treatment issues. However, LIMSCTs have rarely been analyzed separately. The authors reported a large case series of LIMSCTs and analyzed the clinical characteristics and treatment outcomes.
The medical data of patients with LIMSCTs at our institution between January 2015 and December 2019 were retrospectively reviewed. Demographics, tumor size and location, pathology, extent of resection, and neurological functional status were collected.
A total of 43 consecutive cases were included. Twenty-three cases (53.5%) of LIMSCTs were ependymal tumors. All patients with ependymal tumors achieved gross total resection (GTR). In ependymal tumor cases, 3 cases (13%) of ependymal tumors experienced postoperative neurological deterioration, and 66% of them showed an improvement at follow-up; 25.6% were low-grade astrocytic tumors. The rates of GTR, subtotal resection (STR) and partial resection (PR) were 63.6%, 27.3%, and 9.1%, respectively. Twenty-seven percent cases showed postoperative neurological worsening, and 33% of them had an improvement at follow-up; 20.9% were high-grade astrocytic tumors. The excision rates were 44.4% for GTR, 44.4% for STR, and 11% for PR, respectively. Fifty-five percent cases showed postoperative neurological worsening, and none of them had an improvement at follow-up.
In this series, all LIMSCTs were gliomas. Aggressive tumor resection did not increase the risk of long-term functional deterioration in ependymal tumors and low-grade astrocytic tumors, but in high-grade astrocytic tumors, patients had a higher risk of neurological deterioration and difficulty in recovery. In ependymal tumors and low-grade astrocytic tumors, patients can achieve long-time survival after performing aggressive tumor resection.
长节段脊髓髓内肿瘤（LIMSCTs）引发复杂的治疗问题。然而，LIMSCTs很少被单独分析。作者报告了一大例LIMSCTs病例系列，并分析了其临床特征和治疗结果。
回顾性分析2015年1月至2019年12月在本机构接受治疗的LIMSCTs患者的医疗数据。收集人口统计学信息、肿瘤大小和位置、病理、切除范围以及神经功能状态。
共纳入43例连续病例。23例（53.5%）LIMSCTs为室管膜瘤。所有室管膜瘤患者均实现了全切除（GTR）。在室管膜瘤病例中，3例（13%）室管膜瘤患者术后出现神经功能恶化，其中66%在随访时有所改善；25.6%为低级别星形细胞瘤。GTR、次全切除（STR）和部分切除（PR）的比例分别为63.6%、27.3%和9.1%。27%的病例术后神经功能恶化，其中33%在随访时有所改善；20.9%为高级别星形细胞瘤。GTR、STR和PR的切除率分别为44.4%、44.4%和11%。55%的病例术后神经功能恶化，且无一例在随访时有所改善。
在本系列中，所有LIMSCTs均为胶质瘤。积极的肿瘤切除并未增加室管膜瘤和低级别星形细胞瘤长期功能恶化的风险，但在高级别星形细胞瘤中，患者神经功能恶化风险更高且恢复困难。在室管膜瘤和低级别星形细胞瘤中，患者进行积极的肿瘤切除后可实现长期生存。
