Du Zhiye, Tang Xiaodong, Cai Zhenyu, Wang Han, Wei Ran, Wang Jun
Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China.
Orthop Surg. 2024 Aug;16(8):1753-1760. doi: 10.1111/os.14104. Epub 2024 Jun 10.
It is always difficult to obtain a comfortable surgical margin for patients with recurrent malignant or invasive benign spinal tumors. Tumor intraspinal invasion and dural adhesion are the essential reasons. There are always residual tumor cells maintained at the edge of dura. Dural resection is a key point to obtain a comfortable surgical margin for such cases. Whether such patients benefit from this risky surgical procedure is unknown. This study aims to understand better the oncological results, associated risks, and neurological function of this risky surgical procedure.
We retrospectively reviewed clinical data from six consecutive patients who registered spinal tumors in our institute and underwent dural resection during en bloc spinal resection from June 2013 to May 2020. The demographic and perioperative data, oncological outcomes, complications, and neurological status were collected and analyzed.
All six patients were followed up for 24 to 46 months (mean follow-up time: 32.8 months). Local recurrence was detected in one patient (1/6, 16.7%) at 36 months postoperatively and in five patients with no evidence of disease at the last follow up (survival rate 83.3%). Eleven complications occurred in four patients (66.7%), and the dural resection-related complications included only four cases of cerebrospinal fluid leakage (CSFL), which accounted for 36.4% (4/11) of all complications. Neurologic status evaluated by the Frankel grade showed improvement of one grade in one case and deterioration of one to two grades in five patients immediately after surgery. All deterioration cases recovered to the preoperative level 6 months after the operation.
Dural resection is significant for patients with dura matter invaded by recurrent primary malignant or invasive benign spinal tumors with the purpose of clinical cure. This study demonstrated that in strictly selected cases, intentional dural resection could provide satisfying local control and long-term disease-free survival with acceptable complications and satisfying neurological function.
对于复发性恶性或侵袭性良性脊柱肿瘤患者，获得满意的手术切缘一直很困难。肿瘤的椎管内侵犯和硬脊膜粘连是其根本原因。硬脊膜边缘总会残留肿瘤细胞。硬脊膜切除是此类病例获得满意手术切缘的关键。此类患者是否能从此有风险的手术中获益尚不清楚。本研究旨在更好地了解这种有风险手术的肿瘤学结果、相关风险及神经功能。
我们回顾性分析了2013年6月至2020年5月期间在我院登记脊柱肿瘤并在整块脊柱切除术中接受硬脊膜切除的6例连续患者的临床资料。收集并分析了人口统计学和围手术期数据、肿瘤学结果、并发症及神经状态。
6例患者均获随访，随访时间24至46个月（平均随访时间：32.8个月）。1例患者（1/6，16.7%）术后36个月出现局部复发，5例患者末次随访时无疾病证据（生存率83.3%）。4例患者（66.7%）出现11例并发症，与硬脊膜切除相关的并发症仅4例脑脊液漏（CSFL），占所有并发症的36.4%（4/11）。术后根据Frankel分级评估神经状态，1例患者改善1级，5例患者恶化1至2级。所有恶化病例术后6个月恢复至术前水平。
对于硬脊膜受复发性原发性恶性或侵袭性良性脊柱肿瘤侵犯的患者，硬脊膜切除对于临床治愈具有重要意义。本研究表明，在严格选择的病例中，有意进行硬脊膜切除可提供满意的局部控制和长期无病生存，并发症可接受，神经功能良好。
