Muncan Emilia, Klurfan Paula, Rymond Michael, Jakola Asgeir S, Corell Alba
Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Heliyon. 2024 Jul 26;10(15):e35346. doi: 10.1016/j.heliyon.2024.e35346. eCollection 2024 Aug 15.
Schwannomas and meningiomas are intradural extramedullary spinal tumors which are regularly encountered in the neurosurgical clinic. These tumors cause neurological deficit by compression on the spinal cord and commonly pain when affecting the cauda equina. The traditional treatment with standard laminectomy (SL) can cause instability to the dorsal segments of the spinal column, and the less invasive option of hemilaminectomy (HL) has therefore been developed. We aim in this study to investigate transition from SL to HL in a population-based cohort.
Adult patients (18 years and older) undergoing primary surgery due to spinal meningioma or schwannoma between 2007 and 2022 at the neurosurgical clinic were included. Data related to clinical, surgical and outcome variables were retrospectively collected.
A total of 187 patients were identified: 155 in the SL group, 26 in the HL group and in 6 patients a combination of SL and HL. The mean age of the SL group was 62.7 years (SD14.2) compared to 58.0 (SD15.7) in the HL group (p = 0.16). Preoperative motor deficit was more common in SL group compared to HL group (76.8 % and 61.5 %, respectively, p = 0.14). Thoracal location was most common for both groups (SL 65.8 % and HL 61.5 %). Postoperative change in McCormick grades and early complications were similar between groups.
Outcome after hemilaminectomy due to intradural extramedullary schwannoma or meningioma is comparable to standard laminectomy with regards to postoperative complications and neurological improvement. Our findings support the transition to hemilaminectomy in selected cases.
施万细胞瘤和脑膜瘤是硬脊膜内髓外脊髓肿瘤，在神经外科临床中经常遇到。这些肿瘤通过压迫脊髓导致神经功能缺损，影响马尾神经时通常会引起疼痛。传统的标准椎板切除术（SL）会导致脊柱背段不稳定，因此开发了侵入性较小的半椎板切除术（HL）。我们在本研究中的目的是调查基于人群队列中从SL向HL的转变。
纳入2007年至2022年期间在神经外科诊所因脊髓脑膜瘤或施万细胞瘤接受初次手术的成年患者（18岁及以上）。回顾性收集与临床、手术和结果变量相关的数据。
共确定了187例患者：SL组155例，HL组26例，6例患者采用了SL和HL联合手术。SL组的平均年龄为62.7岁（标准差14.2），而HL组为58.0岁（标准差15.7）（p = 0.16）。与HL组相比，SL组术前运动功能缺损更常见（分别为76.8%和61.5%，p = 0.14）。两组中胸段位置最为常见（SL组为65.8%，HL组为61.5%）。两组之间麦考密克分级的术后变化和早期并发症相似。
对于硬脊膜内髓外施万细胞瘤或脑膜瘤，半椎板切除术后的结果在术后并发症和神经功能改善方面与标准椎板切除术相当。我们的研究结果支持在特定病例中向半椎板切除术的转变。
