Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
Medical Faculty of Heidelberg, Heidelberg University Hospital, Heidelberg, Germany.
Acta Neurochir (Wien). 2024 Oct 3;166(1):393. doi: 10.1007/s00701-024-06290-w.
The treatment of spinal chordomas presents a significant challenge due to their resistance to both radiotherapy and chemotherapy as well as the complexity of the surgical procedures required. This study presents a series of cases of primary spinal chordomas, focusing on the development of a personalized therapeutic strategy that is tailored to each patient's unique clinical status. This approach aims to ensure that treatments are optimally aligned with the patient's overall prognosis and surgical eligibility.
This retrospective study analyzed 14 patients with primary spinal chordomas treated at our institution. We evaluated surgical strategies, clinical outcomes, and survival rates, The therapeutic strategy was formulated after interdisciplinary conferences with sarcoma management specialists. Data were collected on patient demographics, surgical details, postoperative outcomes, and follow-up status.
All patients presented with neurological deficits preoperatively, which generally improved post-surgery. The study included a detailed analysis of two distinct surgical approaches: five patients underwent en bloc resection with dorsal stabilization and nine received decompression only. Patients undergoing en bloc resection showed a reduced need for additional surgery due to the comprehensive removal of the tumor. As anticipated, 40% of the patients who underwent decompression experienced tumor progression within the first three months. However, given the poor overall prognosis, the objective of maintaining neurological function was achieved.
Surgical en bloc resection offers a viable and effective intervention for spinal chordomas, enhancing neurological function. It is imperative to tailor treatment strategies to individual prognoses, integrating insights from multidisciplinary discussions that meticulously evaluate surgical risks. This collaborative approach aids in selecting the most appropriate surgical technique tailored to each patient's specific condition.
由于对放疗和化疗均具有抗性，且手术过程复杂，脊髓脊索瘤的治疗极具挑战性。本研究报道了一系列原发性脊髓脊索瘤病例，重点在于制定个性化治疗策略，根据每位患者的独特临床状况进行调整。这种方法旨在确保治疗与患者的整体预后和手术适应证最佳匹配。
本回顾性研究分析了 14 例在我院治疗的原发性脊髓脊索瘤患者。我们评估了手术策略、临床结果和生存率。治疗策略是在与肉瘤管理专家进行多学科会议后制定的。收集了患者人口统计学、手术细节、术后结果和随访情况的数据。
所有患者术前均存在神经功能缺损，术后通常会改善。本研究详细分析了两种不同的手术方法：5 例患者行整块切除加背侧稳定术，9 例患者仅行减压术。行整块切除术的患者因肿瘤的全面切除，需要进一步手术的可能性降低。正如预期的那样，40%行减压术的患者在头 3 个月内肿瘤进展。然而，鉴于整体预后较差，维持神经功能的目标得以实现。
整块切除术为脊髓脊索瘤提供了一种可行且有效的干预方法，可增强神经功能。根据多学科讨论的结果，制定个体化的治疗策略至关重要，这些讨论需要仔细评估手术风险。这种协作方法有助于根据每位患者的具体情况选择最合适的手术技术。
