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[儿童椎管内肿瘤的临床研究]

[Clinical study of intraspinal neoplasms in children].

作者信息

Takahashi I, Iwasaki Y, Hida K, Koyanagi I, Abe H

机构信息

Department of Neurosurgery, Hokkaito University School of Medicine.

出版信息

No Shinkei Geka. 1996 Jul;24(7):605-11.

PMID:8752872
Abstract

The authors report a series of 10 children under 15 years of age with primary intraspinal neoplasm who underwent surgical resection from 1981 to 1994. The tumors consisted of 4 intramedullary tumors (myxopapillary ependymoma, pilocytic astrocytoma, subpial liporna, cavernous angioma), 2 intradural extramedullary tumors (2 neurinomas), and 4 extradural tumors (ganglioneuroma, chordoma, osteochondroma, rhabdomyosarcoma). The initial symptoms in these patients were gait disturbance (50%), weakness of lower extremities (50%), pain (40%), weakness of upper extremities (10%), and tetraparesis (10%). The neurological findings on admission in these patients revealed motor paresis (90%), sensory disturbance (60%), abnormality of deep tendon reflex (60%), pathological reflex (30%), neurogenic bladder (30%), and Lasegue's sign (10%). All patients were treated surgically; laminectoy was performed in 8 patients, laminoplasty in one patient, and transoral approach in one patient. Five patients (50%) underwent a grossly total resection, 3 (30%) had a subtotal resection, and 2 (20%) had a partial resection. Mean follow-up period was 5.6 years. One (10%) patient died due to recurrence and dissemination of the tumor at eight months after surgery in a case of rhabdomyosarcoma. 9 (90%) have had no recurrent tumor and have improved neurologically. In 4 patients (40%) spinal deformity developed, and 2 patients required operative treatment for the spinal deformity. We emphasized the advantage of laminoplasty to prevent postoperative spinal deformity in children.

摘要

作者报告了1981年至1994年间接受手术切除的10例15岁以下原发性脊柱内肿瘤患儿。肿瘤包括4例髓内肿瘤(黏液乳头状室管膜瘤、毛细胞型星形细胞瘤、软膜下脂肪瘤、海绵状血管瘤)、2例硬脊膜内髓外肿瘤(2例神经鞘瘤)和4例硬脊膜外肿瘤(神经节神经瘤、脊索瘤、骨软骨瘤、横纹肌肉瘤)。这些患者的初始症状为步态障碍(50%)、下肢无力(50%)、疼痛(40%)、上肢无力(10%)和四肢瘫(10%)。这些患者入院时的神经学检查结果显示运动性轻瘫(90%)、感觉障碍(60%)、深腱反射异常(60%)、病理反射(30%)、神经源性膀胱(30%)和直腿抬高试验阳性(10%)。所有患者均接受了手术治疗;8例患者行椎板切除术,1例患者行椎板成形术,1例患者行经口入路手术。5例患者(50%)实现了大体全切,3例(30%)行次全切除,2例(20%)行部分切除。平均随访期为5.6年。1例(10%)横纹肌肉瘤患者术后8个月因肿瘤复发和播散死亡。9例(90%)无肿瘤复发且神经功能得到改善。4例患者(40%)出现脊柱畸形,2例患者因脊柱畸形需要手术治疗。我们强调了椎板成形术在预防儿童术后脊柱畸形方面的优势。

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