Roux F X, Nataf F, Pinaudeau M, Borne G, Devaux B, Meder J F
Department of Neurosurgery, C.H. Sainte-Anne, Paris, France.
Surg Neurol. 1996 Nov;46(5):458-63; discussion 463-4. doi: 10.1016/s0090-3019(96)00199-1.
Intraspinal meningiomas account for 25%-46% of primary spinal cord tumors. Technical advances in magnetic resonance imaging (MRI) and surgical procedures (ultrasonic cavitation aspirators [CUSA], lasers) have brought about better clinical results. In spite of these new techniques, a small percentage of patients still present with poor postoperative results and/or a recurrence. The authors tried to determine which data could influence clinical outcome and what therapeutic modalities could limit recurrence rate.
We reviewed 54 patients who from 1963 to 1994, each had surgery for an intraspinal meningioma. There were 43 females and 11 males, aged 8 to 85 years old. Thirty-six (66.6%) patients were ambulatory on admission; only 2 presented with a paraplegia. Tumor location was cervical in 10 cases, thoracic in 43 cases, lumbar in 1 case. Forty-seven tumors were intradural, 5 epidural, 2 epidural and intradural. Thirty patients underwent a myelography, 10 a computed tomography (CT) scan, and 14 an MRI. Twenty-three spinal angiographies were performed before surgery. Complete removal was achieved in 50 patients (92.6%). Ultrasonic cavitation was used 10 times for debulking the tumor, and laser was used in 12 surgical procedures to perform hemostasis of the meningioma and to coagulate the dural attachment.
The majority of the neoplasms were meningothelial (N = 24) or psammomatous (N = 11). No mortality was noted. Morbidity concerned five patients: two pulmonary embolisms, one definitive paraplegia, one transient deficit, and one epidural suppuration, which necessitated a second operation. Mean follow-up was 28 months. Final functional results were very good in 85% and good in 13%; one patient (2%) worsened. Two recurrences were noted: one with clinical signs and the other with only CT-scan modifications. Both patients underwent complementary radiotherapy.
The authors discuss factors influencing functional results. Sex, pregnancy, pathologic diagnosis, and recurrence do not seem to have any influence. Calcification of the meningioma, as well as an anterior dural attachment, are pejorative factors. They insist on preoperative angiography and point out the advantage of using a CUSA and/or a laser to debulk and coagulate the tumor itself and its dural attachment. They propose radiation therapy as an adjuvant treatment or an alternative to reoperation, which could be hazardous for some patients when, for instance, a recurrence is located in a critical area or when the patient's general status is fragile.
脊髓内脑膜瘤占原发性脊髓肿瘤的25% - 46%。磁共振成像（MRI）和外科手术（超声空化吸引器[CUSA]、激光）技术的进步带来了更好的临床效果。尽管有这些新技术，但仍有一小部分患者术后效果不佳和/或复发。作者试图确定哪些数据会影响临床结果以及哪些治疗方式可以降低复发率。
我们回顾了1963年至1994年间接受脊髓内脑膜瘤手术的54例患者。其中女性43例，男性11例，年龄8至85岁。36例（66.6%）患者入院时可行走；仅2例出现截瘫。肿瘤位于颈椎10例，胸椎43例，腰椎1例。47例肿瘤位于硬膜内，5例位于硬膜外，2例硬膜外和硬膜内均有。30例患者进行了脊髓造影，10例进行了计算机断层扫描（CT），14例进行了MRI。术前进行了23次脊髓血管造影。50例患者（92.6%）实现了完全切除。超声空化用于10次肿瘤减容，12例手术中使用激光进行脑膜瘤止血和硬膜附着处凝固。
大多数肿瘤为脑膜内皮型（N = 24）或砂粒型（N = 11）。未观察到死亡病例。5例患者出现并发症：2例肺栓塞，1例永久性截瘫，1例短暂性神经功能缺损，1例硬膜外化脓，后者需要再次手术。平均随访28个月。最终功能结果85%非常好，13%良好；1例患者（2%）病情恶化。观察到2例复发：1例有临床症状，另1例仅CT扫描有改变。两名患者均接受了辅助放疗。
作者讨论了影响功能结果的因素。性别、妊娠、病理诊断和复发似乎没有任何影响。脑膜瘤钙化以及硬膜前部附着是不良因素。他们强调术前血管造影，并指出使用CUSA和/或激光进行肿瘤减容和凝固肿瘤本身及其硬膜附着处的优势。他们建议放疗作为辅助治疗或再次手术的替代方法，对于一些患者，再次手术可能有风险，例如复发位于关键区域或患者一般状况较差时。
