10例原发性脊柱血管母细胞瘤患者临床治疗及预后分析
|
摘要
目的回顾性分析原发性脊柱血管母细胞瘤病例资料,提出该疾病临床治疗思路。方法回顾性分析2006年12月至2015年2月上海长征医院骨肿瘤科原发性脊柱血管母细胞瘤患者的病例资料。所有患者至少进行过1次手术治疗,术后病理检查证实为脊柱血管母细胞瘤,术后均定期随访。结果 6例男性和4例女性患者被纳入研究,平均年龄50.4岁(13～71岁)。9例患者肿瘤位于活动性脊柱,1例患者肿瘤位于骶骨。所有患者均行后路手术切除,其中9例患者行次全脊椎切除术,1例患者行全脊椎切除术。3例髓内-髓外及髓外病变的患者行术前动脉栓塞术。患者术后Frankel评分较术前改善1级或至少保留在术前水平。患者随访时间为(55.8±22.2)个月(28～98个月)。研究结束时所有患者生存良好,无疾病复发迹象。结论原发性脊柱血管母细胞瘤患者预后良好。术者应考虑手术切除和重建方式,使患者获得更好的预后以及神经功能的恢复。对于原发性脊柱血管母细胞瘤患者,尤其是髓内-髓外及髓外病变者,建议在术前栓塞下行完全切除。
引文
[1]Isu T,Abe H,Iwasaki Y,et al.Diagnosis and surgical treatment of spinal hemangioblastoma[J].No Shinkei Geka,1991,19(2):149-155.
[2]Takai K,Taniguchi M,Takahashi H,et al.Comparative analysis of spinal hemangioblastomas in sporadic disease and von Hippel-Lindau syndrome[J].Neurol Med Chir(Totyo),2010,50(7):560-567.
[3]Varshney N,Kebede AA,Owusu-Dapaah H,et al.A review of von Hippel-Lindau syndrome[J].J Kidney Cancer VHL,2017,4(3):20-29.
[4]Bostr9m A,Hans FJ,Reinacher PC,et al.Intramedullary hemangioblastomas:timing of surgery,microsurgical technique and follow-up in 23patients[J].Eu Spine J,2008,17(6):882-886.
[5]Escott EJ,Kleinschmidt-Demasters BK,Brega K,et al.Proximal nerve root spinal hemangioblastomas:presentation of three cases,MR appearance,and literature review[J].Surg Neurol,2004,61(3):262-273.
[6]Das JM,Kesavapisharady K,Sadasivam S,et al.Microsurgical treatment of sporadic and von Hippel-Lindau Disease associated spinal hemangioblastomas:a single-institution experience[J].Asian Spine J,2017,11(4):548-555.
[7]Winestone JS,Lin J,Sanford RA,et al.Subepyndemal hemangioblastomas of the cervicomedullary junction:lessons learned in the management of two cases[J].Childs Nerv Syst,2007,23(7):761-764.
[8]Joaquim AF,Ghizoni E,dos Santos MJ,et al.Intramedullary hemangioblastomas:surgical results in 16patients[J].Neurosurg Focus,2015,39(2):E18.
[9]Malis,LI.Atraumatic bloodless removal of intramedullary hemangioblastomas of the spinal cord[J].J Neurosurg,2002,97(Suppl 1):S1-S6.
[10]Yasargil MG,de Preux JD.Microsurgical experiments in 12cases of intramedullary hemangioblastomas[J].Neurochirurgie,1975,21(6):425-434.
[11]Yuyama T.A clinical study on the diagnosis of spinal cord tumor using magnetic resonance imaging[J].Nihon Seikeigeka Gakkai Zasshi,1989,63(10):1212-1220.
[12]Lee DK,Choe WJ,Chung CK,et al.Spinal cord hemangioblastoma:surgical strategy and clinical outcome[J].J Neurooncol,2003,61(1):27-34.
[13]Kitanaka C,Kuwahara M,Teraoka A.Intradural,purely extramedullary hemangioblastoma of the spinal cord:case report[J].Neurol Med Chir(Totyo),1993,33(6):377-380.
[14]Taniguchi S,Ogikubo O,Nakamura T,et al.A rare case of extramedullary-intradural hemangioblastoma in the thoracic spine[J].Spine(Phila Pa 1976),2009,34(26):E969-E972.
[15]Toyoda H,Seki M,Nakamura H,et al.Intradural extramedullary hemangioblastoma differentiated by MRimages in the cervical spine:a case report and review of the literature[J].J Spinal Disord Tech,2004,17(4):343-347.
[16]Yasuda T,Hasegawa T,Yamato Y,et al.Relationship between spinal hemangioblastoma location and age[J].Asian Spine J,2016,10(2):309-313.
[17]Chung SY,Jeun SS,Park JH.Disseminated hemangioblastoma of the central nervous system without von Hippel-Lindau disease[J].Brain Tumor Res Treat,2014,2(2):96-101.
[18]Conway JE,Chou D,Clatterbuck RE,et al.Hemangioblastomas of the central nervous system in von Hippel-Lindau syndrome and sporadic disease[J].Neurosurgery,2001,48(1):55-62.
[19]Neumann HP,Eggert HR,Weigel K,et al.Hemangioblastomas of the central nervous system.A 10-year study with special reference to von Hippel-Lindau syndrome[J].J Neurosurg,1989,70(1):24-30.
[20]Roonprapunt C,Silvera VM,Setton A,et al.Surgical management of isolated hemangioblastomas of the spinal cord[J].Neurosurgery,2001,49(2):321-328.
[21]Li Z,Curtis B,Layser R,et al.Intraosseous hemangioblastoma of the cervical spine:case report[J].JNeurosurg Spine,2017,27(3):312-315.
[22]Meng XX,Zhang YQ,Liao HQ,et al.Dynamic contrast-enhanced MRI for the assessment of spinal tumor vascularity:correlation with angiography[J].Eur Spine J,2016,25(12):3952-3961.
[23]Orru’E,Sorte DE,Wolinsky JP,et al.Intraoperative spinal digital subtraction angiography:indications,technique,safety,and clinical impact[J].J Neurointerv Surg,2017,9(6):601-607.
[24]Willinsky RA,Taylor SM,TerBrugge K,et al.Neurologic complications of cerebral angiography:prospective analysis of2,899 procedures and review of the literature1[J].Radiology,2003,227(2):522-528.
[25]Liu X,Zhang Y,Hui X,et al.Surgical management of medulla oblongata hemangioblastomas in one institution:an analysis of 62cases[J].Int J Clin Exp Med,2015,8(4):5576-5590.
[26]Deng X,Wang K,Wu L,et al.Intraspinal hemangioblastomas:analysis of 92 cases in a single institution:clinical article[J].J Neurosurg Spine,2014,21(2):260-269.
[27]Cui H,Zou J,Bao Y,et al.Surgical treatment of solid hemangioblastomas of the posterior fossa:a report of 28cases[J].Oncol Lett,2017,13(3):1125-1130.
[28]Ozkan E,Gupta S.Embolization of spinal tumors:vascular anatomy,indications,and technique[J].Tech Vasc Interv Radiol,2011,14(3):129-140.
[29]Pikis S,Itshayek E,Barzilay Y,et al.Preoperative embolization of hypervascular spinal tumors:current practice and center experience[J].Neurol Res,2014,36(6):502-509.
[30]Mandigo CE,Ogden AT,Angevine PD,et al.Operative management of spinal hemangioblastoma[J].Neurosurgery,2009,65(6):1166-1177.
[2]Takai K,Taniguchi M,Takahashi H,et al.Comparative analysis of spinal hemangioblastomas in sporadic disease and von Hippel-Lindau syndrome[J].Neurol Med Chir(Totyo),2010,50(7):560-567.
[3]Varshney N,Kebede AA,Owusu-Dapaah H,et al.A review of von Hippel-Lindau syndrome[J].J Kidney Cancer VHL,2017,4(3):20-29.
[4]Bostr9m A,Hans FJ,Reinacher PC,et al.Intramedullary hemangioblastomas:timing of surgery,microsurgical technique and follow-up in 23patients[J].Eu Spine J,2008,17(6):882-886.
[5]Escott EJ,Kleinschmidt-Demasters BK,Brega K,et al.Proximal nerve root spinal hemangioblastomas:presentation of three cases,MR appearance,and literature review[J].Surg Neurol,2004,61(3):262-273.
[6]Das JM,Kesavapisharady K,Sadasivam S,et al.Microsurgical treatment of sporadic and von Hippel-Lindau Disease associated spinal hemangioblastomas:a single-institution experience[J].Asian Spine J,2017,11(4):548-555.
[7]Winestone JS,Lin J,Sanford RA,et al.Subepyndemal hemangioblastomas of the cervicomedullary junction:lessons learned in the management of two cases[J].Childs Nerv Syst,2007,23(7):761-764.
[8]Joaquim AF,Ghizoni E,dos Santos MJ,et al.Intramedullary hemangioblastomas:surgical results in 16patients[J].Neurosurg Focus,2015,39(2):E18.
[9]Malis,LI.Atraumatic bloodless removal of intramedullary hemangioblastomas of the spinal cord[J].J Neurosurg,2002,97(Suppl 1):S1-S6.
[10]Yasargil MG,de Preux JD.Microsurgical experiments in 12cases of intramedullary hemangioblastomas[J].Neurochirurgie,1975,21(6):425-434.
[11]Yuyama T.A clinical study on the diagnosis of spinal cord tumor using magnetic resonance imaging[J].Nihon Seikeigeka Gakkai Zasshi,1989,63(10):1212-1220.
[12]Lee DK,Choe WJ,Chung CK,et al.Spinal cord hemangioblastoma:surgical strategy and clinical outcome[J].J Neurooncol,2003,61(1):27-34.
[13]Kitanaka C,Kuwahara M,Teraoka A.Intradural,purely extramedullary hemangioblastoma of the spinal cord:case report[J].Neurol Med Chir(Totyo),1993,33(6):377-380.
[14]Taniguchi S,Ogikubo O,Nakamura T,et al.A rare case of extramedullary-intradural hemangioblastoma in the thoracic spine[J].Spine(Phila Pa 1976),2009,34(26):E969-E972.
[15]Toyoda H,Seki M,Nakamura H,et al.Intradural extramedullary hemangioblastoma differentiated by MRimages in the cervical spine:a case report and review of the literature[J].J Spinal Disord Tech,2004,17(4):343-347.
[16]Yasuda T,Hasegawa T,Yamato Y,et al.Relationship between spinal hemangioblastoma location and age[J].Asian Spine J,2016,10(2):309-313.
[17]Chung SY,Jeun SS,Park JH.Disseminated hemangioblastoma of the central nervous system without von Hippel-Lindau disease[J].Brain Tumor Res Treat,2014,2(2):96-101.
[18]Conway JE,Chou D,Clatterbuck RE,et al.Hemangioblastomas of the central nervous system in von Hippel-Lindau syndrome and sporadic disease[J].Neurosurgery,2001,48(1):55-62.
[19]Neumann HP,Eggert HR,Weigel K,et al.Hemangioblastomas of the central nervous system.A 10-year study with special reference to von Hippel-Lindau syndrome[J].J Neurosurg,1989,70(1):24-30.
[20]Roonprapunt C,Silvera VM,Setton A,et al.Surgical management of isolated hemangioblastomas of the spinal cord[J].Neurosurgery,2001,49(2):321-328.
[21]Li Z,Curtis B,Layser R,et al.Intraosseous hemangioblastoma of the cervical spine:case report[J].JNeurosurg Spine,2017,27(3):312-315.
[22]Meng XX,Zhang YQ,Liao HQ,et al.Dynamic contrast-enhanced MRI for the assessment of spinal tumor vascularity:correlation with angiography[J].Eur Spine J,2016,25(12):3952-3961.
[23]Orru’E,Sorte DE,Wolinsky JP,et al.Intraoperative spinal digital subtraction angiography:indications,technique,safety,and clinical impact[J].J Neurointerv Surg,2017,9(6):601-607.
[24]Willinsky RA,Taylor SM,TerBrugge K,et al.Neurologic complications of cerebral angiography:prospective analysis of2,899 procedures and review of the literature1[J].Radiology,2003,227(2):522-528.
[25]Liu X,Zhang Y,Hui X,et al.Surgical management of medulla oblongata hemangioblastomas in one institution:an analysis of 62cases[J].Int J Clin Exp Med,2015,8(4):5576-5590.
[26]Deng X,Wang K,Wu L,et al.Intraspinal hemangioblastomas:analysis of 92 cases in a single institution:clinical article[J].J Neurosurg Spine,2014,21(2):260-269.
[27]Cui H,Zou J,Bao Y,et al.Surgical treatment of solid hemangioblastomas of the posterior fossa:a report of 28cases[J].Oncol Lett,2017,13(3):1125-1130.
[28]Ozkan E,Gupta S.Embolization of spinal tumors:vascular anatomy,indications,and technique[J].Tech Vasc Interv Radiol,2011,14(3):129-140.
[29]Pikis S,Itshayek E,Barzilay Y,et al.Preoperative embolization of hypervascular spinal tumors:current practice and center experience[J].Neurol Res,2014,36(6):502-509.
[30]Mandigo CE,Ogden AT,Angevine PD,et al.Operative management of spinal hemangioblastoma[J].Neurosurgery,2009,65(6):1166-1177.