230例椎管内肿瘤的诊断及手术治疗经验
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摘要
[目的]总结椎管内肿瘤的临床诊断及手术治疗的经验。[方法]回顾性分析本院2010年1月～2016年12月脊柱外科及神经外科,收治并采取手术治疗的230例椎管内肿瘤患者的临床资料。采取ASIA神经功能分级评估神经功能情况。[结果]依据术中所见,硬膜外肿瘤占13.04%,全切除率93.33%;髓外硬膜下肿瘤占72.61%,全切除率95.21%;髓内肿瘤占14.35%,全切除率63.64%。术后出现并发症如脑脊液漏26例(11.30%),头痛7例(3.04%),发热7例(3.04%),术区包块2例(0.87%),切口愈合不良8例(3.48%),颅内感染及窦道形成2例(0.87%)。围手术期死亡2例,无1例与手术直接相关。其中,212例术后随访3～60个月,平均(22.17±12.09)个月, 212例患者术后末次随访时ASIA神经功能评估较术前明显改善,差异有统计学意义(P<0.001);91.51%(194/212)患者症状有不同程度的好转,且术后无一例发生脊柱变形。术后肿瘤复发共5例,其中良性肿瘤3例(1.40%)和恶性肿瘤2例(13.33%),恶性肿瘤复发率高于良性肿瘤,差异有统计学意义(P<0.01)。[结论]椎管内肿瘤多为良性肿瘤,MRI对术前诊断及手术方案的制定帮助很大,术后总体效果满意。
[Objective] To summarize the experience of clinical diagnosis and surgical treatment for intraspinal tumors.[Methods]A retrospective study was conducted on 230 patients who were diagnosed of intraspinal tumors and surgically treated in our hospital from January 2010 to December 2016.The neurological function were evaluated by using ASIA neurological grading.[Results]Based on intraoperative findings,epidural tumors accounted for 13.04% with total resection rates of 93.33%,while extramedullary subdural tumors accounted for 72.61% with total resection rates of 95.21%,and intramedullary tumors accounted for 14.35% with total resection rates of 63.64%.After operation,cerebrospinal fluid leakage occurred in 26 patients(11.30%),headache in 7 patients(3.04%),fever in 7 patients(3.04%),operation area mass in 2 patients(0.87%),poor incision healing in 8 patients(3.48%),and intracranial infection and sinus formation in 2 cases(0.87%).Two patients died during the perioperative period,one of them was not directly related to the surgery.Of the 230 patients,212 patients were followed up for 3-60 months with an average of(22.17±12.09) months.The neurological function graded by ASIA at the latest follow-up significantly improved compared with that before operation in these 212 patients(Z=-12.858,P<0.001).The symptoms in 91.51%patients(194/212) improved to some extent without spine deformities.A total of 5 patients had tumor recurrence,including 3 cases of benign tumors(1.40%) and 2 cases of malignant tumors(13.33%),and the former took significantly lower recurrence rate than the latter(P<0.05).[Conclusion]Most of the tumors in the spinal canal are benign tumors.MRI is helpful for preoperative diagnosis and surgical planning.The overall surgical outcomes for these tumors are satisfactory.
[Objective] To summarize the experience of clinical diagnosis and surgical treatment for intraspinal tumors.[Methods]A retrospective study was conducted on 230 patients who were diagnosed of intraspinal tumors and surgically treated in our hospital from January 2010 to December 2016.The neurological function were evaluated by using ASIA neurological grading.[Results]Based on intraoperative findings,epidural tumors accounted for 13.04% with total resection rates of 93.33%,while extramedullary subdural tumors accounted for 72.61% with total resection rates of 95.21%,and intramedullary tumors accounted for 14.35% with total resection rates of 63.64%.After operation,cerebrospinal fluid leakage occurred in 26 patients(11.30%),headache in 7 patients(3.04%),fever in 7 patients(3.04%),operation area mass in 2 patients(0.87%),poor incision healing in 8 patients(3.48%),and intracranial infection and sinus formation in 2 cases(0.87%).Two patients died during the perioperative period,one of them was not directly related to the surgery.Of the 230 patients,212 patients were followed up for 3-60 months with an average of(22.17±12.09) months.The neurological function graded by ASIA at the latest follow-up significantly improved compared with that before operation in these 212 patients(Z=-12.858,P<0.001).The symptoms in 91.51%patients(194/212) improved to some extent without spine deformities.A total of 5 patients had tumor recurrence,including 3 cases of benign tumors(1.40%) and 2 cases of malignant tumors(13.33%),and the former took significantly lower recurrence rate than the latter(P<0.05).[Conclusion]Most of the tumors in the spinal canal are benign tumors.MRI is helpful for preoperative diagnosis and surgical planning.The overall surgical outcomes for these tumors are satisfactory.
引文
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[10]McGirt MJ,Garces-Ambrossi GL,Parker SL,et al.Short-term progressive spinal deformity following laminoplasty versus laminectomy for resection of intradural spinal tumors:analysis of 238 patients[J].Neurosurgery,2010,66(5):1005-1012.
[11]Rho YJ,Rhim SC,Kang JK.Is intraoperative neurophysiological monitoring valuable predicting postoperative neurological recovery[J].Spinal Cord,2016,54(12):1121-1126.
[2]Iacopino DG,Giugno A,Guli C,et al.Surgical nuances on the treatment of giant dumbbell cervical spine schwannomas:description of a challenging case and review of the literature[J].Spinal Cord Ser Cases,2016,2:15042.
[3]Korn A,Halevi D,Lidar Z,et al.Intraoperative neurophysiological monitoring during resection of intradural extramedullary spinal cord tumors:experience with 100 cases[J].Acta Neurochir(Wien),2015,157(5):819-830.
[4]Hirano K,Imagama S,Sato K,et al.Primary spinal cord tumors:review of 678 surgically treated patients in Japan.A multicenter study[J].Eur Spine J,2012,21(10):2019-2026.
[5]Turel MK,D'Souza WP,Rajshekhar V.Hemilaminectomy approach for intradural extramedullary spinal tumors:an analysis of164 patients[J].Neurosurg Focus,2015,39(2):9.
[6]Westwick HJ,Shamji MF.Effects of sex on the incidence and prognosis of spinal meningiomas:a surveillance,epidemiology,and end results study[J].J Neurosurg Spine,2015,23(3):368-373.
[7]Xiao R,Miller JA,Abdullah KG,et al.Quality of life outcomes following resection of adult intramedullary spinal cord tumors[J].Neurosurgery,2016,78(6):821-828.
[8]Viereck M J,Ghobrial G M,Beygi S,et al.Improved patient quality of life following intradural extramedullary spinal tumor resection[J].J Neurosurg Spine,2016,25(5):640-645.
[9]Yu Y,Zhang X,Hu F,et al.Minimally invasive microsurgical treatment of cervical intraspinal extramedullary tumors[J].J Clin Neurosci,2011,18(9):1168-1173.
[10]McGirt MJ,Garces-Ambrossi GL,Parker SL,et al.Short-term progressive spinal deformity following laminoplasty versus laminectomy for resection of intradural spinal tumors:analysis of 238 patients[J].Neurosurgery,2010,66(5):1005-1012.
[11]Rho YJ,Rhim SC,Kang JK.Is intraoperative neurophysiological monitoring valuable predicting postoperative neurological recovery[J].Spinal Cord,2016,54(12):1121-1126.