PDF(Pubmed)
Abstract：
Background and Objectives: Intramedullary spinal cord tumors (IMSCT) are rare entities. A location in the upper cervical spine as a highly eloquent region carries the risk of postoperative neurological deficits, such as tetraparesis or respiratory dysfunction. Evidence for respiratory dysfunction is scarce. This study aimed to describe these highly eloquent tumors\' early and late postoperative clinical course. Materials and Methods: This is a single-center retrospective cohort study. We included 35 patients with IMSCT at levels of the craniocervical junction to C4 who underwent surgical treatment between 2008 and 2022. The authors analyzed the patients\' preoperative status, tumor- and surgery-specific characteristics, and follow-up functional status. Results: The study cohort included twenty-two patients with grade II ependymoma (62.9%), two low-grade astrocytomas (5.7%), two glioblastomas (5.7%), six hemangioblastomas (17.1%), two metastases (5.7%), and one patient with partially intramedullary schwannoma (2.9%). Gross total resection was achieved in 76% of patients. Early dorsal column-related symptoms (gait ataxia and sensory loss) and motor deterioration occurred in 64% and 44% of patients. At a follow-up of 3.27 ± 3.83 years, 43% and 33% of patients still exhibited postoperative sensory and motor deterioration, respectively. The median McCormick Scale grade was 2 in the preoperative and late postoperative periods, respectively. Only three patients (8.6%) developed respiratory dysfunction, of whom, two patients, both with malignant IMSCT, required prolonged invasive ventilation. Conclusions: More than 60% of the patients with IMSCT in the upper cervical cord developed new neurological deficits in the immediate postoperative period, and more than 40% are permanent. However, these deficits are not disabling in most cases since most patients maintain functional independence as observed by unchanged low McCormick scores. The rate of respiratory insufficiency is relatively low and seems to be influenced by the rapid neurological deterioration in high-grade tumors.
摘要：
背景和目的：脊髓髓内肿瘤（IMSCT）是一种罕见的肿瘤。上颈椎的位置作为一个非常有说服力的区域，存在术后神经功能缺损的风险，如四瘫或呼吸功能障碍。呼吸功能障碍的证据很少。这项研究旨在描述这些高度雄辩的肿瘤术后早期和晚期临床过程。材料和方法：这是一项单中心回顾性队列研究。我们纳入了35例颅颈交界处至C4水平的IMSCT患者，他们在2008年至2022年之间接受了手术治疗。作者分析了患者的术前状态，肿瘤和手术特异性特征，和后续功能状态。结果：研究队列包括22例II级室管膜瘤患者（62.9％），两个低级星形细胞瘤（5.7％），两个胶质母细胞瘤（5.7％），6例血管母细胞瘤（17.1%），两个转移（5.7％），1例部分髓内神经鞘瘤(2.9%)。76％的患者实现了总切除。早期背柱相关症状（步态共济失调和感觉丧失）和运动恶化发生在64％和44％的患者中。在3.27±3.83年的随访中，43％和33％的患者仍表现为术后感觉和运动恶化，分别。术前和术后晚期的McCormick评分中位数为2级，分别。只有3名患者(8.6%)出现呼吸功能障碍,谁,两个病人,都患有恶性IMSCT，需要长时间的有创通气。结论：60％以上的上颈脊髓IMSCT患者在术后即刻出现新的神经功能缺损，超过40%是永久性的。然而,这些缺陷在大多数情况下并不致残,因为大多数患者保持功能独立性,如麦考密克低分不变所观察到的.呼吸功能不全的发生率相对较低，并且似乎受到高级肿瘤中神经系统迅速恶化的影响。
