背景:高位颈硬膜内髓外肿瘤并不常见。它们与周围神经结构和椎动脉的关系使得手术切除具有挑战性。以前没有研究比较高颈椎和颈下硬膜内髓外脊柱肿瘤来阐明它们的独特特征和手术结果。
方法:我们进行了一项回顾性研究,将接受宫颈硬膜内髓外肿瘤切除术的患者分为高颈组和轴下颈组。变量包括性别,年龄,Charlson合并症指数,volume,偏侧性,术前虚弱,使用神经监测和排水,仪器融合,并发症,逗留时间,组织学,放电位置,复发,和随访时间。比较两组变量。术前绘制肢体力量和Nurick分类图,在放电时,并在6个月时绘制他们的恢复轨迹。
结果:纳入84例患者共90个肿瘤,其中高颈椎组40例,下颈椎组44例。较多的患者为神经纤维瘤(P=0.011)和双侧肿瘤(P=0.044)。双侧高位宫颈肿瘤的1型神经纤维瘤病患病率更高(P=0.033)。轴下组患者较多(P=0.045)。术后出院前高颈组患者的肢体功率(P=0.025)和Nurick分级(P=0.0001)均有改善。到6个月,两组的恢复情况相似.两组均无手术死亡。
结论:高位颈椎硬膜内髓外脊柱肿瘤有更多的双侧肿瘤与1型神经纤维瘤病相关。尽管解剖学具有挑战性,本组手术切除安全,预后良好.
High cervical intradural extramedullary tumors are uncommon. Their relationship to surrounding neural structures and vertebral arteries makes surgical excision challenging. No previous studies have compared high cervical to subaxial cervical intradural extramedullary spinal tumors to elucidate their unique characteristics and surgical outcomes.
We performed a retrospective
study in which patients who underwent excision of a cervical intradural extramedullary tumor were divided into a high cervical group and a subaxial cervical group. Variables included sex, age, Charlson Comorbidity Index, volume, laterality, preoperative weakness, use of neuromonitoring and drains, instrumented fusion, complications, length of stay, histology, discharge location, recurrence, and duration of follow-up. Variables were compared between the 2 groups. Limb power and Nurick classification were charted preoperatively, at discharge, and at 6 months to plot their recovery trajectory.
Eighty-four patients with a total of 90 tumors were enrolled, including 40 patients in the high cervical group and 44 patients in the subaxial spine group. More patients with neurofibromas (P = 0.011) and bilateral tumors (P = 0.044) were in the high cervical group. A greater prevalence of neurofibromatosis type 1 was significant for bilateral high cervical tumors (P = 0.033). More patients in the subaxial group had instrumented fusion (P = 0.045). More patients in the high cervical group had improvement in limb power (P = 0.025) and Nurick classification (P = 0.0001) postoperatively before discharge. By 6 months, both groups had similar recovery. No mortality was attributable to surgery in either group.
High cervical intradural extramedullary spine tumors have more bilateral tumors associated with neurofibromatosis type 1. Despite the challenging anatomy, surgical resection is safe with good outcomes in this group.