目的:硬膜内脊柱转移瘤被认为是罕见的。目前,关于发病率的信息有限,手术管理,和结果。
方法:我们从2002年到2024年进行了回顾性病例回顾,确定了所有接受硬膜内脊柱转移手术治疗的患者。临床,收集手术和生存数据,并将其与接受硬膜外脊柱转移手术治疗的患者的文献数据进行比较。
结果:共发现172例脊柱转移患者,其中13例患者符合纳入标准(7.6%)。诊断为硬膜内脊柱转移瘤的平均年龄为52±22岁,具有不同的原发性,包括肺(n=3),乳房(n=2),肉瘤(n=2),和六个独特的实体。在初次诊断后平均3.3年诊断出硬膜内脊柱转移瘤。总的来说,我们观察到五个(38%)硬膜内-髓外转移和八个(62%)髓内转移,位于子宫颈(38.5%),胸椎(46.1%)和腰椎(15.4%)。最常见的术前症状是疼痛,感官变化,步态共济失调(各76.9%)。总切除率达到54%,和局部肿瘤控制在85%。术后,92%表现出临床改善或稳定性。最常见的辅助治疗是85%的放疗和/或化疗。脊柱硬膜内转移瘤术后平均生存期为5个月,从1个月到120个月不等。颈椎硬膜内转移的位置与明显更有利的生存结果相关(与胸/腰位置相比,p=0.02)。
结论:脊髓转移瘤的硬膜内位置很少见(7.6%)。即便如此,手术切除对神经系统的改善是安全有效的,与据报道的硬膜外脊柱转移瘤的生存率相比,生存率似乎较低。
OBJECTIVE: Intradural spinal metastases are considered rare. At present, limited information is available on incidence, surgical management, and outcomes.
METHODS: We conducted a retrospective patient chart review from 2002 to 2024, identifying all patients surgically treated for intradural spinal metastases. Clinical, surgical and survival data were collected and compared to literature data for patients surgically treated for extradural spinal metastases.
RESULTS: A total of 172 patients with spinal metastases were identified with 13 patients meeting inclusion criteria (7.6%). The mean age at diagnosis of intradural spinal metastases was 52 ± 22 years, with diverse primaries including lung (n = 3), breast (n = 2), sarcoma (n = 2), and six unique entities. Intradural spinal metastasis was diagnosed on average of 3.3 years after primary diagnosis. In total, we observed five (38%) intradural-extramedullary and eight (62%)
intramedullary metastases, located in the cervical (38.5%), thoracic (46.1%) and lumbar spine (15.4%). The most common preoperative symptoms were pain, sensory changes, and gait ataxia (each 76.9%). Gross total resection was achieved in 54%, and local tumor control in 85%. Postoperatively, 92% exhibited clinical improvement or stability. Most frequent adjuvant treatment was radio- and/or chemotherapy in 85%. The average survival after operation for spinal intradural metastases was 5 months, ranging from 1 month to 120 months. The location of the intradural metastasis in the cervical spine was associated with a significantly more favorable survival outcome (compared to thoracic/lumbar location, p = 0.02).
CONCLUSIONS: Intradural location of spinal metastases is rare (7.6%). Even so, surgical resection is safe and effective for neurological improvement, and survival appears lower compared to the reported survival of extradural spinal metastases.