■硬膜内髓外(IDEM)脊髓肿瘤约占良性椎管内肿瘤的三分之二。这些都适合于总切除,但可以有可变的功能结果,这在评估它们对患者生活质量的影响方面起着关键作用。了解与这些肿瘤相关的功能结果对于医疗保健专业人员制定适当的治疗计划并提供全面的护理至关重要。
■在这项研究中,我们回顾性分析了在过去6年中,在2017年1月至2022年12月期间,130例IDEM肿瘤患者在一家机构接受手术治疗的结局.患者人口统计学,症状,分析所有手术脊柱IDEM肿瘤的肿瘤特征(解剖学和病理学)。根据Frankel分级评估术前阶段和术后随访期间获得的神经系统检查结果。使用Denis疼痛量表(DPS)评估背痛。
■年龄范围,性别分布,介绍,组织病理学,并对肿瘤特征进行分析。该研究的组织病理学结果如下:神经鞘瘤56例,37例脑膜瘤,16例神经纤维瘤,表皮样囊肿6例,室管膜瘤和皮样囊肿各5例,蛛网膜囊肿3例,2例转移,和一个副神经节瘤。疼痛是最常见的症状(38.5%),其次是四肢无力(31.5%),感觉异常/麻木(22.3%),和括约肌紊乱(7.7%)。在93%的病例中可以看到完全切除,7%接受小计切除。所遇到的并发症有:手术部位感染4例,脑脊液漏各1例,假性脑膜膨出,和硬膜外血肿.在我们的系列中,根据Frankel评分的改善,49.3%的患者在功能结局方面有显著良好的改善,43%的患者功能改善良好。术后立即随访时注意到显著的功能改善,2周随访,和六个月的随访期。复发7例(5.4%)。与术前平均值相比,DPS评分平均值在随访期间显着降低。在前面出现的IDEM肿瘤中,结果明显较差。
■IDEM肿瘤通常是良性的,容易通过对比增强磁共振成像扫描检测到。这些在不同的中心具有可变的功能结果。评估这种功能结果是管理IDEM脊髓肿瘤的一个重要方面。通过我们的研究观察到肿瘤的腹侧位置,胸部肿瘤,患者术前神经系统状况较差与术后功能结局较差相对应.此外,术后观察到疼痛症状随着Frankel评分的改善而显著降低,因此,这提示了手术后功能结局的显著改善.这项研究有助于得出结论,与IDEM肿瘤切除相关的发病率并不像最初认为的那样重要。
UNASSIGNED: Intradural extramedullary (IDEM) spinal cord tumors account for approximately two-thirds of benign intraspinal neoplasms. These are amenable to gross total excision but can have variable functional outcomes, which plays a key role in assessing their impact on a patient\'s quality of life. Understanding the functional outcomes associated with these tumors is crucial for healthcare professionals to devise appropriate treatment plans and provide comprehensive care.
UNASSIGNED: In this study, we retrospectively reviewed the outcomes of 130 patients with IDEM tumors who underwent surgery in the past six years between January 2017 and December 2022 at a single institution. Patient demographics, symptoms, and tumor characteristics (anatomical and pathological) in all operated spinal IDEM tumors were analyzed. The neurological findings obtained during the preoperative stage and the postoperative follow-up were evaluated according to the Frankel grading. The back pain was assessed using the Denis pain scale (DPS).
UNASSIGNED: The age range, gender distribution, presentation, histopathology, and tumor characteristics were analyzed. The histopathological outcomes of the study were as follows: 56 cases of schwannoma, 37 cases of meningiomas, 16 patients of neurofibroma, six cases of epidermoid cyst, five cases each of ependymoma and dermoid cyst, three cases of arachnoid cyst, two cases of metastasis, and one case of paraganglioma. Pain was the most common symptom (38.5%), followed by weakness in limbs (31.5%), paresthesia/numbness (22.3%), and sphincter disturbance (7.7%). Complete total resection was seen in 93% of cases, with 7% undergoing subtotal excision. The complications encountered were - four cases of surgical site infection and one case each of cerebrospinal fluid leak, pseudomeningocele, and epidural hematoma. In our series, 49.3% of patients had significantly good improvement in functional outcomes as per improvement in Frankel score, and 43% of patients had good functional improvement. Significant functional improvement was noted at immediate postoperative follow-up, 2-week follow-up, and six-month follow-up periods. Reoccurrence was seen in 7 cases (5.4%). The DPS score mean values showed a significant decrease over the follow-up duration as compared to preoperative mean values. Significantly poor outcome was seen in IDEM tumours present anteriorly.
UNASSIGNED: The IDEM tumors are usually benign and are readily detected by contrast-enhanced magnetic resonance imaging scans. These have variable functional outcomes in different centers. Assessing this functional outcome is an essential aspect of managing IDEM spinal tumors. It was observed through our study that the ventral location of the tumor, thoracic tumors, and poor preoperative neurological status of the patient correspond with poorer postoperative functional outcomes. Furthermore, a significant decrease in the pain symptoms with improvement of Frankel score was seen postoperatively, thus this being suggestive of a significant improvement of functional outcome after surgery. This study helps to conclude that the morbidity associated with the resection of IDEM tumors is not as significant as originally thought to be.