Introduction: Spinal intradural tumors account for 15% of all CNS tumors. Typical tumor entities include ependymomas, astrocytomas, meningiomas, and neurinomas. In cases of multiple affected segments, extensive approaches may be necessary to achieve the gold standard of complete tumor resection. Methods: We performed a bicentric, retrospective cohort study of all patients equal to or older than 14 years who underwent multi-segment surgical treatment for spinal intradural tumors between 2007 and 2023 with approaches longer than four segments without instrumentation. We assessed the surgical technique and the clinical outcome regarding signs of symptomatic spinal instability. Children were excluded from our cohort. Results: In total, we analyzed 33 patients with a median age of 44 years and interquartile range IQR of 30–56 years, including the following tumors: 21 ependymomas, one subependymoma–ependymoma mixed tumor, two meningiomas, two astrocytomas, and seven patients with other entities. The median length of the approach was five spinal segments with a range of 4–14 and with the foremost localization in the cervical or thoracic spine. Laminoplasty was the most chosen approach (72.2%). The median time to follow-up was 13 months IQR (4–56 months). Comparing pre- and post-surgery outcomes, 72.2% of the patients (n= 24) reported pain improvement after surgery. The median modified McCormick scores pre- and post surgery were equal to II IQR (I–II) and II IQR (I–III), respectively. Discussion: We achieved satisfying results with long-segment approaches. In general, patients reported pain improvement after surgery and received similar low modified McCormick scores pre- and post surgery and did not undergo secondary dorsal fixation. Thus, we conclude that intradural tumor resection via extensive approaches does not seem to impair long-term spinal stability in our cohort.
引言：脊髓硬膜内肿瘤约占所有中枢神经系统肿瘤的15%。典型肿瘤类型包括室管膜瘤、星形细胞瘤、脑膜瘤和神经鞘瘤。对于累及多节段的病例，可能需要采用广泛入路以实现肿瘤完全切除的金标准。 方法：我们开展了一项双中心回顾性队列研究，纳入2007年至2023年间因脊髓硬膜内肿瘤接受多节段手术治疗（入路范围超过四个节段且未使用内固定）的所有≥14岁患者。我们评估了手术技术及临床结局，重点关注症状性脊柱不稳的体征。儿童患者被排除在本队列之外。 结果：共分析33例患者，中位年龄44岁，四分位距（IQR）为30-56岁。肿瘤类型包括：21例室管膜瘤、1例混合性室管膜瘤-室管膜下瘤、2例脑膜瘤、2例星形细胞瘤以及7例其他类型肿瘤。手术入路中位长度为5个脊柱节段（范围4-14节段），主要位于颈段或胸段脊柱。椎板成形术是最常采用的手术入路（72.2%）。中位随访时间为13个月（IQR：4-56个月）。比较术前术后结果，72.2%的患者（n=24）报告术后疼痛改善。术前与术后改良McCormick评分中位数均为II级，IQR分别为（I-II）和（I-III）。 讨论：通过长节段入路我们获得了满意的手术效果。总体而言，患者术后疼痛得到改善，术前术后改良McCormick评分均维持在较低水平且未行二次后路固定术。因此我们得出结论：在本研究队列中，通过广泛入路进行硬膜内肿瘤切除似乎不会影响脊柱的长期稳定性。
Spinal Intradural Tumor Resection via Long-Segment Approaches and Clinical Long-Term Follow-Up
肿瘤(癌症)患者之家