长节段脊髓室管膜瘤的显微手术治疗及脊髓功能影响因素

Neurological functions and its influencing factors in surgical treatment of long segmental intramedullary spinal cord ependymomas

目的 初步探讨长节段脊髓室管膜瘤(范围≥3个椎体水平)的患者手术前后神经功能变化及其相关影响因素。方法 纳入2016年3月—2021年6月于新疆医科大学第一附属医院神经外科接受手术治疗的25例长节段脊髓室管膜瘤患者,回顾性分析手术前后改良McCormick分级(MMCS)变化,探讨其可能的影响因素。结果 25例患者均行后正中全椎板入路肿瘤切除术,全切(Ⅰ级)15例(60%),次全切(Ⅱ级)9例(36%),大部分切除(Ⅲ级)1例(4%)。手术前MMCS 1+2级8例(32%),末次随访MMCS 1+2级15例(68.2%),脊髓功能较术前改善者11例(50%),无变化者6例(27.3%),恶化者5例(22.7%)。与脊髓功能正常或轻度障碍(MMCS 1+2级)的患者进行比较,肿瘤头端位于胸10水平以上为术前脊髓功能不良(MMCS>2级)的独立危险因素(OR=7.497,B=2.015)。对改善/稳定组和加重组进行单因素分析提示脊髓空洞(P=0.019)和脊髓水肿(P=0.030)与术后脊髓功能恶化相关,Logistic回归结果提示术前伴有脊髓水肿(OR=13.914,B=2.633)为术后3个月脊髓功能不良的独立危险因素,而术前伴有脊髓空洞(OR=0.060,B=-2.813)为保护因素。而年龄、性别、手术时长、肿瘤切除程度、病理分级、术中是否脊柱内固定均无统计学意义(均P>0.05)。结论 长节段脊髓室管膜瘤患者的神经功能障碍发生率较高,手术治疗后大部分患者脊髓功能较术前改善,手术效果满意,但术前伴有脊髓水肿或不伴脊髓空洞的患者术后3个月时脊髓功能状态相对不良。

Objective To preliminarily explore the neurological functions and its influencing factors in the treatment of multisegmental intramedullary spinal cord ependymomas(tumor extension over ≥3 vertebrae). Methods 25 patients with multisegmental intramedullary spinal cord ependymomas who underwent microsurgical tumor resection from March 2016 to June 2021 at the Department of Neurosurgery of the First Affiliated Hospital of Xinjiang Medical University were collected. The changes of neurological functions evaluated against the Modified McCormick Scale and Sensory Pain Scale were analyzed retrospectively, and the related factors affecting neurological outcome were discussed. Results All 25 cases underwent tumor resection through posterior median approach, gross total resection(grade Ⅰ) in 15(60%), subtotal resection(grade Ⅱ) in 9(36%), and partial resection(grade Ⅲ) in 1(4%). Preoperative assessment revealed MMCS grade Ⅰ+Ⅱ in 8(32%), and at last follow-up in 15(68.2%)the function status were MMCS grade Ⅰ+Ⅱ, 11 cases(50%)showed neurological improvement, no change in 6(27.3%), while deterioration in 6(27.3%). Compared with the MMCS grade Ⅰ+Ⅱ groups, lesion upper pole located higher than T10level was the risk factor of preoperative poor functions(MMCS grade>2)(OR=7.497,B=2. 015). Univariate analysis suggested that syringomyelia( P = 0. 019) and spinal cord edema( P =0. 030) were associated with postoperative deterioration of function,and logistic regression indicated that preoperative spinal cord edema was an independent risk factor for function aggravation in 3months after operation( OR = 13. 914,B = 2. 633),while the syringomyelia seemed was considered as a protective factor( OR = 0. 060,B =-2. 813). However,there was no statistical significance in age,gender,surgical duration,extent of tumor resection,pathological grade and simultaneous instrumented fusion( all P > 0. 05). Conclusions The incidence of neurological dysfunction in patients with long segment spinal cord ependymoma is high. After surgery,the spinal cord function of most patients is improved compared with that before surgery, and the surgical effect is satisfactory. However,the spinal cord function of patients with preoperative spinal cord edema or without syringomyelia is relatively poor 3 months after surgery.