Spinal ependymomas(SEs) are common adult intramedullary tumors; however,determining the absolute boundary between the tumor and the tumor residual may be difficult. We assessed outcomes following the use of fluorescei...Spinal ependymomas(SEs) are common adult intramedullary tumors; however,determining the absolute boundary between the tumor and the tumor residual may be difficult. We assessed outcomes following the use of fluorescein sodium(FS) during surgical removal of SEs. We performed a retrospective analysis of 112 patients with SEs who were treated at Beijing Tsinghua Changgung Hospital between December 2014 and December 2016. Each patient received intravenous FS(3–4 mg/kg) to determine the SE boundaries during surgery. Tumor removal efficiencies and tumor residuals were assessed using magnetic resonance imaging(MRI) at 10 days and 3 months after surgical recovery; McC ormick's spinal function classification was also performed at the 3-month follow-up. The complete tumor removal rate was 92%(103/112). Ninetyfour patients underwent tumor removal under fluorescent light, which provided distinctive tumor fluorescence. Tumor removal under white light was performed in18 patients; fluorescent images were invisible or indistinctive in these 18 patients. At the 3-month follow-up, sensory function(85.8%(91/106)) and movement(84.3%(86/102)) were improved in patients with pre-surgical dysfunction; urination and defecation functions were improved in 66.7%(16/24). The Mc Cormick spinal cord functional classifications, at the 3-month follow-up, showed significant differences in the percentages of patients with disease classified to each grade(I–IV), compared with preoperative classifications(each, P < 0.05). There was no MRI evidence of tumor relapse or residuals at the 3-month follow-up. FS use during the surgical treatment of SE enables complete tumor removal and detection of tumor residuals.展开更多
BACKGROUND Myxopapillary ependymomas are rare spinal tumours.Although histologically benign,they have a tendency for local recurrence.CASE SUMMARY We describe a patient suffering from extra-and intradural myxopapillar...BACKGROUND Myxopapillary ependymomas are rare spinal tumours.Although histologically benign,they have a tendency for local recurrence.CASE SUMMARY We describe a patient suffering from extra-and intradural myxopapillary ependymoma with perisacral spreading.He was treated with subtotal resection and postoperative radiation therapy.After treatment,he experienced slight sphincter disorders and lumboischialgic pain with no motor or sensory disturbances.Eight months later,a tumour regression was documented.The patient is still followed-up regularly.CONCLUSION Lumbar myxopapillary ependymomas may present with lumbar or radicular pain,similar to more trivial lesions.Magnetic resonance imaging(MRI)is the primary modality for diagnosis.The treatment aim is to minimize both tumour and therapy-related morbidity and to involve different treatment modalities.展开更多
BACKGROUND & OBJECTIVE: The majority of intramedullary spinal cord tumors (IMSCT) are low-grade gliomas. Radical resection for IMSCTs remains challenging. Recently, improved neuroimaging and advanced microsurgical...BACKGROUND & OBJECTIVE: The majority of intramedullary spinal cord tumors (IMSCT) are low-grade gliomas. Radical resection for IMSCTs remains challenging. Recently, improved neuroimaging and advanced microsurgical technique have made great success in surgical management of the intramedullary spinal cord tumors. METH-ODS & RESULTS: Twenty-nine patients with intramedullary spinal cord tumors were treated by radical resection dur-ing the past 4 years in our institute. The histological results were as follows: 12 ependymomas, 4 astrocytomas, 4 heman-gioblastomas, 4 epidermoids, 1 cavernoma, 2 lipomas, 2 metastatics. A gross -total resection (】 95%) was achieved in 25 surgical procedures. Subtotal resections (80-95% ) were performed in 4 cases. There was no surgical death.When comparing the preoperative and 3-month postoperative functional grades, 12 patients were stable 14 improved,and 3 deteriorated. Patients with either no deficit or only mild deficit before surgery were rarely impaired by the proce-dure, reinforcing the importance of early diagnosis and treatment. The major determinant of long-term survival was histologi-cal composition of the tumor. Patients in whom an IMSCT was only partially resected (【80% ) fared significantly worse. CONCLUSIONS: The long-term survival and quality of life for patients with low-grade gliomas treated by radi-cal resection alone is comparable or superior to minimal resection plus radiotherapy. The optimal therapy for patients with high-grade glioma is yet to be determined. For benign lesion, such as hemangioblastoma and cavernoma could be cured by total resection of the tumor. For lipoma and epidermoid, fibrous adhesions to the cord make total removal difficult,and thus, removal is not the goal of surgery. The carbon dioxide laser is particularly useful during surgery for this lesion.展开更多
目的:对比分析多节段髓内先天性肿瘤和良性室管膜瘤患者在性别、年龄分布,以及肿瘤部位、瘤体长度、切除程度和对围手术期神经功能状况影响方面的异同。方法:选取北京大学第三医院近8年来连续收治的12例多节段(≥3个椎体节段)髓内先天...目的:对比分析多节段髓内先天性肿瘤和良性室管膜瘤患者在性别、年龄分布,以及肿瘤部位、瘤体长度、切除程度和对围手术期神经功能状况影响方面的异同。方法:选取北京大学第三医院近8年来连续收治的12例多节段(≥3个椎体节段)髓内先天性肿瘤和19例良性室管膜瘤患者,均行后正中入路显微镜下肿瘤切除术。收集患者临床资料,将二便功能状态分为4级(正常,尿频或/和便秘等轻度异常,排便困难、无力等中度异常,失禁),以改良JOA评分系统(improved Japanese orthopaedic association score system,IJOA)评价神经功能状况,以IJOA分值差(术后IJOA和术前IJOA差值)评估手术效果。所有患者随访至2009年6月30日。以独立样本的t检验和非参数检验分析统计学数据。结果:先天性肿瘤患者的平均年龄为(23.5±14.3)岁,良性室管膜瘤患者为(37.8±12.9)岁,差异有统计学意义(t=-2.89,P=0.007)。两组性质不同的多节段髓内肿瘤比较,其肿瘤部位(Z=-3.59,P=0.001)和肿瘤切除程度(Z=-2.89,P=0.004)差异均有统计学意义。83.3%(10/12)患者的多节段髓内先天性肿瘤累及脊髓圆锥部位,部分肿瘤和脊髓结构粘连紧密或脂肪组织穿插生长在神经结构中,为避免神经功能的缺失,不能强行切除粘连紧密的肿瘤组织,其中66.7%(8/12)肿瘤组织得以全部切除或近乎全部切除。78.9%(15/19)患者的多节段髓内良性室管膜瘤累及颈段或颈胸段脊髓,其中94.7%(18/19)肿瘤组织得以全部切除或近乎全部切除。结论:多节段髓内先天性肿瘤可能多见于青年患者,常累及脊髓圆锥,部分肿瘤全部切除难度较大;多节段髓内良性室管膜瘤可能多见于中年患者,常累及颈段或颈胸段脊髓,肿瘤全部切除较容易。展开更多
基金Supported by the Beijing Tsinghua Changgung Hospital Fund(No.12015C1045)
文摘Spinal ependymomas(SEs) are common adult intramedullary tumors; however,determining the absolute boundary between the tumor and the tumor residual may be difficult. We assessed outcomes following the use of fluorescein sodium(FS) during surgical removal of SEs. We performed a retrospective analysis of 112 patients with SEs who were treated at Beijing Tsinghua Changgung Hospital between December 2014 and December 2016. Each patient received intravenous FS(3–4 mg/kg) to determine the SE boundaries during surgery. Tumor removal efficiencies and tumor residuals were assessed using magnetic resonance imaging(MRI) at 10 days and 3 months after surgical recovery; McC ormick's spinal function classification was also performed at the 3-month follow-up. The complete tumor removal rate was 92%(103/112). Ninetyfour patients underwent tumor removal under fluorescent light, which provided distinctive tumor fluorescence. Tumor removal under white light was performed in18 patients; fluorescent images were invisible or indistinctive in these 18 patients. At the 3-month follow-up, sensory function(85.8%(91/106)) and movement(84.3%(86/102)) were improved in patients with pre-surgical dysfunction; urination and defecation functions were improved in 66.7%(16/24). The Mc Cormick spinal cord functional classifications, at the 3-month follow-up, showed significant differences in the percentages of patients with disease classified to each grade(I–IV), compared with preoperative classifications(each, P < 0.05). There was no MRI evidence of tumor relapse or residuals at the 3-month follow-up. FS use during the surgical treatment of SE enables complete tumor removal and detection of tumor residuals.
文摘BACKGROUND Myxopapillary ependymomas are rare spinal tumours.Although histologically benign,they have a tendency for local recurrence.CASE SUMMARY We describe a patient suffering from extra-and intradural myxopapillary ependymoma with perisacral spreading.He was treated with subtotal resection and postoperative radiation therapy.After treatment,he experienced slight sphincter disorders and lumboischialgic pain with no motor or sensory disturbances.Eight months later,a tumour regression was documented.The patient is still followed-up regularly.CONCLUSION Lumbar myxopapillary ependymomas may present with lumbar or radicular pain,similar to more trivial lesions.Magnetic resonance imaging(MRI)is the primary modality for diagnosis.The treatment aim is to minimize both tumour and therapy-related morbidity and to involve different treatment modalities.
文摘BACKGROUND & OBJECTIVE: The majority of intramedullary spinal cord tumors (IMSCT) are low-grade gliomas. Radical resection for IMSCTs remains challenging. Recently, improved neuroimaging and advanced microsurgical technique have made great success in surgical management of the intramedullary spinal cord tumors. METH-ODS & RESULTS: Twenty-nine patients with intramedullary spinal cord tumors were treated by radical resection dur-ing the past 4 years in our institute. The histological results were as follows: 12 ependymomas, 4 astrocytomas, 4 heman-gioblastomas, 4 epidermoids, 1 cavernoma, 2 lipomas, 2 metastatics. A gross -total resection (】 95%) was achieved in 25 surgical procedures. Subtotal resections (80-95% ) were performed in 4 cases. There was no surgical death.When comparing the preoperative and 3-month postoperative functional grades, 12 patients were stable 14 improved,and 3 deteriorated. Patients with either no deficit or only mild deficit before surgery were rarely impaired by the proce-dure, reinforcing the importance of early diagnosis and treatment. The major determinant of long-term survival was histologi-cal composition of the tumor. Patients in whom an IMSCT was only partially resected (【80% ) fared significantly worse. CONCLUSIONS: The long-term survival and quality of life for patients with low-grade gliomas treated by radi-cal resection alone is comparable or superior to minimal resection plus radiotherapy. The optimal therapy for patients with high-grade glioma is yet to be determined. For benign lesion, such as hemangioblastoma and cavernoma could be cured by total resection of the tumor. For lipoma and epidermoid, fibrous adhesions to the cord make total removal difficult,and thus, removal is not the goal of surgery. The carbon dioxide laser is particularly useful during surgery for this lesion.
文摘目的:对比分析多节段髓内先天性肿瘤和良性室管膜瘤患者在性别、年龄分布,以及肿瘤部位、瘤体长度、切除程度和对围手术期神经功能状况影响方面的异同。方法:选取北京大学第三医院近8年来连续收治的12例多节段(≥3个椎体节段)髓内先天性肿瘤和19例良性室管膜瘤患者,均行后正中入路显微镜下肿瘤切除术。收集患者临床资料,将二便功能状态分为4级(正常,尿频或/和便秘等轻度异常,排便困难、无力等中度异常,失禁),以改良JOA评分系统(improved Japanese orthopaedic association score system,IJOA)评价神经功能状况,以IJOA分值差(术后IJOA和术前IJOA差值)评估手术效果。所有患者随访至2009年6月30日。以独立样本的t检验和非参数检验分析统计学数据。结果:先天性肿瘤患者的平均年龄为(23.5±14.3)岁,良性室管膜瘤患者为(37.8±12.9)岁,差异有统计学意义(t=-2.89,P=0.007)。两组性质不同的多节段髓内肿瘤比较,其肿瘤部位(Z=-3.59,P=0.001)和肿瘤切除程度(Z=-2.89,P=0.004)差异均有统计学意义。83.3%(10/12)患者的多节段髓内先天性肿瘤累及脊髓圆锥部位,部分肿瘤和脊髓结构粘连紧密或脂肪组织穿插生长在神经结构中,为避免神经功能的缺失,不能强行切除粘连紧密的肿瘤组织,其中66.7%(8/12)肿瘤组织得以全部切除或近乎全部切除。78.9%(15/19)患者的多节段髓内良性室管膜瘤累及颈段或颈胸段脊髓,其中94.7%(18/19)肿瘤组织得以全部切除或近乎全部切除。结论:多节段髓内先天性肿瘤可能多见于青年患者,常累及脊髓圆锥,部分肿瘤全部切除难度较大;多节段髓内良性室管膜瘤可能多见于中年患者,常累及颈段或颈胸段脊髓,肿瘤全部切除较容易。
