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首页> 外文期刊>Neurosurgical focus >Intramedullary spinal cavernoma: clinical presentation, microsurgical approach, and long-term outcome in a cohort of 48 patients
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Intramedullary spinal cavernoma: clinical presentation, microsurgical approach, and long-term outcome in a cohort of 48 patients

机译：髓内脊髓海绵状瘤：48例患者的临床表现，显微外科手术方法和长期预后

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OBJECT Intramedullary spinal cavernoma (ISC) is a rare entity and accounts for approximately 5%?12% of all spinal vascular pathologies. The purpose of the present study was to examine the influence of clinical presentation, localization, and different surgical approaches on long-term outcome in patients treated for ISC. METHODS The authors performed a retrospective single-center study of 48 cases of ISC treated microsurgically over the past 28 years. Analyzed factors included preoperative clinical history, microsurgical strategies, neurological outcome (American Spinal Injury Association [ASIA] grade, Epstein and Cooper grade), and the occurrence of postoperative spinal ataxia. Univariate analysis was performed to identify factors influencing long-term outcome. RESULTS Preoperatively, 18.8% of all patients experienced a slow, progressive decline in neurological function and 33.3% suffered repetitive episodes of acute neurological deterioration over a time frame of months to years. Moreover, 16.7% noted the sudden onset of a severe neurological deficit, whereas 25% experienced the sudden onset of symptoms with a subsequent gradually progressive decline in neurological function. On long-term follow-up after treatment (mean ± SD, 79.3 ± 35.2 months), 70.8% of patients showed no change in neurological function, 6.3% suffered from a decline, and 22.9% improved neurologically. Thoracolumbar localization (p = 0.043), low preoperative Epstein and Cooper grade for the lower extremities (p CONCLUSION Postoperative neurological function in ISC patients is determined by the preoperative neurological status. On long-term follow-up after microsurgical treatment, 93.7% of patients presented with a stable or improved condition (ASIA grade); thus, definite microsurgical treatment should be considered as long as patients present with only mild symptoms after the diagnosis of symptomatic ISC.
机译：目的髓内脊髓海绵状瘤（ISC）是一种罕见的实体，约占所有脊髓血管病变的5％〜12％。本研究的目的是检查临床表现，定位和不同手术方法对接受ISC治疗的患者长期预后的影响。方法作者在过去28年中对48例经外科手术治疗的ISC病例进行了回顾性单中心研究。分析的因素包括术前临床病史，显微手术策略，神经系统结局（美国脊柱损伤协会[ASIA]级，爱泼斯坦和库珀级），以及术后脊柱共济失调的发生率。进行单因素分析以确定影响长期预后的因素。结果术前，所有患者中有18.8％的患者的神经功能缓慢，进行性下降，而33.3％的患者在数月至数年的时间内反复发作急性神经功能恶化。此外，有16.7％的人注意到突然出现严重的神经功能缺损，而25％的人出现了症状的突然发作，随后神经功能逐渐下降。治疗后的长期随访（平均±SD，79.3±35.2个月），有70.8％的患者神经功能没有变化，有6.3％的患者出现了下降，而有22.9％的患者的神经功能得到了改善。结论：ISC患者的术后神经功能由术前神经状态决定，经显微外科手术后的长期随访，占93.7％;术后胸廓定位（p = 0.043），术前爱泼斯坦和下肢Cooper评分低（p结论）。表现为稳定或好转的疾病（ASIA级）;因此，只要患者在症状性ISC诊断后仅出现轻度症状，就应考虑进行明确的显微手术治疗。

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