颈椎髓内肿瘤的神经外科治疗

Yevgeniy I. Slynko, O. O. Potapov, Y. Derkach, A. I. Pastushyn
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摘要

材料和方法。本文分析了2010 - 2020年在乌克兰医学科学院罗莫达诺夫神经外科研究所因颈椎髓内肿瘤接受手术治疗的47例患者。所有颈椎髓内肿瘤患者均行手术治疗。根据肿瘤切除量分为全切除(17例)、小切除(14例)和部分切除(19例)。至少95%的肿瘤体积被认为是完全切除,这可以通过手术结束时在显微镜下检查手术视野或术后早期的mri来证实。全肿瘤切除是髓内脊髓肿瘤手术治疗的金标准。Ferrante L.等报道,行肿瘤全切除术的患者无复发,而行次全切除术的患者有57.1%的复发。作者认为,切除肿瘤的体积是影响进一步预后的重要因素。对于大多数颈脊髓髓内肿瘤,建议行肿瘤全切除术。术前无法确定是否可以完全切除肿瘤。颈椎髓内肿瘤可以完全切除。手术应在诊断后立即进行,不要预期神经功能缺损会增加。
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NEUROSURGICAL TREATMENT OF INTRAMEDULLAR TUMOR OF CERVICAL LOCATION
Materials and methods. This report analyzes 47 patients who were operated on at Romodanov Neurosurgery Institute of the Academy of Medical Sciences of Ukraine in the period from 2010 to 2020 due to intramedullary tumors of the cervical spine. Results. All patients with intramedullary tumors of the cervical spine were operated. According to the volume of tumor removal, operations with total (17 observations), subtotal (14 observations), and partial (19 observations) removal were distinguished. The removal of at least 95% of the tumor volume was considered total, which was confirmed by examination of the operating field under a microscope at the end of the operation or by early postoperative MRI. Discussion. Total tumor removal is the gold standard in the surgical treatment of intramedullary spinal cord tumors. Ferrante L. et al reported that none of the patients who underwent total tumor resection had a recurrence, while 57.1% of patients with subtotal resection had a recurrence. The authors argue that the volume of the removed tumor is an important factor influencing the further prognosis. Total tumor resection can be recommended for most cases of intramedullary tumors of the cervical spinal cord. It is not possible to determine preoperatively whether total tumor removal is possible. Conclusions. Intramedullary tumors of the cervical spine can be completely removed. Surgery should be performed immediately after diagnosis without expecting an increase in neurological deficit.
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