LONG-TERM RESULTS OF SURGICAL TREATMENT IN PATIENTS WITH INTRADURAL SPINAL TUMORS

Cover Page


Cite item

Full Text

Abstract

Background: Intradural spinal cord tumors include extramedullary and intramedullary tumors. The search for literature sources in the Pubmed, Medline, and E-Library databases detected a little number of researches on the long-term results of the surgical treatment of intradural spinal cord tumors. These clinical series include a small number of patients and do not consider the factors influencing clinical outcomes of surgical treatment.

Aim: To evaluate the long-term results of surgical treatment in patients with intradural spinal cord tumors, to identify the main factors influencing the clinical and neurological outcomes of surgical interventions in this group of patients.

Materials and methods: The study included 277 medical records of 244 patients with intradural extramedullary and 33 patients with intradural intramedullary tumors of the spinal cord. Clinical-neurological outcomes of surgical treatment in patients with intradural spinal cord tumors and factors influencing the outcomes were analyzed.

Results: When comparing the degree of neurologic deficit in patients with intradural extramedullary tumors prior to surgery, no significant differences were found (p=0.241) both in the early postoperative period and 6 months after the surgery. Nevertheless, when comparing these indicators in a period of 12, 24, 36, 48, and 60 months after the surgery, statistically significant differences were revealed (p<0.001). There was no statistically significant difference (p=0.437) between the scores in patients with intramedullary tumors on the modified McCormick Scale preoperatively, at the 6-month and one-year follow-up; however, comparison of the clinical and neurological indicators at 24, 26, 48, and 60 months revealed a significant difference (p<0.001). The surgery outcomes in considered groups of patients were significantly influenced by the following indicators: the ASA risk level (odds ratio (OS) 2.138; 95% confidence interval (95% CI) 3.346–12.145) and intraoperative neurophysiological monitoring (OR 2.84; 95% CI 1.67–9.56).

Conclusion: The study registered good and excellent long-term outcomes in most cases of intradural spinal cord tumors when the maximum possible tumor excision was performed. Analysis of the influence of various factors on the clinical and neurological outcomes in the study group of patients showed that the use of intraoperative neurophysiological monitoring and the degree of operational and anesthetic risk according to the ASA scale have a significant effect.

About the authors

V. A. Byvaltsev

Irkutsk State Medical University; Railway Clinical Hospital on the station Irkutsk-Passazhirskiy of Russian Railways Ltd.; Irkutsk Scientific Center of Surgery and Traumatology; Irkutsk State Academy of Postgraduate Education; Institute of Nuclear Physics n.a. G.I. Budker of the SB RAS

Email: byval75vadim@yandex.ru
ORCID iD: 0000-0003-4349-7101

Доктор медицинских наук, главный нейрохирург Дирекции здравоохранения ОАО «РЖД»; руководитель Центра нейрохирургии ДКБ на ст. Иркутск-Пассажирский ОАО «РЖД-Медицина»; заведующий курсом нейрохирургии ИГМУ; заведующий научно-клиническим отделом нейрохирургии Иркутского научного центра хирургии и травматологии; профессор кафедры травматологии, ортопедии и нейрохирургии ИГМАПО; ведущий научный сотрудник ИЯФ им. Г.И. Будкера.

664082, Иркутск, ул. Боткина, д. 10, тел.: +7 (3952) 63-85-28.

SPIN-код: 5996-6477

Россия

I. A. Stepanov

Irkutsk State Medical University

Author for correspondence.
Email: edmoilers@mail.ru
ORCID iD: 0000-0001-9039-9147

Аспирант курса нейрохирургии.

664003, Иркутск, ул. Красного Восстания, д. 14, тел.: +7 (3952) 63-88-30.

SPIN-код: 5485-5316

Россия

E. G. Belykh

Irkutsk State Medical University

Email: e.belykh@yandex.ru
ORCID iD: 0000-0003-2060-5739

Ассистент курса нейрохирургии.

664082, Иркутск, ул. Боткина, д. 10, тел.: +7 (3952) 63-85-28.

SPIN-код: 4191-8687

Россия

M. A. Aliyev

Irkutsk State Medical University

Email: a.marat.a0903@mail.ru

Докторант курса нейрохирургии.

050006, Алма-Ата, мкр. Калкаман, д. 20, тел.: +7 (7272) 28-07-77.

SPIN-код: 1138-9307

Казахстан

References

  1. Bhat AR, Kirmani AR, Wani MA, Bhat MH. Incidence, histopathology, and surgical outcome of tumors of spinal cord, nerve roots, meninges, and vertebral column — data based on single institutional (Sher-i-Kashmir Institute of Medical Sciences) experience. J Neurosci Rural Pract. 2016;7(3):381–391. doi: 10.4103/0976-3147.181489.
  2. Zadnik PL, Gokaslan ZL, Burger PC, Bettegowda C. Spinal cord tumours: advances in genetics and their implications for treatment. Nat Rev Neurol. 2013;9(5):257−266. doi: 10.1038/nrneurol.2013.48.
  3. Behmanesh B, Gessler F, Quick-Weller J, et al. Regional spinal cord atrophy is associated with poor outcome after surgery on intramedullary spinal cord ependymoma: a new aspect of delayed neurological deterioration. World Neurosurg. 2017;100:250–255. doi: 10.1016/j.wneu.2017.01.026.
  4. Samartzis D, Gillis CC, Shih P, et al. Intramedullary spinal cord tumors: part I — epidemiology, pathophysiology, and diagnosis. Global Spine J. 2015;5(5):425–435. doi: 10.1055/s-0035-1549029.
  5. Lee SM, Cho YE, Kwon YM. Neurological outcome after surgical treatment of intramedullary spinal cord tumors. Korean J Spine. 2014;11(3):121–126. doi: 10.14245/kjs.2014.11.3.121.
  6. Hirano K, Imagama S, Sato K, et al. Primary spinal cord tumors: review of 678 surgically treated patients in Japan. A multicenter study. Eur Spine J. 2012;21(10):2019–2026. doi: 10.1007/s00586-012-2345-5.
  7. Бывальцев В.А., Сороковиков В.А., Дамдинов Б.Б., и др. Факторы, влияющие на исход хирургического лечения экстрамедуллярных опухолей спинного мозга: мультицентровое исследование // Вопросы нейрохирургии им. Н.Н. Бурденко. — 2014. — Т.78. ― №6 — С. 15−23. doi: 10.17116/neiro201478615-23.
  8. Кушель Ю.В., Белова Ю.Д., Текоев А.Р. Интрамедуллярные опухоли спинного мозга и нейрофиброматоз // Вопросы нейрохирургии им. Н.Н. Бурденко. — 2017. — Т.81. ― №1 — С. 70−73. doi: 10.17116/neiro201780770-73.
  9. Abd-El-Barr MM, Huang KT, Moses ZB, et al. Recent advances in intradural spinal tumors. Neuro Oncol. 2017. Forthcoming. doi: 10.1093/neuonc/nox230.
  10. Westwick HJ, Shamji MF. Effects of sex on the incidence and prognosis of spinal meningiomas: a Surveillance, Epidemiology, and End Results study. J Neurosurg Spine. 2015;23(3):368–373. doi: 10.3171/2014.12.spine14974.
  11. Bellut D, Burkhardt J-K, Mannion AF, Porchet F. Assessment of outcome in patients undergoing surgery for intradural spinal tumor using the multidimensional patient-rated Core Outcome Measures Index and the modified McCormick Scale. Neurosurg Focus. 2015;39(2):E2. doi: 10.3171/2015.5.focus15163.
  12. Nambiar M, Kavar B. Clinical presentation and outcome of patients with intradural spinal cord tumours. J Clin Neurosci. 2012;19(2):262–266. doi: 10.1016/j.jocn.2011.05.021.
  13. Slynko Y, Zozulya Y, Al-Qashqish I. Surgical treatment of ventral and ventrolateral intradural extramedullary tumors of craniovertebral and upper cervical localization. Asian J Neurosurg. 2011;6(1):18. doi: 10.4103/1793-5482.85629.
  14. Бывальцев В.А., Ступак В.В., Степанов И.А., Кичигин А.И. Применение коэффициента диффузии в предоперационной оценке пролиферативного потенциала опухолей позвоночного канала // Хирургия позвоночника. — 2017. — Т.14. ― №3 — С. 93−99. doi: 10.14531/ss2017.3.93-99.
  15. Коновалов Н.А., Шевелев И.Н., Назаренко А.Г., и др. Применение минимально инвазивных доступов для удаления интрадуральных экстрамедуллярных опухолей спинного мозга // Вопросы нейрохирургии им. Н.Н. Бурденко. — 2014. — Т.78. ― №6 — С. 24−36. doi: 10.17116/neiro201478624-36.
  16. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK. World Health Organization histological classification of tumours of the central nervous system. Lyon: International Agency for Research on Cancer; 2007.
  17. Williams J. The Declaration of Helsinki and public health. Bull World Health Organ. 2008;86(8):650–651. doi: 10.2471/blt.08.050955.
  18. Byvaltsev VA, Damdinov BB, Belykh EG, et al. [Neurosurgical outcomes of intradural extramedullary spinal tumors in 97 cases: Siberian experience. (In Japanese).] No Shinkei Geka. 2017;45(9):781–787. doi: 10.11477/mf.1436203592.
  19. Ng Z, Ng S, Nga V, et al. Intradural spinal tumors — review of postoperative outcomes comparing intramedullary and extramedullary tumors from a single institution’s experience. World Neurosurg. 2018;109:e229–e232. doi: 10.1016/j.wneu.2017.09.143.
  20. Fisahn C, Sanders FH, Moisi M, et al. Descriptive analysis of unplanned readmission and reoperation rates after intradural spinal tumor resection. J Clin Neurosci. 2017;38:32–36. doi: 10.1016/j.jocn.2016.12.013.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2018 "Paediatrician" Publishers LLC



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies