Spinālu intradurālu ekstramedullāru audzēju ķirurģiskās ārstēšanas rezultāti RAKUS “ Gaiļezers”
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ievads: Intradurāli ekstramedulāri audzēji sastāda 2/3 no visiem primāriem intraspināliem jaunveidojumiem. Kļūstot pieejamākiem kvalitatīviem diagnostiskiem izmeklējumiem (MR) var prognozēt diagnosticēto patoloģiju skaita pieaugumu tuvākajā nākotnē. Veikto operāciju rezultātu analīze palīdzēs pilnveidot ķirurģiskās pieejas algoritmu, kā arī prognozēt operatīvas terapijas rezultātu, balstoties uz pirmsoperācijas simptomu kompumu.
Darba mērķis: Izvērtēt spinālo audzēju operatīvās terapijas rezultātus atkarībā no audzēja morfoloģijas, lokalizācijas, klīniskajiem simptomiem un operācijas veida, pacienta neiroloģiskā stāvokļa pirms operācijas.
Materiāli un metodes – a) analizējot 49 pacientu slimības vēstures no 2013.-2018. gadam, kuriem diagnosticēta spināla intradurāla ekstramedullāra neoplāzija, iegūt datus par audzēja morfoloģisko veidu, lokalizāciju, simptomiem un ārstēšanas veidu, b) veikt pacientu neiroloģiskā un fukcionālā stāvokļa izvērtēšanu pirms un pēc operācijas balstoties uz Modified McCormick scale un izvērtēt pacientu dzīves kvalitāti vēlīnā pēcoperācijas periodā ar multidimensionālo COMI skalu līdz 60 mēnešiem pēc operācijas.
Darbs paredzēts 2019/2020.mācību gada ietvaros.
Rezultāti: Pētījumā tika iekļauti 49 pacienti (80% sievietes un 20% vīrieši). Vidējais pacientu vecums bija 57,5 gadi. Ķirurģiska audzēja rezekcija tika pielietota 44(90%) gadījumu. Visbiežāk audzēji lokalizējās attiecīgi torokālā daļā- 55%, cervikālā 31% gadījumu un lumbālā- 14%. Biežākās histoloģiski diagnosticētās audzēja formas bija meningioma (51%) un švannoma(31%), savukārt retāk sastopami audzēji bija miksopapillāra ependimoma(10%) un neirofibroma(8%). Pēcoperācijas komplikācijas bija novērojamas 10 pacientiem: 6 pacientiem pēc operācijas progresēja neiroloģiskais deficīts, 2 gadījumos attīstījās pseidomeningocēle, 2 gadījumos bija novērojamas lokālas problēmas ar operācijas brūci.
Vidējais COMI skalas rādītājs visiem pacientiem ilgtermiņā pēc operācijas - 39 punkti. Pacientu vidējais hospitalizācijas laiks - 12,4 dienas. Tika atklāta statistiski nozīmīga atsķirība starp Modified McCormick scale rezultātiem pirms un pēc operācijas (p=<0,01), kā arī starp audzēja lokalizāciju un neiroloģisko un funkcionālo statusu pēc operācijas (p=<0,01). Netika atrasta statistiski nozīmīga atšķirība starp audzēja veidu, ķirurģiskās pieejas metodi un Modified McCormick scale rezultātiem.
Secinājumi:
1. Spinālu intradurālu/ekstramedullāru audzēju ķirurģiskās ārstēšanas rezultāti ir ar samērā augstu (76% gadījumi) pozitīvu rezultātu attiecībā uz pacientu neiroloģiskā un funkcionālā stāvokļa uzlabošanu. Labākie rezultāti tika novēroti pacientiem ar krūšu un jostas daļās lokalizētiem audzējiem.
2. Pacientu grupā ar vidēji smagu un smagu neiroloģisku deficītu pirms operācijas bija novērojama visbūtiskākā pozitīvā dinamika pēcoperācijas periodā, savukārt pacientiem ar vieglu neiroloģisku deficītu pirms operācijas, uzlabojums pēc operācijas bija salīdzinoši mazāk izteikts.
Introduction: Intradural extramedullary tumors compile 2/3 of all primary intraspinal neoplasms. Analysis of postoperative results in patients also considering their preoperative neurological and functional status would help to improve tactics and algorithms, predict outcome before surgery. Aim: The aim of our study was to evaluate outcome in patients after undergoing surgical treatment for intradural extramedullary spinal tumors and to analyze neurological and functional status according to the tumor localization, type and surgical approach. Materials and Methods: Retrospectively collected data from 49 patients with intradural spinal tumors were analyzed and compared in relation to neurological status and to scores on the physician-rated modified McCormick Scale and the patient-rated multidimensional COMI Score, before and up to 60 months after surgery. Data were analyzed using Word Excel and IMB SPSS 22.0. Results: Study included 49 patients (79.6% were female and 20.4% men). Average age was 57.5 years. In 90% of cases patients were treated surgically. Regarding location- In 55% spinal tumor was thoracic, 31% cervical, 14% lumbar. Histological examination revealed, that in 51% tumor type was meningioma, 31% schwannoma, 10% myxopapillaryependymoma, 8% neurofibroma. In majority (52%) of all the cases surgical method was laminectomy, in 52% hemilaminectomy. Complications after the surgery were found in 23% of patients. 15 % of patients underwent spinal reoperation from which 12,5% had reoperation in the same segment. Average hospitalization period was 12,4 days. Mean COMI score for all patients who underwent surgery- 39 points. There was found statistically significant difference between McCormick score before and after surgery (p<0.01), there was also found statistically significant difference between tumor localization and neurological status by McCormick scale before and after surgery (p<0.01). In 68% there was statistically significant improvement in neurological status after surgery according to localization of tumor. There was no statistically significant difference between tumor type, surgical approach and McCormick score. Conclusions. 1. Spinal Intradural/ Extramedullary tumor surgical treatment results revealed good outcome ir 76% of patient in relation to neurological and functional status before and after the surgery. 2. Patients with moderate and severe neurological deficit prior the surgical resection showed highest positive outcome in dynamics after the surgery. However, patients with mild symptoms before the surgery did not show so high positive outcome after resection of tumor. 3. In late postoperative period common complains are radicular and back pain. Average pain intensity level for patients mostly is moderate.
Introduction: Intradural extramedullary tumors compile 2/3 of all primary intraspinal neoplasms. Analysis of postoperative results in patients also considering their preoperative neurological and functional status would help to improve tactics and algorithms, predict outcome before surgery. Aim: The aim of our study was to evaluate outcome in patients after undergoing surgical treatment for intradural extramedullary spinal tumors and to analyze neurological and functional status according to the tumor localization, type and surgical approach. Materials and Methods: Retrospectively collected data from 49 patients with intradural spinal tumors were analyzed and compared in relation to neurological status and to scores on the physician-rated modified McCormick Scale and the patient-rated multidimensional COMI Score, before and up to 60 months after surgery. Data were analyzed using Word Excel and IMB SPSS 22.0. Results: Study included 49 patients (79.6% were female and 20.4% men). Average age was 57.5 years. In 90% of cases patients were treated surgically. Regarding location- In 55% spinal tumor was thoracic, 31% cervical, 14% lumbar. Histological examination revealed, that in 51% tumor type was meningioma, 31% schwannoma, 10% myxopapillaryependymoma, 8% neurofibroma. In majority (52%) of all the cases surgical method was laminectomy, in 52% hemilaminectomy. Complications after the surgery were found in 23% of patients. 15 % of patients underwent spinal reoperation from which 12,5% had reoperation in the same segment. Average hospitalization period was 12,4 days. Mean COMI score for all patients who underwent surgery- 39 points. There was found statistically significant difference between McCormick score before and after surgery (p<0.01), there was also found statistically significant difference between tumor localization and neurological status by McCormick scale before and after surgery (p<0.01). In 68% there was statistically significant improvement in neurological status after surgery according to localization of tumor. There was no statistically significant difference between tumor type, surgical approach and McCormick score. Conclusions. 1. Spinal Intradural/ Extramedullary tumor surgical treatment results revealed good outcome ir 76% of patient in relation to neurological and functional status before and after the surgery. 2. Patients with moderate and severe neurological deficit prior the surgical resection showed highest positive outcome in dynamics after the surgery. However, patients with mild symptoms before the surgery did not show so high positive outcome after resection of tumor. 3. In late postoperative period common complains are radicular and back pain. Average pain intensity level for patients mostly is moderate.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Intradurāls ekstramedullārs audzējs, COMI, Modified McCormick scale, Intradural extramedullary tumor, COMI, Modified McCormick scale