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Journal of Neurosurgical Sciences 2002 March;46(1):18-24

lingua: Inglese

Spinal intra­du­ral extram­e­dul­lary ­tumors. Personal expe­ri­ence

Albanese V., Platania N.

Department of Neurosciences, Section of Neurosurgery, University of Catania, Catania


Background. Spinal intra­du­ral extram­e­dul­lary ­tumors ­account for 2/3 of all intra­spi­nal neo­plasms and are main­ly rep­re­sent­ed by menin­gio­mas and schwan­no­mas, ­with the for­mer account­ing for the 25-46% of all pri­mary intra­spi­nal ­tumors. Technical advanc­es in imag­ing tech­nique, magnetic resonance imaging (MRI) and sur­gi­cal pro­ce­dures ­have ­brought ­about sig­nif­i­cant bet­ter clin­i­cal ­results in the ­last 2 ­decades. Neverthless a ­small per­cent­age of ­patients ­still ­present ­poor post­op­er­a­tive out­come main­ly relat­ed to the dura­tion of clin­i­cal his­to­ry, the sever­ity of pre­op­er­a­tive neu­ro­log­i­cal def­i­cits and to ­some spe­cif­ic ana­to­mo-sur­gi­cal ­aspects.
Methods. In an ­effort to clar­i­fy the influ­ence of ­these fac­tors on ­patient’s out­come, the ­authors ana­lyze the clin­i­cal, sur­gi­cal and prog­nos­tic ­data of 41 ­patients ­with intra­du­ral extram­e­dul­lary spi­nal ­tumor sur­gi­cal­ly treat­ed ­between January 1990 and December 1999. The fol­low-up peri­od ­ranged ­from 1 to 9 ­years. The clin­i­cal his­to­ry ­until admis­sion and treat­ment was 3-48 ­months for menin­gio­mas and 1-72 ­months for schwan­no­mas.
Results. Morbidity and mor­tal­ity ­rate was 5 and 0% for menin­gio­mas and 0 and 6% for schwan­no­mas. Almost all the ­patients expe­ri­enced a sig­nif­i­cant neu­ro­log­i­cal improve­ment ­after sur­gery, ­with a per­cent­age of Nurick’s ­grade 1 and 2 of 68% ­among ­patients ­with menin­gio­mas and 66% ­among ­patients ­with schwan­no­mas. Removal of the ­tumor was com­plete in 90% of menin­gio­mas and 94% of schwan­no­mas.
Conclusions. The ­authors ­address rad­i­cal sur­gery as the ­ideal ­goal in ­these neo­plasms, as it ­gives the ­patients the ­best ­long-­terms ­results, point­ing out the impor­tance of system­at­ic ear­ly iden­tifi­ca­tion of any ­main radic­u­lom­e­dul­lary ­artery dur­ing debulk­ing and dis­sec­tion of the ­tumor to ­avoid any ­risk of ­severe post­op­er­a­tive neu­ro­log­i­cal wors­en­ing of the ­patients.

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