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 (p0.001). 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 (p0.001). 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.
Highlights
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
Summary
Проанализированы клинико-неврологические исходы хирургического лечения пациентов с интрадуральными опухолями спинного мозга, а также факторы, влияющие на указанные исходы. Исследование продемонстрировало, что в большинстве случаев хирургического лечения с достижением максимально возможной степени резекции опухолевой ткани у пациентов с интрадуральными опухолями спинного мозга в отдаленном периоде отмечены хорошие и отличные результаты. (Для цитирования: Бывальцев В.А., Степанов И.А., Белых Е.Г., Алиев М.А. [4], интрамедуллярные опухоли составляют 20−30% всех первичных опухолей спинного мозга, в то время как экстрамедуллярные опухоли встречаются в 70−80% случаев. Частота встречаемости экстрамедуллярных опухолей составляет 80−90% среди всех опухолей спинного мозга [7], в другом отечественном исследовании отмечено, что распространенность интрамедуллярных спинальных опухолей варьирует в пределах 5−10% [8]. Цель исследования ― оценить отдаленные результаты хирургического лечения пациентов с интрадуральными опухолями спинного мозга, а также определить основные факторы, влияющие на клинико-неврологические исходы оперативных вмешательств у данной группы пациентов. 3) декомпенсированный сахарный диабет; 4) тяжелая сердечная и/или дыхательная недостаточность; 5) тяжелая почечная и/или печеночная недостаточность; 6) множественное метастатическое поражение органов и тканей
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