ABSTRACT
Presentamos el caso de un hombre de 60 años con signos clínicos de mielopatía cervical de un año de evolución, dolor cervicodorsal intenso (estadio B de Frankel, grado V de Nurick), en el momento de nuestro primer examen. Trae una resonancia magnética que informa un tumor cervicotorácico compatible con meningioma. El paciente requería una rápida resolución quirúrgica y exéresis. Si bien el tiempo entre la presentación clínica inicial y el diagnóstico preliminar de meningioma por resonancia magnética está dentro de lo estipulado en la bibliografía, creemos que esta enfermedad se podría haber diagnosticado y tratado de forma más temprana. Llegamos a la conclusión de que el diagnóstico tardío sumado a las limitaciones en el sistema de salud pública actual han contribuido al resultado final poco satisfactorio, ya que luego de la resección tumoral, la liberación medular y la estabilización con material quirúrgico, aunque el resultado inmediato fue satisfactorio, no se logró un buen resultado funcional a largo plazo, porque el paciente no recuperó la función motora ni sensitiva, sólo se logró que la mielopatía no progresara y el paciente no sufra más dolor.
We report the case of a 60-year-old man with clinical signs of cervical myelopathy during a year, intense cervicodorsal pain (Frankel B stage, Nurick grade V), at the moment of our first examination. He shows a magnetic resonance study reporting cervicothoracic tumor compatible with meningioma. The patient required a quick surgical resolution and excision. Although the time between the initial clinical presentation and the preliminary diagnosis of meningioma by magnetic resonance imaging is within that reported in the literature, we believe that this disease could have been diagnosed and treated earlier. We conclude that late diagnosis added to the limitations in the current public health system have contributed to the unsatisfactory outcome, because after tumor resection, spinal release and stabilization with surgical material, immediate results were successful, but the patient did not obtain a long-term good functional outcome, because he did not recover motor and sensory function, we only avoided myelopathy progression and pain.
Subject(s)
Middle Aged , Meningioma , Spinal Cord Neoplasms , Cervical Vertebrae , Thoracic VertebraeABSTRACT
Intraspinal tumors with kinds of pathological type are common in clinic, whose first option of the treatment is the surgical resection.In recent years, neurosurgeons pay more attention to the postoperative stability of spine biomechanics on the basis of the total resection of the tumors.This paper reviews the approaches in intraspinal tumors resection and the methods of the reconstruction of spinal stability postoperatively which influence the stability of spine biomechanics most.
ABSTRACT
To investigate the diagnosis and surgical treatment of inraspinal tumors. The clinical data of 246 patients with inraspinal tumors who had undergone operations in the Affiliated Hospital of Qingdao University Medical Col ege between January 2010 and January 2013 were retrospectively analyzed. The treatment and prognosis of inraspinal tumors were reviewed. 262 operations were performed, with posterior bilateral laminectomy approach in 202 cases, semi-laminectomy approach in 28 cases, laminoplasty approach in 10 cases, and lateral resection of extra-vertebral canal dumbbel shaped tumors in 22 cases. The short-term remission rate of the nerve root pain reached 95.0%(133/140), and the improvement rates of the sensory disability, motor disturbance, and sphincter dysfunction were 85.6%(125/146), 86.7%( 136/157), and 84.6(11/13) respectively. The ASIA nervous function scores and grades at the last fol ow-up were significantly superior to those before and 3 months after the operation in 236 patients. Intraspinal tumors are mostly benign. The clinical appearance of them should be watched closely, and thorough physical check-up should be performed. MRI is the examination of choice at early diagnosis. The key to improve the treatment effects is to perform operations as soon as possible.
ABSTRACT
Objective To explore the application value of preoperative methylene blue staining in locating for the operation of intraspi-nal tumors. Methods The clinical data of patients with intraspinal tumors from September 2010 to September 2012 in our hospital were ret-rospectively analyzed. The patients were divided into tag group and control group according to whether stained by methylene blue or not. The operation time( min) ,intraoperative hemorrhage,the rate of total resection of tumor,spinal instability rate,tumor recurrence rate,and reopera-tion rate of two groups were compared. Results The operation time of tag group was significantly shorter than that of the control group. The amount of intraoperative bleeding was significantly less than that of in control group, the differences were statistically significant(P<0. 05). The total resection rate of tumor was significantly higher than that in control group,the differences were statistically significant(P<0. 05). The spinal instability rate,tumor recurrence rate and operation rate of patients within 1 year in two groups were not significant. Conclusion The methylene blue method is simple and convenient,and provides favorable conditions for the operation,which reduces the operation time and intraoperative hemorrhage,increases the rate of complete tumor resection. There was no difference in recurrence rate,operation rate and the stability of the spine within 1 year compared to traditional method.
ABSTRACT
Objective To summarize the experiences of the diagnosis and treatment of the intraspinal tumors. Methods One hundredand twenty-three cases of the intraspinal tumors were analyzed retrospectively. Results The intraspinal tumors in those patients included meningiomas/neurofibroma in 32 cases (19.5%), neurinoma in 32 cases (26.0%), ependymoma in 8 cases (6.5%), astrocytoma in 13 cases (10.6%), lipoma in 10 cases (8.1%), metastatic tumors and hemangioma each in 5 cases (4.1%), arachnoid cyst in 9 cases (7.3%), and others in 17 cases (13.8%). The extramedullary subdural, epidural and intramedullary tumors accounted for 56.9%, 21.1% and 22.8%. According to the locations, 30.1% tumors located at cervical region, 37.4% at thoracic region, 19.5% at lumbar region and 13.0% at sacral segments. The total removal rates of tumors were 69.1% (the total removal rates of extramedullary tumors were 70.1%, and the removal rates of intramedullary tumors were 60.7%).The improvement rates of different degree of movement, sense and sphincter function were 75.2%, 73.8% and 77.8%. Conclusion Most of the intraspinal tumors are benign, and the surgical outcome is satisfied. The keys of therapeutic efficacy were MRI and microsurgical techniques application. The spinal stability reconstruction is in the extreme need if spinal stability is breached in surgery.