Artikel
Spinal intradural meningiomas and nerve sheath tumors – surgical results and clinical outcome
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Autoren
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R. Goldbrunner
- Neurochirurgische Klinik, Klinikum Grosshadern, München, Deutschland
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C.A. Erös
- Neurochirurgische Klinik, Klinikum Grosshadern, München, Deutschland
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S. Zausinger
- Neurochirurgische Klinik, Klinikum Grosshadern, München, Deutschland
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J.-C. Tonn
- Neurochirurgische Klinik, Klinikum Grosshadern, München, Deutschland
| Veröffentlicht: | 16. April 2008 |
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Gliederung
Text
Introduction: Meningiomas and nerve sheath tumors (NST) represent the majority of intradural extramedullary tumors. Surgery is the primary treatment for these entities. Therefore, clinical outcome is dependent on the quality of surgical care. Aim of our study was to assess surgical results and the neurological outcome of these patients.
Material and methods: 93 patients (49 meningioma, 44 NST, WHO °I-IV), which have been operated between 1/2002 and 10/2006, were included. Intraoperative electrophysiological monitoring (IEM) was performed routinely, intraoperative ultrasound (IOU) was used in 62% and 61%, with increasing frequency. Clinical outcome using the McCormick scale (0, no deficit – 5, completely dependent) was assessed preoperatively, one week and 6 months after surgery. Routine postoperative MRT was done to rate complete tumor removal.
Results: Resection grade Simpson I and II was achieved in 23/26 meningiomas, in 3 cases of large thoracic meningiomas with paraparesis Simpson III was attained. In NST, complete resection was achieved in 23/27 patients. In 4 patients, tumor remnants had to be left on nerve roots to preserve function. IOU allowed exact localization before dura opening in all cases. IEM was very valuable in defining the degree of resection particularly in NST. There was no patient with postoperative clinical deterioration or spinal instabilty. In meningiomas median preoperative McCormick score was 2, which was highly significantly (p<0.01) improved after 6 months (median 1) compared to preoperative score and score after one week. Comparably, in NST patients McCormick median score after 6 months (1) was highly significantly (p<0.01) improved compared to preoperative medain score (2).
Conclusion: Using contemporary techniques, safe tumor removal with favourable clinical course can be accomplished in nearly any patient with an extramedullary tumor. Since preservation of function is the primary goal in these mostly benign lesions, radicalty of resection should be optimized by IEM.
