gms | German Medical Science

125. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

22. - 25.04.2008, Berlin

Spinal intradural meningiomas and nerve sheath tumors – surgical results and clinical outcome

Meeting Abstract

  • corresponding author R. Goldbrunner - Neurochirurgische Klinik, Klinikum Grosshadern, München, Deutschland
  • C.A. Erös - Neurochirurgische Klinik, Klinikum Grosshadern, München, Deutschland
  • S. Zausinger - Neurochirurgische Klinik, Klinikum Grosshadern, München, Deutschland
  • J.-C. Tonn - Neurochirurgische Klinik, Klinikum Grosshadern, München, Deutschland

Deutsche Gesellschaft für Chirurgie. 125. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 22.-25.04.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. Doc08dgch9553

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgch2008/08dgch209.shtml

Veröffentlicht: 16. April 2008

© 2008 Goldbrunner et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


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.