Factors Affecting Postoperative Neurological Deficits After Nerve Root Resection for the Treatment of Spinal Intradural Schwannomas
Factors Affecting Postoperative Neurological Deficits After Nerve Root Resection for the Treatment of Spinal Intradural Schwannomas
复制标题
神经根切除治疗脊髓硬膜内神经鞘瘤术后神经功能缺损的影响因素
DOI：
10.1097/brs.0000000000001248
复制
发表时间：
2016-03-01
期刊：
影响因子：
3
通讯作者：
Ma, Xiaosheng
中科院分区：
文献类型：
--
作者：
Zou, Fei;Guan, Yunzhi;Ma, Xiaosheng
研究设计。对临床资料进行回顾性分析。目标。目的探讨脊髓硬膜内神经鞘瘤神经根切除术后神经功能障碍的相关因素。背景数据摘要。脊髓硬膜内神经鞘瘤肿瘤相关神经根切除后可观察到神经功能障碍。因此，寻找与术后神经功能障碍相关的因素是非常重要的。方法：研究方法。临床和病理资料来自T11~S行全切除的孤立性硬膜内神经鞘瘤患者，分为术后神经功能缺陷阳性组(PND组，n = 12例)和阴性组(非PND组，n = 52例)。分析患者的年龄、性别、病程、糖尿病、术前视觉模拟评分(VAS)、SF-36评分、术前症状、肿瘤大小、肿瘤部位、免疫组织化学染色结果。结果。两组患者的年龄、性别、病程、糖尿病、术前视觉模拟评分、SF-36评分、肿瘤长度、肿瘤占有率差异均无统计学意义(P >； )。PND组患肢疼痛、感觉障碍和运动障碍的发生率分别为25.0%、50.0%和75.0%，非PND组分别为76.9%、17.3%和7.7%，差异有统计学意义(P <； 0.05)。肿瘤位于胸腰椎交界处(T11~L2)的术后神经功能缺损率高于其他节段(L2~S；P = 0.009)。免疫组化结果显示，两组间CD34阳性率差异有统计学意义(P = 0.013)。结论。术前无下肢疼痛、感觉和运动障碍、胸腰椎交界处肿瘤位置(T11-L2)是术后神经功能障碍的预测因素。年龄、性别、病程、糖尿病、术前VAS评分、术前SF-36评分、肿瘤长度和肿瘤占有率与术后神经功能缺失无关。在肿瘤免疫染色方面，CD34阴性结果与术后神经功能障碍的发生有关。证据级别：4
Study Design. A retrospective clinical data analysis. Objective. To investigate the factors related to postoperative neurological deficits after nerve root resection in the treatment of spinal intradural schwannoma. Summary of Background Data. Neurological deficits could be observed after resection of tumor-involved nerve roots in spinal intradural schwannoma. Thus, it is important to find the factors related to postoperative neurological deficits. Methods. Clinical and pathological data were selected from patients underwent total resection of the solitary spinal intradural schwannoma from T11 to S. Patients were divided into the postoperative neurological deficits positive group (PND group, n = 12) and negative group (non-PND group, n = 52). Clinical features including age, sex, duration of disorders, diabetes, preoperative visual analogue scale (VAS) and SF-36 score, preoperative symptoms, tumor size, tumor location, and immunostaining results were analyzed. Results. Age, sex, duration of disorders, diabetes, preoperative VAS and SF-36 score, tumor length, and tumor-occupied ratio were not significantly different between the two groups (P > 0.05). Lower extremity pain, sensory disturbance, and motor disturbance were found in 25.0%, 50.0%, and 75.0% of patients in the PND group and 76.9%, 17.3%, and 7.7% of patients in the non-PND group, respectively, and the results were significantly different (P < 0.05). The rate of postoperative neurological deficits was higher when the tumor was located in the thoracolumbar junction (T11–L2) than other segments (L2–S; P = 0.009). For immunostaining study, CD34-positive rate was significantly different between the two groups (P = 0.013). Conclusion. The absence of preoperative lower extremity pain, presence of sensory and motor disturbances, and tumor location in the thoracolumbar junction (T11–L2) are the predictors of postoperative neurological deficits. Age, sex, duration of the disorders, diabetes, preoperative VAS score, preoperative SF-36 score, tumor length, and tumor-occupied ratio are not related to postoperative neurological deficits. On immunostaining of tumors, CD34-negative results are related to the development of postoperative neurological deficits. Level of Evidence: 4