Surgical Experiences with Intradural Spinal Metastases from Systemic Neoplasms

源自非中樞神經系統的惡性腫瘤轉移到脊椎的硬腦脊膜內空間極為罕見。對於此類轉移腫瘤，目前文獻中並無針對東方人的報告。本篇報告我們收集十二個脊椎脊髓硬腦脊膜內系統性惡性腫瘤轉移的個案，以回溯性研究的方法統計其病史，臨床症狀／徵象，治療方法及治療結果。於診斷時所有的病人均有與病灶對應的肢體無力症狀。最常見的原發腫瘤是肺癌。最常見的轉移位置是胸腰椎交界處。所有的病患均接受椎板切除減壓併完全或部份腫瘤移除手術。於十二名接受手術的病患中，六名病患於術後肌力有進步，四名維持不變，二名惡化。從本篇統計結果得知，對患有硬腦脊髓膜內脊髓外(intradural extramedullary)之脊椎惡性轉移腫瘤的病人，於體感覺誘發電位(somatosensory evoke potential)監測下進行椎板切除併腫瘤切除手術，可緩解腫瘤造成之疼痛及無力症狀。對於脊髓內(intramedullary)之脊椎惡性轉移腫瘤的病人，腫瘤切除手術治療結果並不理想。對於對放射線敏感的腫瘤，應考慮採取放射治療。

關鍵字

硬腦脊髓膜內轉移；脊椎轉移；腫瘤轉移；椎板切除術

並列摘要

Intradural metastasis of neoplasms from non-CNS origin is rare. In the English literature, there is no report regarding intradural spinal metastasis from such tumors concerning oriental population. We present a retrospective review of 12 spinal intradural metastases. Clinical history, symptom/signs, surgical approach and surgical outcome were obtained by review of patient charts. All of the patients had presented some degree of limb weakness in addition to other symptoms. The most common primary tumor was carcinoma of the lung. The most common site of metastasis was the thoracolumbar junction. All patients underwent laminectomy with total or partial tumor removal. Of the 12 patients, 6 patients reported muscle power improvement, 4 remained the same, and 2 deteriorated. Our results indicated that, for patients with intradural extramedullary metastatic lesion, laminectomy with tumor removal under SSEP monitoring provided pain relief, muscle power/functional status restoration and pathology proof. For intramedullary lesion, the result of surgical treatment is less satisfactory. Nonsurgical treatment may be warranted, particularly for radiosensitive tumors.

並列關鍵字

intradural metastasis ； spinal metastasis ； metastatic tumor ； laminectomy

國際替代計量

Surgical Experiences with Intradural Spinal Metastases from Systemic Neoplasms

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