The Clinical Features And Prognostic Analysis Of The Upper Cervical Intraspinal Tumors

1、The microsurgical treatments of the upper cervical intraspinal tumors.Objective To discuss the clinical manifestations and imaging features of different pathological tumors in the upper cervical canal, and analyse the microsurgical treatments effect and related factors of prognosis.Methods Retrospect the clinical files of135cases from Jan.2003to Dec.2013which received surgical treatments in our Neurosurgery department.Results All the patients received MRI examination before the operation in order to indentify the location of the tumors. Five surgical approaches were employed. Posterior approach was adopted in105cases, Lateral approach was used in17cases and anterior approach in6cases. Far lateral approach was used in5cases. Combined approach was used in2cases. The tumors were total removed in124cases(91.85%) and subtotal removed in10cases(7.41%) and partial removed in1cases (0.74%). There were96subdural-extramedullary tumors,35cases of intramedullary tumors and4epidural tumors, including42cases of dumbbell tumors. The pathology of tumors in this series mainly were neurinoma(56cases) and meningioma(39cases), the other types were totally29.63%. After the operation, all the patients received regular examination of MRI. We could see that the spinal tissue of operation had edema.5patients had simple cerebrospinal fluid leakage with no intracranial infection after timely treatment.1case of elderly patients had postoperative pulmonary infection and died of respiratory failure in16days. There were110postoperative patients who were followed-up2months to3years had no cervical instability.Conclusion Early diagnosis of the upper cervical intraspinal tumors is not easy. Compared with other spinal segments, the risk of operation in upper cervical tumors is high and the process is difficult. MRI is the first choice of imageological examination. Surgical treatment should be accepted positively after clarify diagnosis. Posterior approach can be used in most of the cases. Lateral approach and far lateral approach have a advantage of exposing the tumors in the spine canal, but have a large lesion. Schwannoma and meningioma are the common type of pathology. Intramedullary tumors are always be benign or low malignant grade, different degree of swelling of the spinal cord are common after operation. Dehydration drug and hormone should be prophylactic used to avoid the postoperative clinical symptoms. Patients with only mild myodynamia falling, numbness may be improved obviously, but the one who has been a significant myodynamia falling, bladder and bowel dysfunction may improve slowly. After a long-term compression of the tumor, the spine cord may be get another hurt when the tumor was removed because of ischemia-reperfusion injury, then aggravate the clinical symptoms. There is a significant interface between ependymoma and the spinal cord, so it can be totally resected and have a lower recurrence. Intramedullary astrocytoma has a characteristic of invasive growth and there is no clear boundary between tumor and normal spinal cord. If we emphasize the resection rate, it often can cause serious complications. 2、Neuro-electrophysiological monitoring use in the microsurgery of upper cervical intraspinal tumors.Objective To explore the applications and effect factors of using electrophysiolo-gical monitoring in upper cervical intraspinal tumors.Methods To retrospect the clinical data of64patients with upper cervical intraspinal tumors which received surgery in our Neurosurgery department between Jan.2008to Dec.2013.Results The64patients were operated under electrophysiological monitoring. Total tumor resection was achieved in54patients (84.38%) and subtotal resection in8cases (12.50%) and partial resection in2cases (3.12%). There were42patients whose spinal function is in McCormick grade Ⅰ and22cases in grade Ⅱ. Two weeks after the operation, the patients of McCormick grade Ⅰ were48cases and15cases in grade Ⅱ and1case in grade Ⅲ.In operation, the MEP electrophysiology amplitude changed in48cases patients and SEP changed in30cases, then it went back to normal when the surgeon took some measures and left no neurological dysfunction. One patient have a false negative monitoring results and have activity obstacle in her upper limbs, who had normal activity before operation.Conclusions The combined application of electrophysiological and microsurgical techniques can significantly improve the total resection rate of upper cervical tumors, maximize the protection of the spinal cord and nerve. But if the monitoring result is false positive, it can mislead the surgeon and prolong operation time. If the result is false negative, the surgeon failed to stop the operation which may cause a spinal cord injury and lead nerve dysfunction. Intraoperative monitoring can be easily affected by many factors at the same time; so the electrophysiological monitoring accuracy was went down. When doing the laminectomy of the meningioma of the spinal cord, the SEP/MEP amplitude can reduce. Maybe it is because in the process of lamina excision, there exist the possibility of damage to the spinal cord, so the operation should be gentle. In the remove of the upper cervical intramedullary tumor, electrophysiology amplitude can also change, the surgeon should suspend the operation. If the boundary of intramedullary tumor is not clear, the operator should not pursuit a complete tumor resection, even if under the guidance of electrophysiological monitoring.