The Curative Effect Of Microsurgery For Tumors In The Superior Cervical Spinal Cord And Analyze The Related Factors On Prognosis

Objective To evaluate the curative effect of microsurgery for tumors in the superiorcervical spinal cord and analyze the related factors on prognosis.Methods We retrospectively analyzed a series of41patients with tumors in thesuperior cervical spinal cord of C4or above who were treated by Neurosurgerydepartment of Wuhan Union from January2007to May2011.The tumors are locatedat the extramedullary level in7patients, foramen magnum in3,pulp ventral in7,growth dumbbell shaped inside or outside spinal canal in9. The ration of the averagewidth between intramedullary tumor in the superior cervical spinal cord and spinalcord is1.08>0.80; The ration of the average width between the extramedullarytumor in the superior cervical spinal cord and spinal cord is2.18. Surgical operationswere performed for resection,including posterior central unilateral laminectomyapproach in25and laminollasty in16cases.Results Pathology reports in the surgical operation showed: ependymoma was in4cases, variant ependymoma in1case,astrocytomas in2cases, Schwannomas in28cases, eningiomas in4,untypical-eningiomas in1case, Syncytial meningioma in1case.There were39cases of total resection,among which2cases were resected jointlywith other departments.(in one case in postoperative pathologic examination of neckmass resection operated by vascular surgery, nerve sheath tumor was found, so theotolaryngology resected the extraspinal tumor; in another case C2-3tumor withmultiple nerve fibersfibromatosis was totally-resected in our department, thendepartment of orthopedics arranged a tumor resection of C4,-6and L4-5、S1). Therewere2cases of partial resection (in one case intramedullary star-shaped cell tumor wasat level II, which has been followed for2years without recurrence; in another caseintraspinal and extraspinal dumbbell-shaped growing tumor, endoscopic intraspinaltumor was totally-resected, part of the tumor extended out of the spinal canal from theintervertebral foramen. It was so closely adhesive that can not be removed. Thus electrocautery was adopted to stop bleeding completely). Postoperative complications:in one case the patient with dyspnea before the operation has a coma after the operation;in another case patient with postoperative fever suspected infection recovered aftertreatment, and there was no death during perioperative period.The motor and sensoryfunctions were found to be improved after operation in89.30％（25/28）and63.30%（19/30）respectively.The sphincter function was improved in100%（3/3）.The rate ofpain relief was94.10%（16/17）.The follow-up periods ranged from1to5.1years in37patients with an average of3years and1recurrence was found.73.2%(30/41) ofpatients were graded to E level according to neural function ASIA and1case withrecurrence was found.(Ⅲ level in variant intramedullary ependymoma withtotal-resection and postoperative chemotherapy, the tumor was to recur and shifted tobrain after three months, and the patient suferred hearing-loss.)The average time offixing the neck-collar after operation was34.5days.After one year of follow-up, therewere4cases of the patients sufferring pain and stiffness on the neck and back (one caseof nerve sheath tumors, and one case of pulp ependymoma),the occurrence of axialsymptoms reached6.3%﹤＜45%(P<0.05).And the score of cervical vertebra JOAimproved obiviously（P<0.005）.Conclusion The radical microneurosurgery treatment for intradullary tumor in thesuperior cervical spinal cord has been increasingly improved and the ration of tallresection has been heightened.Even if the diameter in the intramedullary tumor isrelatively big and the whole results are satisfactory, prognosis and neurological statusbefore surgical operation are closely related. Reduction of wearing the fixed neck-collarand doing proper muscle functional exercise can reduce the occurrence of axialsymptoms. Acupuncture treatment for rehabilitation can promote the recovery of spotrsand feeling functions, which should not be neglected.