Background

Intraspinal epidermoid/dermoid cysts are very rare, benign tumors arising from pathological displacement of epidermal cells into the spinal canal. Literature data about the long-term outcome after microsurgical resection with multimodal intraoperative neurophysiological monitoring (IONM) are lacking. We analyzed one of the largest case series with special regard to intraoperative characteristics and long-term outcome after IONM-aided surgery.

Method

All 12 patients (m:f = 1.4:1) who underwent microsurgical tumor resection with multimodal IONM for intraspinal epidermoid/dermoid tumors between 1998 and 2019 in our university hospital were included. We retrospectively investigated the patients’ characteristics, imaging/surgical parameters, and postoperative long-term outcomes.

Results

Symptomatic tumor manifestation was seen during adulthood in 4 patients (median age 33.0 years) and during childhood in 8 patients (median age 4.3 years). Spinal dysraphism was the most often comorbidity (75%). The most frequent symptoms at diagnosis were spastic pareses (75%), ataxia (58%), and vegetative disorders (42%). Tumors were most often lumbosacral (L1–L5 42%, L5–S3 50%) and intradural-extramedullary (92%). For microsurgical resection, IONM with EMG, SSEPs, and TcMEPs of the limbs and pudendal nerve/anal sphincter was always applied and feasible; intraoperative corrective actions were initiated in three cases due to transient IONM deterioration. None of the patients showed a postoperative deterioration of the neurological status with a gross total resection rate of 92%. Pain situation, McCormick grade, and mJOA Score were improved at long-term follow-up (median 4.8 years).

Conclusions

IONM-aided resection of intraspinal epidermoid/dermoid tumors is feasible both in adult and pediatric cases and enables a satisfying clinical and surgical outcome.

中文翻译：

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脊柱内表皮样和皮样囊肿的肿瘤切除，并进行多模式术中神经生理学监测和长期预后。

背景

脊柱内表皮样/皮样囊肿非常罕见，良性肿瘤是由表皮细胞病理性移位进入椎管引起的。缺乏有关采用多模式术中神经生理监测（IONM）进行显微手术切除后的长期预后的文献资料。我们分析了最大的病例系列之一，特别关注了IONM辅助手术后的术中特征和长期预后。

方法

在1998年至2019年间，我们的12例患者（m：f = 1.4：1）在我校大学医院接受了针对脊柱内表皮样/皮样肿瘤多模式IONM的显微外科肿瘤切除术。我们回顾性研究了患者的特征，影像/手术参数以及术后长期预后。

结果

有症状的肿瘤表现在成年期有4例患者（中位年龄33.0岁），在儿童期有8例（中位年龄4.3岁）。脊柱发育不良是最常见的合并症（75％）。诊断时最常见的症状是痉挛性轻瘫（75％），共济失调（58％）和植物性疾病（42％）。肿瘤多为腰s部（L1-L5 42％，L5-S3 50％）和硬膜外延髓（92％）。对于显微手术切除，四肢和阴部神经/肛门括约肌肌电图，SSEP和TcMEP的IONM一直被应用并且可行。由于短暂的IONM恶化，在三例中开始了术中纠正措施。没有患者表现出术后神经系统状况恶化，总切除率为92％。疼痛情况，麦考密克等级，

结论

IONM辅助的椎管内表皮样/皮样肿瘤切除术在成人和小儿病例中都是可行的，并能使临床和手术结果令人满意。