Medulloblastoma originated in the brain and metastasized to the spine, which is very common in children.
Gliomas (ependymomas, astrocytomas or ganglioneuromas) are cancers formed in cells called glial cells.
Chordoma, originated from the residual chordal tissue of embryo.
Neurilemmoma originating from peripheral nerve.
Meningioma, originating from the tissue around the spinal cord (meninges)
According to the position of spinal cord tumor, it is generally divided into intramedullary tumors and extramedullary tumors:
Intramedullary-extramedullary-tumor is located in the thin layer (dura mater) of the spinal cord, but outside the actual spinal cord. The frequency of this place is 40%. The more common tumor types occur in the arachnoid membrane (meningioma) of the spinal cord, nerve roots extending from the spinal cord (neurilemmoma and neurofibroma) or the spinal cord base (ependymoma of the terminal filament). Although meningiomas are usually benign, they are difficult to remove and may recur. Nerve root tumors are usually benign, although neurofibromas may become malignant over time. The ependymoma at the end of the spinal cord may be very large, and the subtle features of the fine neural structure in this area may make it difficult to remove.
Intramedullary-These tumors grow in the spinal cord. They are usually derived from glial cells or ependymal cells (a kind of glial cells) and distributed throughout the spinal cord. The frequency of this place is about 5%. Astrocytoma and ependymoma are two common types. Astrocytomas are most common in the thoracic segment, followed by the cervical segment. Ependymomas are most common in silk (the bottom of spinal cord), followed by cervical segments. They are usually benign (compared with intracranial), but they are difficult to remove.
Epidural-The tumor is located in the epidural space, which is a thin covering around the spinal cord. The incidence rate in this area and above is about 55%. These lesions are usually caused by metastatic cancer or rare nerve root cell neurilemmoma. Sometimes epidural tumors pass through the intervertebral foramen, some in the spinal canal and some outside the spinal canal.
? At present, the treatment of spinal cord tumor at home and abroad is mainly surgical resection and radiotherapy. Surgical treatment is the first choice for spinal cord tumor. Surgery as soon as possible if it can be removed. The operative effect is related to the time, range and degree of nerve tissue compression and the nature of tumor. In addition, some tumors have infiltrated into medulla, which may lead to serious nervous system dysfunction after operation, or the general situation of patients does not allow surgery, and there is no clear clinical evidence for the pathological diagnosis of radiation sensitive person. Radiotherapy is feasible, but the appropriate dose and course of treatment should be controlled to prevent the occurrence of radiation myelopathy.
? Many patients in clinic have such concerns: "If the operation is unsuccessful, will I be paralyzed?" This kind of worry is not unreasonable. Although modern microscope technology is developing continuously, neurosurgery high-definition microscope can enlarge the surgical field of vision several times, and the spinal cord and its surface vascular structure can be clearly seen, so that electrophysiological monitoring can be carried out in real time during operation. However, the key to spinal cord tumor's operation is to cut off the spinal cord, and the tumor must be carefully separated and removed with a microscope. Slight impropriety is the characteristic of this kind of operation, which may cause serious consequences, so it needs the patient and meticulous operation of experienced neurosurgeons. To put it simply, after all, under the condition that the tissues around the tumor are so complicated, the difference of doctors' ability affects the success or failure of the operation. How to choose a reliable doctor? These are all hot topics that patients care about. A successful neurosurgery operation needs to meet the following conditions:
1. The higher the elimination rate of spinal cord tumor, the longer the recurrence period, and even the long-term non-recurrence. 95%~ 100% resection is obviously superior to 60%~70% resection in terms of overall prognosis, recurrence cycle and overall survival.
2. In addition to ensuring the resection rate, the protection of normal nerve function is also very important. If normal blood vessels and nerves are stripped, they will reach tumor tissue through many obstacles and be safely removed. This requires not only the superb skills of neurosurgeons, but also the precise cooperation of anesthesia teams and advanced intraoperative navigation and electrophysiological monitoring equipment.
Generally speaking, if spinal cord tumor meets the indications for surgery, then surgery is the most important for the whole treatment, survival time and quality of life. The first operation is very important. If the above two points are achieved, the survival time and quality of life will be greatly improved. Moreover, from the perspective of therapeutic economics, perfect surgery saves a lot of ICU nursing expenses, side effects and complications, and even a lot of rehabilitation expenses. Generally speaking, for the whole treatment cycle and survival cycle, not only a good quality of life is obtained, but also the total treatment cost is saved.
Therefore, it is suggested that the majority of patients try to find a good hospital and neurosurgeon who is best at this field, especially in high-risk and complex parts, such as brain stem, medulla oblongata, thalamus, basal ganglia, optic glioma, acoustic neuroma, pituitary adenoma, sellar region tumor, foramen magnum tumor, cavernous sinus tumor and so on. In the ranking of neurosurgical hospitals in China, Beijing Tiantan Hospital and Shanghai Huashan Hospital are both quite powerful.
The construction and development of modern neurosurgery courses in China began in 1980s and 1990s. Compared with the development history of modern neurosurgery in foreign developed countries 100 years, it is still immature. Although China has a large population base and a large number of operations, the quality and quantity of excellent and difficult operations are still far from the international advanced level. The classic surgical approaches used in China were invented by neurosurgeons in Europe, America and Japan, but some improved new surgical approaches have not been mastered, resulting in low tumor resection rate in some complex parts and great nerve damage to surgical approaches and surrounding tissues. In other aspects of neurosurgery, such as anesthesia level, surgical posture, intraoperative neurophysiological monitoring level, intraoperative neuronavigation, intraoperative nuclear magnetic resonance and other advanced equipment experience, and even postoperative ICU nursing level, the level and standard of emergency treatment are still higher than those of top neurosurgical hospitals, departments and teams in some foreign industries. I know a patient in spinal cord tumor who was operated on by Professor Fei from an international company. The result of the operation is very good. This is his video material. Conditional patients can indeed find it.
Preoperative image: Intramedullary tumor occupying space, spinal cord swelling obvious.
Postoperative image: the tumor was completely removed and the swelling effect was reduced.