Intra-axial tumors of the medullocervical junction: diagnosis and microsurgical treatment.
OBJECTIVE
To describe the clinical features, operative methods and postoperative management of the intra-axial tumors of medullocervical junction, and to make differential diagnosis for different subtypes.


METHODS
Fifteen patients with intra-axial tumors of medullocervical junction were treated from August 1988 to June 1997. The diagnoses were confirmed by MRI and histological examinations. The tumors were divided into two subtypes according to the clinical features and the main body of the tumor. The distinctive points of the two subtypes and the appropriate surgical methods of different pathological type tumors were expounded.


RESULTS
Tumors were totally removed in 10 patients and subtotally in 5. There was no death caused by operation. Postoperative complications included respiratory disturbance in six cases, upper digestive tract bleeding in one, depressed cough reflex in two, most of which recovered after proper treatment. On discharge, the nervous system status was improved in 11 cases, stable in 2 and worsened in 2.


CONCLUSIONS
The intra-axial tumors of medullocervical junction can be divided into cervicomedullary and medullocervical subtypes. The MRI examination is decisive in the distinction of the diagnosis, and is important in the determination of the nature of the medullar cystic lesions and the guidance of the resection of tumor extent. The cervicomedullary tumors are more amenable to an aggressive surgical treatment, during which the surgeon should remove the tumors first in the cervical spinal cord area, then in the medullar area with the tumor resection expanding rostrally. It can make the operation safer to remove the tumors using appropriate techniques varied with pathological types of the tumors. Managing postoperative respiratory disturbances without delay is one of the important points in improving the therapeutic effect.
Xu
Q
Q
Department of Neurosurgery, Huashan Hospital, Shanghai Medical University, Shanghai 200040, China.
Bao
W
W
Mao
R
R
Pang
L
L
D000293:Adolescent; D000328:Adult; D020295:Brain Stem Neoplasms / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology*; D008579:Meningioma / Q000175:diagnosis / Q000601:surgery; D008866:Microsurgery; D008875:Middle Aged; D009463:Neuroma / Q000175:diagnosis / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods; D013120:Spinal Cord Neoplasms / Q000175:diagnosis* / Q000601:surgery*