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Behandlung von Wirbelsäulentumoren bei älteren Patienten

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Neurochirurgie bei älteren Patienten

Zusammenfassung

Die häufigsten Tumoren im Bereich der Wirbelsäule sind Metastasen, welche etwa 90 % der spinalen Tumoren ausmachen und zumeist von Tumoren der Mamma, Prostata oder Lunge ausgehen. Spinale Metastasen sind deutlich überwiegend extradural im Bereich der Wirbelkörper und -bögen lokalisiert, Indikationen für die in der Regel palliative operative Therapie sind neurologische Defizite, konservativ nicht beherrschbare Schmerzen oder eine Instabilität der Wirbelsäule. Nach der operativen Behandlung folgen meist eine lokale Bestrahlung und die Fortsetzung der onkologischen Therapie; häufig ist auch eine psychoonkologische Anbindung sinnvoll. Intraspinal lokalisierte, meist benigne Tumoren der Meningen, der Nervenwurzeln oder des Rückenmarks, machen nur ca. 10 % aller spinalen Tumoren aus, können jedoch trotz ihrer oftmals geringen Größe infolge der limitierten Platzverhältnisse im Spinalkanal und ihrer engen Lagebeziehung zu Rückenmark und Nervenwurzeln schwerwiegende Symptome verursachen. In Anbetracht der zumeist günstigen Prognose hinsichtlich des Ausmaßes und Risikos ist die Tumorresektion mit intraoperativem elektrophysiologischem Monitoring auch bei kleineren und intramedullären Tumoren in der Regel die Therapie der ersten Wahl. Eine postoperative Strahlentherapie oder, noch seltener, Chemotherapie sind nur in Ausnahmefällen bei malignen Tumoren oder nichtresektablen Resttumoren/Rezidiven indiziert.

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  1. Neurochirurgie am Stachus, München, Deutschland

    Stefan Zausinger

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  1. Neurochirurgische Klinik, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Gießen, Hessen, Germany

    Eberhard Uhl

  2. Klinik für Spinale Chirurgie, Schön Klinik Hamburg Eilbek, Hamburg, Germany

    Karsten Schöller

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Zausinger, S. (2021). Behandlung von Wirbelsäulentumoren bei älteren Patienten . In: Uhl, E., Schöller, K. (eds) Neurochirurgie bei älteren Patienten. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-60354-3_22

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