| Objective：To investigate the clinical features, differential diagnosis, operative effect and prognosis of primary intravertebral melanoma and pigmented schwannoma.Methods：Clinical data of 5 patients with primary intravertebral melanoma and 7 patients with primary intravertebral pigmentary schwannoma who were surgically treated and confirmed by pathology in the Department of Neurosurgery, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from June 2014 to June 2024 were retrospectively included. Clinical characteristics, differential diagnosis, surgical efficacy and prognosis of the two diseases were analyzed.Results：The clinical characteristics of the 12 patients were not specific, and the symptoms of spinal cord injury were mainly manifested in the corresponding pathological segments, including limb weakness, limb numbness, neck and back pain. Routine MRI examination of 5 cases of primary intravertebral melanoma and 7 cases of primary intravertebral pigmented schwannoma showed equal or high signal T1W1 and equal or low signal T2W1. There are certain differences in MRI enhancement. Primary intravertebral melanoma usually presents uneven enhancement with unclear boundaries, which can invade adjacent tissues, while primary intravertebral pigmented schwannomas are mostly uniform enhancement with relatively clear boundaries. The operative time of 5 patients with primary intramural melanoma was (140±46)min(80 ~ 212min), the intraoperative blood loss was (260±100)ml(100 ~ 600ml), and no death occurred during the perioperative period. Postoperative MRI showed total resection in 2 cases, subtotal resection in 2 cases and partial resection in 1 case. The operative time of 7 patients with primary intravertebral pigmentogenic schwannomas was (150±48)min(100 ~ 228min), the intraoperative blood loss was (250±80) ml(120 ~ 580ml), and there were no deaths during the perioperative period. Postoperative MRI showed total resection in 7 cases . Five patients with primary intraspinal melanoma were followed up regularly after surgery (spinal enhanced MRI and whole-body PET-CT were performed every 3 months, and brain MRI was performed every 6 months to screen for metastasis). Four patients died within 3-15 months after discharge, with a median survival of 8.5 months. The cause of death was distant metastasis (2 brain metastases and 2 lung metastases). One patient had a survival of more than 24 months. As of the last follow-up (June 2024), no signs of local recurrence or metastasis were found. All patients completed at least 6 months of follow-up, and no cases were lost to follow-up. Seven patients with primary intraspinal pigmented schwannoma underwent regular postoperative imaging monitoring (spine MRI plain scan + enhancement every 6-12 months). All patients were followed up for 12-60 months (median 38 months), and all survived without evidence of tumor recurrence and metastasis. One patient had mild nerve root irritation symptoms, and the recurrence was ruled out by MRI review. It was considered to be caused by postoperative adhesion. All 7 patients insisted on completing the preset follow-up cycle.Conclusion：The clinical features of primary intraspinal melanoma and pigmentary schwannoma are not specific, and MRI is feasible for preliminary differential diagnosis, which should be distinguished by pathological findings.Primary intraspinal melanoma is more serious than pigmented schwannoma. Total microscopic resection of the tumor is the first choice. Postoperative combined with chemoradiotherapy can prolong the survival of patients. Pigmented schwannomas are mostly benign tumors, which can generally achieve total tumor resection, and generally do not need radiotherapy and chemotherapy after surgery, but the prognosis is difficult to predict in the later stage, so regular follow-up is very important. |