术中病理诊断对脊髓肿瘤的术中和术后管理具有重要影响。因此，本研究旨在通过与最终病理诊断进行比较，评估术中病理诊断对脊髓病变的可靠性，确定其有用性和局限性。纳入了2000年至2021年间接受初次手术的303例连续性肿瘤性脊髓病变患者（平均年龄53.9岁）。评估了脊髓肿瘤的解剖位置和各肿瘤类型的术中病理诊断实施率。作为主要结局，我们确定了术中病理诊断与最终诊断之间的一致性率。当术中病理诊断与最终诊断相同时，将诊断定义为“一致”。否则，将诊断定义为“不一致”。术中病理诊断的整体实施率为53%，其中髓内肿瘤、硬膜外髓外肿瘤、硬膜外肿瘤和 dumbbell 肿瘤的实施率分别为71%、45%、47%和50%。总体一致性率为87.6%，其中髓内肿瘤、硬膜外髓外肿瘤、硬膜外肿瘤和 dumbbell 肿瘤的一致率分别为80%、95%、75%和90%（p < 0.05）。在髓内肿瘤中，脊髓室管膜瘤、低级别星形细胞瘤和高级别星形细胞瘤的诊断有时较困难。在硬膜外髓外肿瘤中，术中病理诊断难以区分1级脑膜瘤和高级别脑膜瘤。术者必须认识到髓内和硬膜外病变术中病理诊断的较低准确性，并通过考虑术中粗略观察结果、术前临床过程和影像来做出最终决策。 © 2023 同济大学. Elsevier B.V. 发行.

Intraoperative pathological diagnosis has a major influence on the intra- and postoperative management of spinal cord tumors. Thus, the aim of this study was to assess the reliability of intraoperative pathological diagnosis for spinal cord lesions by comparing it with the final pathological diagnosis and to determine its usefulness and limitations.Three-hundred and three consecutive patients (mean age, 53.9 years) with neoplastic spinal cord lesions who underwent initial surgery between 2000 and 2021 were included. The anatomical locations of the spinal cord tumors and the implementation rate of intraoperative pathological diagnosis in each tumor type were evaluated. As the primary outcome, we determined the concordance rates between the intraoperative pathological diagnosis and the final diagnosis. When the intraoperative pathological diagnosis and final diagnosis were the same, the diagnosis was defined as a "match." Otherwise, the diagnosis was defined as a "mismatch."The overall implementation rate of intraoperative pathological diagnosis was 53%, with implementation rates of 71%, 45%, 47%, and 50% for intramedullary, intradural extramedullary, extradural, and dumbbell tumors, respectively. The overall concordance rate was 87.6%, with concordance rates of 80%, 95%, 75%, and 90% for intramedullary, intradural extramedullary, extradural, and dumbbell tumors, respectively (p < 0.05). The diagnoses of ependymomas, low-grade astrocytomas, and high-grade astrocytomas was occasionally difficult among intramedullary tumors. Among intradural extramedullary tumors, differentiation between grade 1 meningioma and high-grade meningioma was difficult using intraoperative pathological diagnosis.Surgeons must recognize the lower accuracy of intraoperative pathological diagnosis for intramedullary and extradural lesions and make a final decision by considering the intraoperative gross findings, preoperative clinical course, and imaging.Copyright © 2023. Published by Elsevier B.V.