I期后入路切除颈胸交界区神经鞘膜瘤的手术指征

目的　明确I期后入路切除颈胸交界区神经鞘膜瘤的手术适应症。 方法　2005年1月至2016年1月对符合以下手术指征患者行I期后入路肿瘤切除术：①有硬膜外占位；②经C6/7、C7/T1、T1/2椎间孔偏一侧向外生长；③具备神经鞘膜瘤影像学特征。收集术前与末次随访的ASIA运动评分、肿瘤最大浸润范围及影像学特点、手术时间、出血量、并发症、病理结果等临床资料，经随访后予以分析总结。 结果　共收治该类患者14例（男8例，女6例，平均年龄51.1岁，28~74岁）。14例患者均为神经鞘膜瘤，其中10例得以经后路I期完整切除，剩余4例交头颈外科行前路II期手术。II期手术患者横断位CT肿瘤浸润最大范围均位于该节段横突尖垂线之外。14例病例均得以随访，随访时间10至48个月，平均23.9个月。未出现复发病例，手术节段均骨性融合，未见内固定松动。术前ASIA运动评分81.71±6.63，末次随访97.14±1.29，差异有统计学意义（P<0.05）。 结论　术前通过MRI判断上颈椎肿瘤类型，对横断位CT肿瘤浸润最大范围均位于该节段横突尖垂线以内的颈胸交界神经鞘膜瘤可行I期后入路切除，术后疗效确切，术后未见复发，预后良好。

Surgical indication of single-stage posterior approach for resection of cervicothoracic junction schwannoma

Objective　To identify the surgical indication of one stage posterior approach for resection of cervicothoracic junction schwannoma.　Methods　From Jan 2005 to Jan 2016, cervicothoracic junction schwannoma cases admitted in our department were selected according to following indication: ①epidural tumor; ②lateral growth pattern which went through C6/7, C7/T1, T1/2 foramen; ③the diagnosis of schwannoma was suggested by MRI. ASIA motor score, radiological images features, operative time, bleeding amount, complications were recorded and analyzed after follow-up. 　Results　14 cases were collected, including 8 male and 6 female, with an average age of 51.1y (28~74 y). 10 case were successfully managed by one stage posterior approach for resection of cervicothoracic junction schwannoma; however, 4 cases were sent to head and neck surgery department for second stage anterior approach tumor resection. The largest tumor size within the vertical line of the tip of transverse process was the indication of one stage posterior operation. All cases were successfully followed up for 10 to 48 month, averaging 23.9 month. There was no recurrence, and operative segments were solid fused. Preoperative ASIA motor score was improved from 81.71±6.63 to 97.14±1.29 at final follow-up, and the difference was significant（P<0.05）.　Conclusion　MRI should be used to diagnose the tumor preoperatively. After careful patient selection, one stage posterior approach for resection of cervicothoracic junction schwannoma could be carried out with a satisfied clinical outcome, few complication and good prognosis.