寰椎后弓半切除在高位上颈椎哑铃状神经鞘瘤手术的应用

目的:探讨寰椎后弓半切除在高位上颈椎哑铃状神经鞘瘤手术的可行性及临床疗效。方法:回顾性分析2005年1月至2018年12月高位上颈椎哑铃状神经鞘瘤患者13例,男10例,女3例;年龄19~67岁;枕骨大孔至C1平面4例,C1,2平面9例。进行寰椎后弓半切除摘除肿瘤,未内固定,临床疗效采用疼痛视觉模拟评分(visual analogue scale,VAS),日本骨科协会(Japanese Orthopaedic Association,JOA)评分及美国脊髓损伤学会(American Spinal Injury Association,ASIA)分级等进行比较。结果:13例均顺利完成手术,术中均未出现椎动脉损伤及脊髓损伤。13例均随访12个月以上,未发现局部复发,VAS评分及JOA评分均较术前改善。术前ASIA分级:C级1例,D级6例,E级6例;末次随访D级3例,E级10例。结论:寰椎后弓半切除可Ⅰ期切除高位上颈椎哑铃状神经鞘瘤,短期临床疗效好,无颈椎不稳等并发症。

Application of posterior arch of the atlasrch resection for high-level cervical dumbbell schwannoma surgery

Objective: To investigate the feasibility and clinical effect of hemi-resection of posterior arch of atlas in the upper cervical spinal dumbbell-shaped schwannomas.Methods: A retrospective analysis was performed on 13 patients with high-level cervical dumbbell schwannomas from January 2005 to December 2018,including 10 males and 3 females,aged 19 to 67 years old. The occipital foramen to the C₁ were 4 cases and 9 cases of C_1,2. Tumors were removed by posterior arch of the atlas resection without internal fixation. The clinical efficacy was evaluated by visual analogue pain scale(VAS),Japanese Orthopaedic Association (JOA) scores,and American Spinal Injury Association(ASIA) ratings.Results: The operation was successfully completed in 13 cases of this group. No vertebral artery injury or spinal cord injury occurred during the operation. All 13 patients were followed up for more than 12 months. No local recurrence was found. Both the VAS and the JOA score were significantly improved compared with those before surgery. The ASIA classification before operation was:1 case of grade C,6 cases of grade D,6 cases of grade E;the latest follow-up was 3 cases of ASIA grade D and 10 cases of E.Conclusion: The posterior arch of the atlas hemisection can remove the upper cervical dumbbell schwannoma in one stage. The short-term clinical effect is good,and there are no complications such as cervical instability.