后路椎板切除入路手术治疗椎管内神经鞘瘤的疗效

目的:探讨后路椎板切除入路手术治疗椎管内神经鞘瘤的临床疗效。方法:我院2005年1月~2011年1月收治71例椎管内神经鞘瘤,男39例,女32例,年龄25~99岁,平均51.6岁;颈段22例,胸段24例,腰、骶段25例,3例肿瘤位于髓内,66例位于髓外硬膜下,2例位于硬膜外。均行后路椎板切除入路手术治疗,术中57例采用半椎板切除,6例行全椎板切除,2例行多节段半椎板切除,6例行半椎板联合患侧关节突关节切除以完全暴露肿瘤组织,切除肿瘤;其中载瘤神经根与肿瘤无法分离而一并切除者9例;14例行全椎板切除或多节段半椎板切除或半椎板联合患侧关节突切除者采用脊柱内固定及植骨融合术。术后随访8~70个月,观察临床疗效,复查X线片观察脊柱稳定性及植骨融合情况,复查MRI观察肿瘤有无复发。结果:手术时间2~6h,平均3.5h;术中出血量300~800ml,平均450ml。71例患者肿瘤均获完全切除,术后均经病理检查证实为神经鞘瘤。术中无脊髓神经损伤。术后12例患者出现不同程度脑脊液漏,4例患者出现脊髓缺血再灌注损伤,给予对症治疗后康复。随访期内(8~70个月)全部患者临床症状及神经功能均有明显改善,复查MRI未见肿瘤残留或复发。14例采用脊柱内固定及植骨融合术患者植骨融合,内固定稳定。随访期间所有患者未见椎体滑脱、失稳现象。结论:后路椎板切除入路能充分暴露肿瘤,有利于完全切除肿瘤,采用此入路手术治疗椎管内神经鞘瘤临床疗效满意。

Efficacy of posterior laminectomy approach for treating intraspinal neurilemmoma

Objectives: To evaluate the efficacy of posterior laminectomy approach for treating intraspinal neurilemmoma.Methods: A total of 71 cases(39 males,32 females) with intraspinal neurilemmoma from January 2005 to January 2011 was reviewed retrospectively.The average age was 51.6 years(range,25-99 years).Of all cases,22 cases had defect in cervical spine,24 in thoracic,25 in lumbar or sacral.3 cases had defect in intramedullary,66 in intradural extramedullary,and 2 cases in epidural.57 patients underwent semilaminectomy,6 cases had laminectomy,2 cases had multi-segmental semi-laminectomy,and 6 cases underwent semi-laminectomy combined with resection of ipsilateral facet joint process.Internal fixation and bone graft was performed in 14 cases.Involved nerve roots which can not be separated from the tumor were removed in 9 cases.Patients were followed up for 8-70 months,the clinical outcome,recurrence as well as spine stability were reviewed by MRl and X-ray.Results: The operative time was 2-6h,with an average of 3.5h,and blood loss was 300-800ml,with an average of 450ml.All tumors were totally resected and confirmed by pathological test.No spinal cord injury was noted during the operation.The CSF leakage was found in 12 patients,and spinal cord ischemia reperfusion injury was observed in 4 cases after surgery,which resolved after corresponsive treatment.All patients recovered during the follow-up period.No residual tumor or recurrence was noted.The bone graft had fusioned,and the location was very stable in all 14 paients who performed the spinal internal fixation and bone graft.No sponndylolisthesis and instability phenomena were observed in all 71 patients.Conclusions: The posterior laminectomy approach has the characteristics of the tumor exposed to the full,which will help to complete resection.The clinical outcomes in patients are satis-factory.