枕大孔区肿瘤的分型及手术入路选择

目的 探讨枕大孔区肿瘤的分型及手术入路.方法 回顾性分析显微手术治疗的43例枕骨大孔区肿瘤,根据肿瘤位置分为:Ⅰ型(背侧)和Ⅱ型(腹侧),Ⅰ型又分为Ⅰ a(髓外)、Ⅰ b(髓内)、Ⅰ c(髓内外)三型,Ⅱ型又分为Ⅱa(髓外)和Ⅱb(髓内)两型.对于17例Ⅰ型患者选择后正中入路,26例Ⅱ型患者选择远外侧入路.结果 全切肿瘤35例(81%),无手术死亡,随访期内无肿瘤复发.临床症状改善32例;保持原有症状3例;加重8例,包括出现新的脑神经症状、肢体运动障碍和呼吸困难.结论 枕大孔区肿瘤的术前分型有助于手术入路的选择和判断手术效果,Ⅰ型多选择后正中入路,Ⅱ型选择远外侧入路.

Abstract：

Objective To explore the classification and surgical approach of magnum foramen tumor.Method A retrospective analysis was performed for 43 surgically treated patients with tumors involving the foramen magnum.According to the site of the tumor,the classification was divided to:Type Ⅰ ,located at dorsal, Ⅰ a extra - medullary, Ⅰ b intra - medullary, Ⅰ cintra - and extramedullary; Type Ⅱ,located at ventral, Ⅱ a extramedullary, Ⅱ b intramedullary.The midline approach was used in the Type Ⅰ (17cases), while the lateral or far- lateral approach for the Type Ⅱ (26 cases).Results Total excision was performed in 35(81% ).There were no mortality and no recurrence during the follow -up period.Thirtytwo patients had improvement in their neurological status, 3 cases unchanged.There were 8 cases aggravation,including newly cranial nerve deficits, hemiplegia, dyspnoea.Conclusions The preoperative classification was useful for the selection of surgical approach and evaluation of surgical outcome.The midline approach was apt to Type Ⅰ , while the lateral or far - lateral approach for the Type Ⅱ.

The classification and microsurgery of magnum foramen tumor

Objective To explore the classification and surgical approach of magnum foramen tumor.Method A retrospective analysis was performed for 43 surgically treated patients with tumors involving the foramen magnum.According to the site of the tumor,the classification was divided to:Type Ⅰ ,located at dorsal, Ⅰ a extra - medullary, Ⅰ b intra - medullary, Ⅰ cintra - and extramedullary; Type Ⅱ,located at ventral, Ⅱ a extramedullary, Ⅱ b intramedullary.The midline approach was used in the Type Ⅰ (17cases), while the lateral or far- lateral approach for the Type Ⅱ (26 cases).Results Total excision was performed in 35(81% ).There were no mortality and no recurrence during the follow -up period.Thirtytwo patients had improvement in their neurological status, 3 cases unchanged.There were 8 cases aggravation,including newly cranial nerve deficits, hemiplegia, dyspnoea.Conclusions The preoperative classification was useful for the selection of surgical approach and evaluation of surgical outcome.The midline approach was apt to Type Ⅰ , while the lateral or far - lateral approach for the Type Ⅱ.