经扩大椎间孔入路显微切除椎管内外哑铃形神经鞘瘤

目的 探讨经病理性扩大的椎间孔入路切除椎管内外哑铃形神经鞘瘤的手术方法和效果.方法 回顾分析南通大学附属医院神经外科自2012年3月至2015年12月收治16例椎管内外哑铃形神经鞘瘤患者临床资料.术前影像学检查显示肿瘤为椎管内外哑铃形生长, 椎间孔呈病理性扩大.所有患者均采用经扩大椎间孔入路显微手术切除肿瘤.肿瘤位于颈段8例、胸段3例、腰段5例.结果 16例肿瘤均达全切除, 本组无手术死亡病例.平均手术时间3.2 h;术中平均失血240 mL;术后平均在院时间7.8 d.术后随访336个月, 平均10.7个月.患者症状和体征均有明显的改善或缓解, 无明显手术并发症与脊柱畸形发生.结论 对于以椎间孔外部分为主的哑铃形神经鞘瘤, 采用经扩大椎间孔入路不破坏脊柱的骨性结构, 避免了术中的过度显露, 能最大限度地维持脊柱的稳定性.

Microsurgical Resection of Intra-and Extraspinal Dumbbell-shape Schwannoma through Enlarged Intervertebral Foramen Approach

Objective To assess the microsurgical resection of dumbbell-shape spinal schwannoma through enlarged intervertebral foramen approach.Methods We performed a retrospective review of 16 patients with dumbbell-shape spinal schwannomas who underwent microsurgical treatment by enlarged intervertebral foramen approach from March 2012 to December 2015 in our department.Preoperative imaging revealed the tumor bestriding intra-and extra-spinal canal, and the intervertebral foramen had been enlarged noticeably.Among which 8 were cervical, 3 were thoracic and 5 were lumbar spinal schwannomas.Results All tumors were removed completely.There was no intraoperative death.The average operation time was 3.2 hours, the average perioperative blood loss was 240 ml, the average hospital stay was 7.8 days postoperation.The average follow-up period was 10.7 months (ranged, 3 months to 36 months) .The symptoms and signs were improved and relieved significantly and no obvious complication or spinal deformity was found.Conclusion The dumbbell-shape spinal schwannoma predominantly located in extraintervertebral foramen could be removed via enlarged intervertebral foramen approach.This approach can aviod the destruction of spine bone structure, excessive exposure during operation and obtain maximum maintenance of spine stability.