上颈段椎管内外哑铃形神经源性肿瘤的手术治疗经验  

Microsurgical experience of dumbbell-shaped neuromas in upper cervical spine

作　　者：吴哲褒[1] 贺崇欣[1] 吴近森[1] 诸葛启钏[1] 郑伟明[1] 苏志鹏[1] 刘藏[2] 

机构地区：[1]温州医学院附属第一医院神经外科,325000 [2]首都医科大学附属北京天坛医院神经外科

出　　处：《中华神经外科杂志》2007年第4期267-269,共3页Chinese Journal of Neurosurgery

摘　　要：目的探讨上颈段椎管内外哑铃形神经源性肿瘤的手术入路、肿瘤与枕下海绵窦的关系、术后颈椎的稳定性。方法从1996至2005年期间经病理证实的上颈段哑铃形神经源性肿瘤17例（神经鞘瘤12例，神经纤维瘤5例），采用枕下后正中入路（13例）和颈后外侧入路（4例）切除肿瘤。所有患者术中均未行颈枕融合术。结果16例肿瘤在显微镜下全切除，1例行近全切。根据术中肿瘤和硬膜的关系，肿瘤位于单纯硬膜外者12例，硬膜内外者5例。随访期间临床症状和影像学检查均无颈椎不稳定性现象发生。结论采用枕下后正中入路或颈后外侧入路显微手术切除肿瘤是理想的治疗方法。术中娴熟处理椎动脉和枕下静脉丛出血至关重要。Objective To discuss the surgical approach, control of suboccipital carvernous sinus, cervical spine stability in the treatment of dumbbell-shaped neuromas in upper cervical spine. Methods A series of 17 patients with neuromas （ 12 neurinomas, 5 neurofibromas） were treated between 1996 and 2005, using the suboccipital midline approach （ 13 cases） or posterolateral approach （4 cases）. No case was planned with concomitant cervical-occipital fusion. Results Complete resection was achieved in all except one patient. According to the relationship between tumor and dural sac, 12 lesions were entirely extradural and 5 were intra-extradural, During the follow-up period, there was no clinical or radiological evidence of upper cervical spine instability. Conclusions Dumbbell-shaped neuromas of the upper cervical spine can be satisfactorily managed with a suboccipital posterior medline approach or posterolateral approach. It is critical to control the vertebral artery and suboccipital carvernous sinus.

关 键 词：上颈段 神经源性肿瘤 枕下海绵窦 显微外科 颈椎稳定性 

分 类 号：R686[医药卫生—骨科学]