椎管哑铃形肿瘤的显微手术治疗  

Microsurgery of dumbbell-shaped tumors of the vertebral canal

作　　者：曾而明[1] 李东海[1] 洪涛[1] 邹安琪[1] 李美华[1] 周东伟[1] 

机构地区：[1]南昌大学第一附属医院神经外科,江西南昌330006

出　　处：《中国现代医学杂志》2009年第22期3447-3449,共3页China Journal of Modern Medicine

摘　　要：目的探讨椎管哑铃形肿瘤的手术方法及其临床疗效。方法回顾性研究36例椎管哑铃形肿瘤,对其临床表现、病理性质及手术方法等进行系统分析。结果30例行肿瘤全切除,6例行近全切除。肿瘤位于颈椎23例、胸椎8例、腰骶椎5例;肿瘤位于髓外、硬膜外者16例,位于硬膜外、硬膜下脊髓外者20例。神经鞘瘤29例,神经纤维瘤3例,软骨肉瘤2例,脊膜瘤1例,恶性神经鞘瘤1例。术后神经症状、体征明显改善者32例,保持原状者4例,无并发症。术后随访未见脊柱畸形发生。结论多数椎管哑铃形肿瘤可由后正中入路全切除。椎管哑铃形肿瘤预后良好。[Objectives] To establish optimal surgical strategies for the dumbbell-shaped spinal tumors. [Methods ] 36 patients with dumbbell-shaped tumors were analyzed retrospectively, including clinical manifestations, surgical approaches, pathological characteristics, operative complications and follow-up results. [ Results] Total removal were achieved in 83.3% （30/36）, and subtotal removal in 16.7% （6/36）. In this series, 23 eases of tumors were located in the cervical, 8 in thoracic, 5 in lumbosacral segment of the spine. Pathological diagnosis revealed 29 schwannomas, 3 neurofibroma, 2 Chondrosarcoma, 1 spinal meningiomas and 1 malignant peripheral nerve sheath tumor. 16 patients was extradural and 20 patients in extradural/intradural extramedullary. 32 eases showed improvement of the neurological status and 4 cases remain presurgical neurological status without any new neurological deficit. There were no complications in these patients. No postoperative spinal instability was observed in any of the patients after there months to two years follow-up stages. [ Conclusion ] Most spinal dumbbell-shaped tumors may be achieved total removal via the standard posterior midline approach. The prognosis of spinal dumbbell-shaped tumors is excellent.

关 键 词：椎管 脊髓肿瘤 手术 

分 类 号：R739.42[医药卫生—肿瘤]