神经电生理监测下高颈段椎管神经鞘瘤的显微外科治疗  

Microsurgical treatment of upper cervical spinal canal neurilemmoma under neuro-electrophysiological monitoring

作　　者：李春[1,2] 牛朝诗[1,3] 丁宛海[1] 刘会林 

机构地区：[1]安徽医科大学附属省立医院神经外科,合肥230001 [2]阜阳市第五人民医院神经外科,236001 [3]安徽省脑立体定向神经外科研究所

出　　处：《中国微侵袭神经外科杂志》2013年第12期529-532,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：国家临床重点专科建设项目(2011年)

摘　　要：目的探讨高颈段椎管神经鞘瘤在神经电生理监测下显微手术方法及疗效。方法回顾性分析74例高颈段椎管神经鞘瘤的临床资料。椎管内外哑铃状肿瘤35例,椎管内肿瘤39例。结果在神经电生理监测下进行显微手术,肿瘤全切除70例(94.6%),次全切除4例(5.4%)。术后症状完全消失67例(90.5%),症状改善7例(9.5%)。术后均未发生脊髓和神经根损伤并发症,2例病人发生中枢神经系统感染,无死亡。6例失访,68例病人术后随访3个月～4年,2例术后复发(1例再次手术),其他病人恢复良好。结论神经电生理及显微手术技术联合应用显著提高高颈段神经鞘瘤的全切率,最大程度地保护脊髓、神经,减少术后复发及并发症,提高高颈段神经鞘瘤的疗效及安全性。Objective To explore microsurgical method and therapeutic efficacy for upper cervical spinal canal neurilemmoma under electroneurophysiological monitoring. Methods The clinical data of 74 patients with upper cervical spinal canal neurilemmoma were analyzed retrospectively, including 35 with both inside and outside the spinal dumbbell tumors and 39 with intraspinal tumor. Results The 74 patients were operated under electroneurophysiological monitoring. Total tumor resection was achieved in 70 patients （94.6%） and subtotal resection in 4 （5.4%）. Postoperative symptoms disappeared completely in 67 cases （90.5%） and improved in 7 （9.5%）. There was no complication of spinal cord and nerve root injury. Two patients developed central nervouS system infection and no patients died after operation. Follow-up observation was carried out in 68 patients fxom 3 months to 4 years, and 6 patients were lost to follow-up. Recurrence occurred in 2 patients, including one patient having reoperation, and another recovered well. Conclusions The combined application of electrophysiological and microsurgical techniques can significantly improve the total resection rate of upper cervical neurilemmoma, maximize the protection of the spinal cord and nerve, and reduce recurrence and postoperative complications, and enhance the therapeutic efficacy and safety for upper cervical neurilemmoma.

关 键 词：神经鞘瘤 神经电生理 高颈段椎管 显微外科手术中图分类丹 R730 264 

分 类 号：R739.4[医药卫生—肿瘤]