经后正中小切口极外侧入路手术切除高位颈椎管哑铃形肿瘤:附1例报道并文献复习  

Efficacy of microsurgery through extreme lateral approach using posterior midline small incision for patients with dumb-bell tumors at high cervical spine:a case report and literature review

作　　者：汪棋笙 侯黎明[1] 唐清明[1] 李华国[1] 徐辉[1] 韩晋 丁华强 刘亮 WANG Qi-sheng;HOU Li-ming;TANG Qing-ming;LI Hua-guo;XU Hui;HAN Jin;DING Hua-qiang;LIU Liang(Department of Neurosurgery,Hejiang People's Hospital,Luzhou 466200,China;Department of Neurosurgery,People's Hospital of Jiangbei District,Chongqing 401120,China;Department of Neurosurgery,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]合江县人民医院神经外科,四川泸州646200 [2]重庆市江北区人民医院神经外科,401120 [3]西南医科大学附属医院神经外科,四川泸州646000

出　　处：《中国临床神经外科杂志》2024年第3期157-160,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨高位颈椎管哑铃形肿瘤的手术方法及其疗效。方法回顾性分析经后正中小切口极外侧入路手术切除的1例高位颈椎管哑铃形肿瘤的临床资料,并结合相关文献进行总结分析。结果55岁男性,因四肢麻木乏力逐渐加重2年余伴跌倒致全身多处疼痛4 h余入院。入院颈椎MRI增强示C2~3层面左侧椎管内外沟通性占位,同层面颈髓受压、水肿,肿瘤包绕左侧椎动脉,考虑神经源性肿瘤。颈椎CT三维重建示C2~3左侧椎体及椎弓部分骨质破坏。完善术前准备,采用俯卧位经正中小切口极外侧入路手术切除肿瘤。肿瘤获得全切除,未行内固定植入术。术后14个月随访,四肢肌力恢复正常,可以从事日常生活活动;复查颈椎MRI增强示肿瘤无复发,行颈椎动力位X线检测示颈椎稳定。结论本文结果提示经后正中小切口极外侧入路手术切除颈椎巨大哑铃形肿瘤,可以不搬动体位,不破坏脊柱稳定性,术中不行额外内固定植入,安全有效,为颈椎巨大哑铃形肿瘤手术切除提供了一种思路。Objective To investigate the surgical methods and outcomes of dumb-bell tumors at high cervical spine.Methods The clinical data of a patient with a dumb-bell tumor at C2~3 canal that was surgically resected through an extreme lateral approach using a posterior midline small incision were retrospectively analyzed,and the related literatures were reviewed and analyzed.Results A 55-year-old male presented with progressive paresthesia and weakness of the extremities for more than 2 years,and he fell down 4 hours prior to admission and caused pain in various parts of the body.The enhanced MRI of the cervical spine showed a intra-and extramedullary lesion at the C2~3 level,causing compression and edema of the cervical cord at the same level,and the lesion encircled the left vertebral artery,suggesting a neurogenic tumor.The CT scan and three-dimensional reconstruction showed partial destruction of the left side of the C2~3 vertebral body and the pars of the cervical spine.After completing preoperative preparations,the tumor was resected through a posterior lateral approach using a posterior midline small incision.The tumor was completely resected,and no internal fixation was performed.After 14 months of follow-up,the muscle strength of the extremities was fully recovered,and the patient could engage in daily activities.The enhanced MRI of the cervical spine showed no recurrence of the tumor,and the cervical spine was stable as assessed by dynamic X-ray examination.Concluions The results suggest that the resection through an extreme lateral approach using a posterior midline small incision for large dumb-bell tumors in the cervical spine can be performed without moving the patient's position and without compromising spinal stability.No additional internal fixation is required during the operation,which is safe and effective,providing an alternative approach for the resection of these tumors.

关 键 词：椎管内肿瘤 哑铃形肿瘤 高位颈椎 显微手术 联合入路 疗效 

分 类 号：R739.42[医药卫生—肿瘤] R651.11[医药卫生—临床医学]