椎管内外沟通性神经鞘瘤的手术治疗策略  

Surgical treatment strategies for intraspinal and extraspinal communicating schwannomas

作　　者：张风江[1] 丁大领[1] 余斌[1] 李恩[1] 陈煜 邱锴[1] Zhang Fengjiang;Ding Daling;Yu Bin;Li En;Chen Yu;Qiu Kai(Department of Neurosurgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院神经外科,河南郑州450052

出　　处：《中国微侵袭神经外科杂志》2023年第12期35-39,共5页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：河南省医学科技攻关计划(编号:202102310138)。

摘　　要：目的探讨椎管内外沟通性神经鞘瘤的临床特征和手术治疗策略。方法回顾性分析56例椎管内外沟通性神经鞘瘤患者病例资料,均经显微镜切除,根据肿瘤生长特点选择手术入路。采取后正中全椎板切除入路29例,颈外侧入路11例,前后联合入路2例,半椎板入路6例以及肌间隙入路8例。结果肿瘤全切除53例,部分切除3例,其中前后联合入路1例因肿瘤包绕同侧椎动脉行次全切除。8例在术中肿瘤切除后采用侧块螺钉植入、椎体次全切术等方式行内固定术。术后病理均为神经鞘瘤。术后患者神经功能症状均得到不同程度改善。术后出现并发症3例。所有患者术后随访5~66个月,肿瘤复发1例,无运动功能障碍加重,无继发脊柱畸形。结论应根据椎管内外沟通性神经鞘瘤的特点制订个体化手术入路,术前、术中准确评估脊柱稳定性,结合显微外科技术,尽可能全切肿瘤,合理选择脊柱内固定,可减少术后脊柱畸形发生率。Objective To investigate the clinical characteristics and surgical treatment strategies for intraspinal and extraspinal communicating schwannomas.Methods A retrospective analysis was conducted on the clinical data of 56 patients with intraspinal and extraspinal communicating schwannomas who underwent microsurgical resection.The surgical approach was selected based on the characteristics of tumor growth.A total of 29 patients underwent posterior midline laminectomy,11 patients underwent lateral cervical approach,2 patients underwent combined anterior-posterior approach,6 patients underwent hemilaminectomy,and 8 patients underwent intermuscular ligamentous space approach.Results Total tumor resection was achieved in 53 cases,and partial resection in 3 cases,including 1 case of subtotal resection due to tumor wrapping around the ipsilateral vertebral artery in the combined anterior-posterior approach.Internal fixation procedures such as lateral mass screw implantation and subtotal vertebrectomy were performed in 8 patients after tumor resection.Postoperative pathological examinations confirmed schwannomas in all cases.Postoperative neurological symptoms improved to varying degrees.Complications occurred in 3 cases.All patients were followed up for 5 to 66 months,with 1 case of tumor recurrence,no worsening of motor dysfunction,and no secondary spinal deformities.Conclusions Individualized surgical approaches should be developed based on the characteristics of intraspinal and extraspinal communicating schwannomas.Accurate preoperative and intraoperative assessment of spinal stability,combined with microsurgical techniques,should aim for complete tumor resection whenever possible.Rational selection of spinal internal fixation can reduce the incidence of postoperative spinal deformities.

关 键 词：神经鞘瘤 椎管内外沟通性肿瘤 显微外科手术 脊柱内固定 

分 类 号：R730.264[医药卫生—肿瘤]