神经电生理监测联合术中超声辅助下显微手术治疗高颈段椎管内肿瘤  

Microsurgery for high cervical intraspinal tumors assisted by intraoperative ultrasound in combination with neuroelectrophysiological monitoring

作　　者：韦可 杜威 杨柳 夏敏 吕丽辉 莫雪红 姚国杰 WEI Ke;DU Wei;YANG Liu;XIA Min;LÜLi-hui;MO Xue-hong;YAO Guo-jie(Department of Neurosurgery,General Hospital of Central Theater Command,PLA,Wuhan 430070,China)

机构地区：[1]中国人民解放军中部战区总医院神经外科,武汉430070

出　　处：《中国临床神经外科杂志》2024年第12期716-719,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨在神经电生理监测联合术中超声辅助下显微手术治疗高颈段椎管内肿瘤的疗效。方法回顾性分析2018年3月至2022年6月收治的26例高颈段椎管内肿瘤的临床资料,在神经电生理监测及术中超声辅助下经后正中入路显微手术治疗。结果术后肿瘤全切除22例,部分切除3例,活检加椎板减压术1例。术后病理证实神经鞘瘤8例,脊膜瘤6例,室管膜瘤4例,星形细胞瘤4例,血管母细胞瘤3例,海绵状血管瘤1例。术后1周Mc Cormick评分Ⅰ级20例,Ⅱ级4例,Ⅲ级2例;术后6个月Mc Cormick评分Ⅰ级22例,Ⅱ级2例,Ⅲ级2例。术后未发生脑脊液漏、颅内感染。结论高颈段椎管内肿瘤尤其髓内肿瘤手术难度大,要求高,全切除困难,神经电生理监测及术中超声能够提高手术的安全性及治疗效果,对全切除肿瘤并最大限度保护神弪功能有重要价值。Objective To explore the efficacy of microsurgical treatment of high cervical spinal cord tumors under the assistance of intraoperative neurophysiological monitoring and ultrasound.Methods The clinical data of 26 patients with high cervical spinal cord tumors admitted from March 2018 to June 2022 were retrospectively analyzed.All patients underwent microsurgical treatment via the posterior median approach under the assistance of intraoperative neurophysiological monitoring and ultrasound.Results Postoperatively,total tumor resection was achieved in 22 patients,partial resection in 3,and biopsy plus laminectomy in 1.Postoperative pathology confirmed 8 schwannomas,6 meningiomas,4 ependymomas,4 astrocytomas,3 hemangioblastomas,and 1 cavernous hemangioma.One week after surgery,McCormick gradeⅠwas achieved in 20 patients,gradeⅡin 4,and gradeⅢin 2.At 6 months postoperatively,McCormick gradeⅠwas achieved in 22 patients,gradeⅡin 2,and gradeⅢin 2.No cerebrospinal fluid leakage or intracranial infection occurred postoperatively.Conclusions The surgery for high cervical spinal cord tumors,especially intramedullary tumors,is highly challenging and demanding,with total resection being difficult.Intraoperative neurophysiological monitoring and ultrasound can enhance the safety and efficacy of the surgery,and are of significant value in achieving total tumor resection and maximizing the preservation of neurological function.

关 键 词：椎管内肿瘤 高颈段椎管 显微手术 神经电生理监测 术中超声 疗效 

分 类 号：R739.42[医药卫生—肿瘤] R615.11[医药卫生—临床医学]