经Quadrant通道显微手术切除椎管内肿瘤

Microsurgery of intra-spinal tumor via the quadrant pathway

目的探讨经Quadrant通道显微切除椎管内肿瘤的手术适应证、技巧及该方式的优缺点。方法回顾性分析西安交通大学第一附属医院神经外科自2014年10月~2015年7月经Quadrant通道进行显微切除手术的椎管内肿瘤患者的资料及手术方式和临床恢复情况。结果共16例肿瘤患者,其中硬脊膜外3例、髓外硬膜下12例、髓内1例;包括颈段（C3~C7）3例,胸段（T1~T10）5例,下胸及腰骶段（T11~S2）8例,肿瘤均做到镜下全切,无中转开放性手术者;按病理分型包括神经鞘瘤（9例）、神经纤维瘤（2例）、脊膜瘤（4例）和神经上皮性囊肿（1例）。术后患者症状与体征明显改善,随访2~10月无1例肿瘤复发或出现脊柱失稳的并发症。结论采取Quadrant通道可进行长度小于2个椎体节段、横截面小于2/3椎管面积的硬膜外及髓外硬膜下肿瘤的切除,但粘连广泛及髓内病变的手术应更慎重,其对手术技术要求较高,需要长时间的实践和学习。

Objective To investigate the indications, surgical principles and advantages and disadvantages of microsurgery of intra-spinal tumor via the quadrant pathway. Methods We made a retrospective analysis of the clinical data of patients with spinal canal tumors treated via the quadrant pathway from October 2014 to July 2015. Results Totally 16 patients were included. Their tumors were fully removed by microscopic resection, in which there were three epidural cases, twelve subdural extra-medullar cases, and one intra-medullar case. In terms of stage, there were three cases of cervical segment （C3- C7）, four cases of thoracic （T1- T10）, nine cases of thoracic and lumbar ones （T11- S2）. In pathology, there were nine cases of neurilemmoma, two cases of neurofibroma, four cases of meningeal tumor and one case of neuroepithelial cyst. The postoperative symptoms and signs of the patients were significantly improved, and no recurrence or complications occurred in the follow-up 2-10 months. Gonclusion Quadrant pathway can be used in removing spinal epidural and subdural tumor, which is shorter than two vertebral segments in length, and the cross-sectional area is less than 2/3 of the spinal cord. However, surgery with extensive adhesion and intra-medullary lesions should he performed carefully, and the surgical techniques are more demanding and a longer learning curve is needed.