高颈段脊髓侧前方肿瘤的显微手术切除

Microsurgical Approaches in Removal of Tumors Ven-trolateral to the Upper Cervical Spinal Cord

高颈段脊髓解剖关系复杂、功能重要,其侧前方生长的肿瘤切除困难。本研究探讨手术人路、切除方式和术后处理。方法:采用三种手术人路,显微手术切除24例肿瘤,主要为神经鞘瘤和脊膜瘤,占本组的87.5%。瘤体大小为3.0cm×2.5cm×2.0cm～12cm×3.0cm×2.5cm。其中4例长人颅内,4例向椎管外生长。结果:肿瘤全切22例(91.7%),随访5月～5.1年,20例(83.3%)恢复正常生活和工作能力。结论:采用改良手术人路和显微手术能明显提高肿瘤全切率,降低神经残疾。

BACKROUND & OBJECTIVE: The anatomy of the upper cervical region is complex. There are many structures with critical functions located lateral and ventral to the upper cervical spinal cord. Hence, it is much more difficult to remove the tumors growing in the spinal canal lateral and ventral to the spinal cord in this region. The aim of this study is to analyze the surgical approaches, the techniques of the tumor removal and the postoperative manage-ments of patient with tumor in this location. METHODS: Twenty-four cases underwent microsurgical tumor excision via three kinds of approaches were reviewed. The tumors were either Schwannoma or meningioma in 87. 5% of 24 cases.The tumor volume ranged from 3. 0cm×2. 5cm×2. 0cm to 12cm×3. 0cm×2. 5cm. Four tumors were dumb-bell-shaped. Another 4 extended intracranially. RESULTS: Total tumor removal was achieved in 22 cases (91. 7%).Twenty patients (83. 3%) returned to their normal life or job within a follow-up period ranging from 5 months to 5. 1 years. CONCLUSION: Application of improved operative approaches and microsurgical technique can increase the rate of total tumor removal and reduce the rate of disability.