哑铃型脊髓肿瘤的MR分型及显微外科手术

Classification and microsurgical treatment of dumbbell tumors of spine

目的探讨哑铃型脊髓肿瘤的MR分型及对外科手术的指导意义,以提高手术疗效。方法将38例哑铃型脊髓肿瘤根据其MR表现,即根据肿瘤主体及其自椎间孔向椎管外生长情况分成三种类型,并采用相应的手术方式切除。结果经后正中入路,全椎板或部分椎板切除行MR 1型肿瘤切除18例;经颈外侧、胸、腹及盆腔入路切除MR 2型肿瘤11例;两种方法联合一期或二期手术切除MR 3型肿瘤9例。其中神经鞘瘤占大多数26例(26/38)。手术肿瘤全切29例,大部切除2例,部分切除7例。手术效果优27例;良5例;差3例。死亡3例。结论MR检查可对哑铃型脊髓肿瘤能做到术前精确定位,利用MR对肿瘤的显示分型,从而选择相应手术入路,可提高全切率并增加手术安全性。熟练的显微外科技术与预后有关。

Objective To study the MR classification and evaluate the importance of microsurgical treatment of dumbbell spinal tumors. Methods38 patients adopted from 1993 to 2002 were confirmatively diagnosed to have dumbbell tumors and then classified into 3 categories (18, 11 and 9 cases respectively in types MR 1, MR 2 and MR 3) judging by the main tumor body and their growth from intervertebral foramen to external vertebral canal based on MRI. Different microsurgical approaches were used for the different categories respectively. Results18 tumors of type MR 1 were removed via posterior midline approach with complete or partial laminectomy. For the 11 type MR 2 cases, unilateral facetectomy were removed via extracranial, thoracic, abdominal or pelvic approach with laminectomy and the 9 type MR 3 tumors via a combined approach. It was found the 26 removed tumors were scheannoma. Among the 38 cases, total laminectomy were achieved in 29 cases, major in 2 and partial in 7, with significant curative effect in 27, effect in 5, poor effect in 3 and death in 3. Conclusion Precise pre-operative diagnosis is very important for surgery and prognosis of dumbbell tumor, the operative approaches were mainly subject to tumor location by MR. Classification of tumors by MR helps choose proper operative approaches beneficial to total and precise removal of tumors. Proper approaches and proficient microsurgical manipulation are key to reducing postoperative complications and improving the curative effect in patients with dumbbell spinal tumor.