侵犯椎体及其附件的高颈段哑铃型椎管内肿瘤的显微外科治疗效果

Microsurgical management of dumbbell-type intraspinal tumor at upper neck invading vertebral body and its appendages

目的 探讨侵犯椎体及其附件的高颈段哑铃型神经鞘膜瘤显微外科手术及颈椎后路植骨固定的方法与特点。方法 分析7例高颈段哑铃形椎管内肿瘤病人的临床特点、影像学特征、显微手术及颈椎后路植骨固定的方法与治疗结果等。结果 7例患者术前均经CT或MRI检查作出临床诊断,肿瘤位于颈1～2椎体平面2例,颈2～4椎体平面5例,均为哑铃形生长,沿椎间孔从椎管内延伸至椎管外,相邻颈椎椎体及其附件不同程度破坏、颈髓不同程度受压移位、椎动脉被肿瘤包绕2例,推挤移位5例,均行显微手术切除肿瘤并颈椎后路植骨固定术,全切5例,部分切除2例,治疗效果良好。结论 高颈段哑铃形椎管内肿瘤多伴不同程度颈椎及其附件破坏,脊柱稳定性受损,切除肿瘤后,绝大多数患者需行颈椎后路植骨固定,以防术后椎体不稳造成脊髓压迫。

Objective To analyze characteristics of microsurgical management and posterior cervical vertebra fusion and fixation of dumbbell-type intraspinal tumor at upper neck invading vertebral body and its appendages. Methods The characteristics of the clinic, imaging and the approaches of microsurgical management and posterior cervical vertebra fixation were retrospectively analyzed in 7 cases with dumbbell-type intraspinal tumor at upper neck invading vertebral body and appendages. Results Seven patients were diagnosed by CT or/and MRI. The dumbbell-type tumor extended from intervertebral foramen to extraspinal tissues. Tumor located in C 1-C 2 in 2 cases, 5 cases in C 2-C 4. The vertebral body and its appendages were damaged in all patients. Gross total resection was achieved in 5 patients, partial resection in 2 cases. The posterior cervical vertebra was fused and fixed in 7 patients by transplantation of 'H' style of iliac bone piece. The therapeutic effects were good in all patients. Conclustion The dumbbell-type intraspinal tumor at upper neck in most patients always invades vertebral body and appendages and damages the stability of spine. The fusion and fixation of cervical vertebra is necessary in most patients after tumor resection to avoid compression of spinal cord caused by vertebral body instability.