椎管内神经鞘瘤的显微外科治疗——附342例临床总结

Microsurgical Treatment of Intraspinal Neurilemmomas:Report of 342 Cases

背景与目的:神经鞘瘤是椎管最常见肿瘤,本研究旨在总结椎管内神经鞘瘤的临床特点,探讨其显微外科治疗方法及手术技巧。方法:对北京天坛医院院神经外科2000年1月至2005年4月间收治的342例经病理证实的椎管内神经鞘瘤患者资料进行回顾性分析。结果:本组342例患者共发现373个病变。根据肿瘤位置不同,采取不同手术入路。全切除341个,近全切除32个,无手术死亡。出院时症状好转314例,无变化26例,变差2例。结论:通过术前评估,制定个性化手术方案,绝大多数椎管内神经鞘瘤可得到全切除,而高颈段哑铃形神经鞘瘤、复发神经鞘瘤及髓内神经鞘瘤的治疗仍具挑战性。

BACKGROUND ＆ OBJECTIVE： Neurilemmomas are the most common benign spinal tumors. This study is to investigae the clinical manifestations and microsurgerical management of intraspinal neurilemmomas. METHODS： Three hundred and forty-two eases of sehwannomas confirmed by pathology from January of 2000 to April of 2005 in the department of neurosurgery, Beijing Tiantan Hospital were retrospectively analysized. RESULTS： There were 373 lesions in 342 patients. Different operative approaches were chosen according to the location of tumors. Total resection was achieved in 341 patients, subtotal removal in 32 patients. There was no surgical death. Relief of symptoms was found in 314 patients, no change in 26 patients and deterioration in 2 patients. CONCLUSIONS： Intraspinal neurilemmomas is common and benign spinal tumor. Most of the tumors can be removed totally through preoperative evaluation and individual operative strategy. Neurilemmomas locating in upper cervical segments or intramedullarily are still challenges to neurosurgeons.