经椎间孔入路切除椎管内外沟通型神经鞘瘤

Microsurgical treatment of intra- and extra- spinal communicating neurinoma through enlarged intervertebral foramen

目的探讨经病理性扩大的椎间孔在袖套内切除偏一侧椎管内外沟通型神经鞘瘤手术方法的应用。方法对11例疑为椎管内神经鞘瘤患者采用经椎间孔袖套内入路显微手术切除肿瘤。全部患者术前影像学检查均显示肿瘤为偏脊髓一侧骑跨椎间孔生长，形态为非明显哑铃形，椎间孔扩大明显。肿瘤位于颈段者7例、胸段者2例、腰段者2例。结果11例患者肿瘤均完全切除，术后第4天即可下床活动，随访4-24个月，平均11个月，症状和体征均明显改善，无手术并发症和脊柱畸形发生。结论经扩大的椎间孔袖套内入路显微手术切除肿瘤避免了术中的过度显露，不破坏脊柱的骨性结构，对椎旁肌及韧带的损伤与半椎板切除入路相同，有利于最大程度地保持脊柱的稳定性，适用于偏侧的骑跨椎间孔生长的非哑铃形神经鞘瘤。

Objective To study the intervertebral foramen approach for the microsurgical treatment of intraspinal neurinoma. Methods 11 patients with intraspinal neurinoma were performed microsurgical treatment intervertebral foramen approach at our hospital. All the patients have got the MRI, and the image showed the tumor bestriding the intervertebral foramen, and the intervertebral foramen had been enlarged obviously, but the tumors were not in dumdbell shape. Among which 7 were cervical,2 were thoracic and 2 lumbar tumors. Results All the tumors were totally excised. The patients can move around early at the 4th day postoperatively. The symptoms and signs were obviously improved without complications of surgery and spinal deformity in the follow-up period （4-24 months, mean 11 months ）. Conclusions Microsurgery via intervertebral foramen can avoid overexposure of surgery field, destruction of spine bony structure, and the curative effect was satisfactory. The merits of this approach including slight surgery injury, safety and reduction of bed rest. So it is worth applying in the surgical treatment of neurinoma which bestrides intervertebral foramen and but not in dumbbell shape.