基于Toyama分型的高颈段哑铃形神经鞘瘤手术入路选择

Selection of Operative Approach to the Dumb-bell Schwannoma of the Upper Cervical Spinal Canal Based on Toyama Classification

目的:探讨高颈段神经鞘瘸的手术入路,以及Toyama分型对于选择最佳手术入路的指导作用。方法:回顾性分析17例高颈段神经鞘瘤的手术入路选择的经验教训,研究Toyama分型与手术入路之间的联系,讨论颈后中线入路、颈前入路以及经前、颈后中线联合入路在高颈段神经鞘瘤手术冶疗中的选择指征。结果:本组16例肿瘤一期全切除,1例肿瘤分两期全切除;全组病例术后病情均有所改善,无手术死亡病例。结论:手术入路的显露途径与范围和肿瘤的部位、大小及其与周围组织的关系是高颈段神经鞘瘤手术入路选择的决定因素,Toyama分型有助于选择正确的高颈段神经鞘瘤的手术入路,从而提高肿瘤切除率,降低术后局部复发率。

Objective： To investigate the operative approach to the Schwannoma of the upper cervical spinal canal and the meaning of Toyama classification as well as its roles to the selection of the best operative approach.Methods： 17 cascs with upper cervical dumbbell Schwannoma were retrospectively studied on operative approach.To research the relation between Toyama classification and operative approach and discuss the selection indication of the cervical posteromcdian approach, the cervical anterior approach and anterior and posterior contemporary approach in the surgical treatment of upper cervical spinal canal Schwannoma,Result：One-stage total removal of tumor was achieved in the 16 patio/Its and sccnnd-stage total rcmoval of tumor in only one patient. All the patients got good recovery, and there was no died case.Conclusion：The exposure approach and region as welt as the tumor＇ s location.size and relalionsh ip to the surrounding tissues were significant for the selection of operative approach to the upper cervical spinal canal Schwannoma, Toyama classification is beneficialtor determining the proper approach to the upper cervical spinal canal Schwannoma.which can increase the rate of complete tumor removal and decrease recun＇encc rate.