神经内镜下切除椎管内肿瘤的临床研究

Clinical study on resection for intraspinal tumor under neuroendoscope

目的探讨神经内镜下切除椎管内肿瘤手术特点及治疗效果。方法采用半椎板或全椎板入路,神经内镜下手术切除12例椎管内(胸段至骶段)肿瘤,包括脊膜瘤3例,神经鞘瘤7例,皮样囊肿2例(其中合并脊髓栓系1例),并随访观察手术疗效。结果 12例肿瘤术中均全切。其中1例伴有脊髓栓系者并进行栓系松解术。术中及术后未出现明显并发症。全部患者术后症状均较术前有不同程度好转。术后随访1月-1.5年,患者症状进一步改善,McCormick评级均达Ⅰ级或以上。复查MRI未见复发。伴发有脊髓栓系者,其神经源性膀胱术后改善不明显,残余尿量多,后行膀胱造瘘手术治疗。结论与传统显微镜下切除椎管内肿瘤手术比较,神经内镜手术具有明显特点:疗效明确,创伤小,恢复快,对脊柱稳定性影响小等。

Objective To investigate the surgical characteristics and clinical efficacy of resection for intraspinal tumor under neuroendoscope.Methods Twelve cases of intraspinal tumor,including 3 of spinal meningiomas,7 of Schwannomas and 2 of dermoid cysts（one associated with tethered cord）,were operated under the neuroendoscope via semi-lamina or all-lamina approach.Results All intraspinal tumors were totally removed,and the one associated with tethered cord received the release surgery at the same time.No obvious complication was found during and after the surgery.All cases were followed up for 1 month to 1.5 years after operation.All the symptoms and signs were remarkably relieved.The McCormick＇s scales of patients all reached gradeⅠor above.The patient associated with tethered cord was again operated with bladder fistulization because the symptoms of neurogenic bladder were not improved.Conclusion The neuroendoscope-assisted resection for the intraspinal tumor is a safe and effective surgical method compared with traditional surgery under microscope.