手术治疗颈椎管内外哑铃型肿瘤的临床研究

A clinical study on the surgical treatment for inner and outer cervical spinal canal dumbbell tumors

目的探讨颈椎管内外哑铃形肿瘤的临床特点、Toyama分型及手术治疗策略。方法回顾分析我院2008年8月至2011年8月期间治疗的5例颈椎哑铃形肿瘤患者的临床表现、影像学特征、病理类型、手术治疗方法和预后。肿瘤节段位于C_(1～2)2例,C_(3～5)1例,C_(4～6)1例,C_(5～7)1例。神经鞘瘤5例。采用Toyama方法分型,ⅡB型1例,ⅢA型1例,Ⅳ型1例,Ⅵ型2例;IF分期Ⅰ期2例,Ⅱ期3例;TF分期Ⅰ期3例,Ⅱ期2例。2例行颈后正中入路,2例行颈前右侧入路,1例行颈前左侧入路。结果肿瘤均完全切除,无椎动脉损伤,无神经功能障碍加重。患者局部疼痛和神经症状均有明显改善,术后即刻出现单侧上肢一过性瘫痪1例,经激素及脱水药物治疗5d后缓解;脑脊液漏1例,保守治疗后闭合;未见颈椎反屈畸形,无术后感染病例。随访6个月至2年,平均9个月。所有患者神经功能均有不同程度恢复,其中3例患者神经功能完全恢复。所有病例均未见局部复发。结论颈椎管内外哑铃形肿瘤可通过Tovama分型选择合适的手术方式和入路,减小对颈髓、椎动脉、神经根损伤风险,并且肿瘤可一次性手术切除。

Objective To investigate the clinical features, Toyama classification and surgical treatment strategy of inner and outer cervical spinal canal dumbbell tumors. Methods Clinical manifestations, imaging features, pathological types, surgical treatment methods and prognosis of 5 patients with inner and outer cervical spinal canal dumbbell tumors adopted by our hospital from August 2008 to August 2011 were analyzed retrospectively. Based on the tumor site, there were 2 patients in C1-2, 1 in C34, 1 in C4.6, and 1 in C5-7. All the tumors were neurinoma. Based on Toyama classification, there was 1 patient of type II B, 1 of type III A, 1 of type IV, and 2 of type VI; 2 patiergs of IF stage I and 3 of IF stage II; 3 patients ofTF I and 2 of TF II. The tumors of 2 patients were removed by posterior middle approach. 2 patients experienced anterior right approach, and 1 underwent anterior left approach. Results All the tumors were removed successfully. There was no injury to vertebral artery and no further impairment of neurological function. Local pain and neurological deficit of the patients were relieved significantly. 1 patient with transient paralysis of unilateral upper limb immediately after surgery recovered after 5 days of pharrnacotherapy of corticosteroids and dehydration. 1 patient with cerebrospinal fluid leakage recovered after conservative management. There was no patient with cervical recurvatum deformity and postoperative infections. The mean follow-up period was 9 months （range; 6 months to 2 years）. All patients had varying degrees of neurological recovery, and complete neurological recovery was noted in 3 patients. All patients showed no local recurrence. Conclusions Selecting the appropriate surgical strategy and approach to remove inner and outer cervical spinal canal dumbbell tumors based on Toyama classification can reduce the risk of cervical spinal cord, vertebral artery and nerve root injuries, and moreover, tumors can be removed by one-time.