前路颈动脉鞘内外联合入路手术治疗ToyamaⅡb和Ⅲb型颈椎管内外哑铃形肿瘤

Anterior through medial and lateral of the carotid sheath approach for Toyama Ⅱb and Ⅲb inner and outer cervical spinal canal dumbbell tumors

目的：探讨经前路颈动脉鞘内外联合人路手术治疗ToyamaⅡb和Ⅲ型颈椎管内外哑铃形肿瘤的效果及手术技巧。方法：2006年2月～2010年10月对17例ToyamaIIb和mb型颈椎管内外哑铃形肿瘤患者采用经前路颈动脉鞘内外联合人路手术切除肿瘤、髂骨或钛网支撑植骨并钛板内固定重建颈椎稳定性，其中男9例，女8例，年龄34～53岁，平均43．6岁。ToyamaⅡb型9例，Ⅲb型8例。术前脊髓神经功能Frankel分级：C级3例，D级10例，E级4例。随访观察患者症状和神经功能改善情况。结果：17例患者均一期手术切除椎管内外肿瘤，手术过程顺利，手术时间90—170min，平均130min；失血量150～700ml，平均280ml。1例术后即刻出现前臂神经症状加重，予激素及脱水剂治疗3d后症状缓解，未出现其他严重并发症。17例随访10～48个月．平均18个月，患者局部疼痛和神经症状均有明显改善或缓解，末次随访时．7例患者脊髓神经功能Frankel分级改善1级，3例改善2级。1例恶性神经鞘瘤患者术后1年出现局部肿瘤复发而再次行后路手术切除，其余患者随访期间肿瘤无复发。结论：ToyamaⅡb和Ⅲb型颈椎管内外哑铃形肿瘤可经前路颈动脉鞘内外联合人路一次手术切除，手术创伤小，瘤体切除彻底，并发症少。

Objectives： To analyze the treatment effect and surgical technique in the treatment of the Toya-ma Ⅱb and III b inner and outer cervical spinal canal dumbbell tumors by the anterior through medial and lateral of the carotid sheath approach. Methods： Between February 2006 and October 2010, 17 cases suffer-ing from Toyama Ⅱb and Ⅲ h inner and outer cervical spinal canal dumbbell tumors undergoing anterior through medial and lateral of the carotid sheath approach were reviewed retrospectively. There were 9 males and 8 females with the age at the time of surgery ranging from 34 to 53 years（mean, 43.6 years）. There were 9 cases of Toyama Ⅱ b and 8 cases of Toyama m b. According to Frankel classification, there were 4 grade E, 10 grade D and 3 grade C. The neurological function and clinical symptoms were used to evaluate the surgical outcome. Results： All tumors were removed successfully. All operations were completed successfully. Overall, mean operative time averaged at 130rain（range, 90-170min）, mean estimated blood loss（EBL） was 280ml（range, 150-700ml）. Apart from one case immediately got a transient forearm nerve symptoms increas-ing, and released with hormone dehydration drugs in 3 days. There was no other serious complication. 17 cases were followed up from 10 to 48 months（on an average of 18 months）. Pain and neurological deficit re-lieved significantly, and at final follow-up, 7 cases had Frankel level improved 1 level, and 3 cases had it improved 2 levels. 1 case with malignant schwannoma occurred local recurrence in 1 year of postoperation and received second operation. Conclusions： Toyama Ⅱ b and Ⅲb inner and outer cervical spinal canal dumbbell tumors can be surgically reseeted by the anterior through medial and lateral of the carotid sheath approach, this surgical technique is beneficial to minimal wound, tumor completely removal, and less compli-cations.