第一、二颈椎椎管内外哑铃型肿瘤的显微外科手术治疗

Microsurgical treatment of C1-2 intra-extra spinal canal dumbbell-shaped tumor

目的总结第一、二颈椎（C1-2）椎管内外哑铃型肿瘤的临床特点、治疗经验、手术入路的选择及显微外科手术体会。方法回颐性分析2004年7月至2013年4月收治的22例C1-2椎管内外哑铃型肿瘤病例，术前经MRI确诊，一期手术选择后正中入路，如需二期手术，选择在一期手术后3个月内经颈部侧方入路切除残余肿瘤。出院前复查磁共振。结果22名患者肿瘤全部切除20例，次全切除2例，其中一期手术全切除18例，经二期手术全切除2例。病理类型：神经鞘瘤18例，脊膜瘤2例，节细胞神经瘤2例。22例术前症状术后均获缓解，无死亡病例，术后有1例出现并发症。术后随访成功21位，随访时间3个月～9年。未见肿瘤复发、颈椎不稳及后循环缺血情况。结论经后正中入路一期手术可以全切除绝大多数c1-2椎管内外哑铃型肿瘤，是较为理想的手术入路。

Objective To summarize the clinical characteristics, operational approaches and mierosurgical treatment of C1-2 dumbbell tumors. Methods The clinical data of 22 patients with C1-2 dumbbell tumor from July 2004 to April 2013 were analyzed retrospectively. All of them were comfirmed by MRI before operation. Middline posterior approach was adopted in one-stage operation, and the second stage operation would be 3 months after the first one by lateral approach to remove the remaining tumor, if it was necessary. And at last the patients were reexamined by MRI before they left hospital. Results Tumor tissues were totally removed in 20 cases, subtotally removed in 2 cases. Eighteen patients in total-removed group underwent one-stage operation, and the other 2 patients went through two-stage operations. Pathological types include 18 cases of neurinoma, two cases of meningioma and 2 cases of ganglioneuroma. After operation, all patients achieved alleviation of preoperative symptoms in different levels. Post- operative complications were confirmed in 1 case, and no death occurred in this series . Twenty-one cases were followed up for 3 months to 9 years, while 1 other case was missing. No tumor recurrence, cervical instability or symptoms of posterior circulation were observed. Conclusion The midline posterior approach is appropriate for total resection of one stage to remove most of C1-2 dumbbell tumor.