3D计算机导航下巨大侵袭性椎管神经鞘瘤的显微外科治疗

Microsurgical treatment for giant invasive spinal schwannoma assisted by three-dimensional navigation

目的总结3D计算机导航辅助下巨大侵袭性椎管神经鞘瘤显微外科治疗的临床经验。方法回顾性分析北京积水潭医院神经外科2013至2014年应用3D计算机导航及显微外科治疗的15例巨大侵袭性椎管神经鞘瘤患者的临床资料。15例患者均在3D计算机导航辅助下行手术治疗，术后所有患者随访至少12个月；同时采用改良的McCormick分级对患者神经功能进行评估。结果肿瘤位于颈椎4例，骶椎3例，颈胸椎、腰椎、胸椎各2例，胸腰椎、腰骶椎各1例。5例患者行椎弓根螺钉内固定术，共置入螺钉28枚；所有螺钉置入位置满意，无并发症发生。手术全切肿瘤13例，次全切除2例。术中所有患者神经压迫都予以充分减压。术后所有患者临床症状均改善，内固定物均未出现松动或移位。结论3D计算机导航为术者实施巨大侵袭性椎管神经鞘瘤手术提供了重要的帮助，在提高术中定位准确性、减少手术损伤、降低手术并发症方面有着巨大的潜力；巨大侵袭性椎管神经鞘瘤应争取全切；若不能全切，应给予椎管内神经充分减压而实现术后临床症状改善。

Objective To summarize the clinical experience of microsurgical treatment for giant invasive spinal sehwannoma assisted by three-dimensional navigation. Methods A total of 15 cases of giant invasive spinal schwannoma were retrospectively analyzed from 2013 to 2014 in Beijing Jishuitan Hospital. All patients were performed mierosurgery assisted by three-dimensional navigation and were followed up for at least 12 months. A modified McCormick Scale was used to assess the patients＇ neurologic status and change. Results Four lesions were in the cervical region, 3 in the sacral, 2 each in the cervicothoracic, lumbar and thoracic regions, 1 each in the thoracolumbar and lumbosacral regions. A total of 28 pedicle screws were placed satisfactorily in the 5 patients with spinal instability. No severe complications were encountered. Gross total resection was performed in 13 of the 15 patients, and subtotal resection performed in 2 patients. Satisfactory decompression was achieved in all patients for neural compression. Postoperative clinical symptoms were improved in all patients, and none of the patients showed loosening or displacement of the implants. Conclusions Three-dimensional navigation provides great help for neurosurgeons in surgical treatment of giant invasive spinal schwannoma, and it has great potential in raising the intraoperative localization accuracy, reducing operational damage and surgical complications. Total resection is suggested for giant invasive spinal schwannoma; if not, total resection of the intraspinal portion is recommended.