一期手术结合脊柱内固定术治疗椎管内外沟通性肿瘤

One-stage microsurgical resection combined with spinal instrumentation for the treatment of communicating intra-and extra-vertebral tumors

目的探讨一期显微手术切除椎管内外沟通性哑铃型肿瘤,及维持术后脊柱稳定性的处理方法。方法回顾性分析12例椎管内外沟通性哑铃型肿瘤病人的临床资料,肿瘤位于颈段6例,胸段4例,腰段2例。均行显微手术切除肿瘤,同时行脊柱内固定术10例。结果肿瘤全切除9例,近全切除2例,部分切除1例。术后病理结果：神经鞘瘤8例,神经纤维瘤、恶性周围神经鞘膜瘤、恶性间皮瘤、高分化血管肉瘤各1例。术后病人神经功能改善11例,无明显变化1例。病例均随访4~16个月,无肿瘤复发,无脊柱畸形发生。结论显微镜下一期手术切除椎管内外沟通性哑铃型肿瘤的同时,为维持术后脊柱稳定性,多数病人需同时行脊柱内固定术。

Objective To investigate the best way to resect the communicating intra- and extra-vertebral （CIE） tumor and maintain the spinal stability through one-stage microsurgery. Methods Clinical data of 12 patients with CIE tumor were analyzed retrospectively, The tumors was located at the cervical spine in 6 patients, at the thoracic spine in 4 and at the lumbar spine in 2. Tumor resection was performed under microscope in all the patients and spinal instrumentation in 10. Results Total tumor removal was achieved in 9 patients, subtotal removal in 2 and partial removal in 1. The pathological results showed schwannoma in 8 patients, and neurofibroma, malignant peripheral nerve sheath tumor, malignant mesothelioma and highly differentiated angiosarcoma in 1 respectively. The neurological fianction was improved in 11 patients and unchanged in 1. All the patients were followed up for 4 to 16 months. No tumor relapse and spinal malformation were found. Conclusion Spinal instrumentation should be performed simultaneously during one-stage microsurgery for most patients with CIE tumors in order to maintain the stability of the spine.