后路椎板切除入路显微外科治疗椎管内神经鞘瘤

Posterior laminectomy approach microsurgery in the treatment of intraspinal schwannoma

目的探讨后路椎板切除入路显微外科治疗椎管内神经鞘瘤的临床疗效。方法选取我院自2011年1月-2014年12月间28例经后路椎板切除入路显微外科治疗并经病理证实的神经鞘瘤患者临床资料进行回顾性分析。结果 28例患者均采用后路椎板切除入路显微手术治疗,其中肿瘤位于颈段13例,胸段10例,腰骶段5例。28例病例中行半椎板切除术20例,全椎板切除8例,所有病例肿瘤均完全切除,术中无脊髓神经损伤。28例患者术后临床症状均缓解,神经功能明显改善。随访6-12个月,无影像学复发。8例全椎板切除术患者进行椎管内固定,内固定稳定。随访期间所有患者未见椎体滑脱、失稳征象。结论后路椎板切除入路能充分暴露肿瘤,有利于手术全切肿瘤。采用显微外科手术可避免脊髓及神经损伤,提高手术疗效。半椎板切除入路显微手术具有创伤性小,有利于脊柱稳定,所以对肿瘤较小且位于脊髓一侧时应首选。

Objective To explore the clinical effect of posterior laminectomy approach microsurgery in the treatment of intraspinal schwannoma. Methods The clinical data of 28 patients who received posterior laminectomy approach microsurgery and were pathologically confirmed to have intraspinal schwannoma in our hospital from January 2011 to December 2014 were collected and analyzed. Results All patients received posterior laminectomy approach microsurgery,among them,13 cases had the tumors located in the cervical segments,10 cases in the thoracic segments,and 5 cases in the lumbar and sacral segments.In the 28 patients,20 cases received hemi-laminectomy and 8 cases received laminectomy,all their tumors were completely removed and no one suffered spinal nerve injury during operation.In all 28 patients,the clinical symptoms were relieved and the neurological functions were improved obviously after operations,there were no radiographically recurrences after 6-12 months of follow-up.In the 8 patients who received laminectomy,the spinal internal fixation and fixation stabilization were applied,and there were no vertebral spondylolisthesis and instability symptoms during follow-up period. Conclusion The posterior laminectomy approach can expose the tumor clearly,which benefits the complete surgical resection of tumor.The microsurgery can avoid spinal cord and nerve injuries,therefore improves the operation effect.The posterior laminectomy approach microsurgery has small incision and benefits the spinal stability,which is the first choice for the patients with small tumors on one side of the spine.