Ⅰ期单侧后入路保留椎板切除上颈椎神经鞘膜瘤的解剖学特点及疗效分析

Clinical outcomes and anatomic evaluation of single-stage one side lamina retaining posterior approach for resection of upper cervical schwannoma

目的评价Ⅰ期一侧后入路保留椎板切除C_(1/2)神经鞘膜瘤的解剖学特点及疗效。方法2009年1月至2014年1月对符合以下手术指征患者行Ⅰ期单侧后入路保留椎板切除C_(1/2)神经鞘膜瘤:(1)硬膜外占位;(2)经C_(1/2)椎板间隙偏一侧向外生长;(3)具备神经鞘膜瘤影像学特征。共收治该类患者9例(男5例,女4例,平均年龄47.2岁,25至74岁)。收集颈椎JOA评分、术后轴性痛发生率、影像学特点、手术时间、出血量、并发症、末次随访颈椎侧位片寰齿前间隙等临床资料,经随访后予以分析总结。结果9例病例均得以随访,随访时间6至48个月,平均20个月。未出现复发病例,未出现颈椎失稳以及术后轴性疼痛病例,末次随访寰齿前间隙均小于2 mm。有神经功能损害的8例患者术前JOA评分(11.3±1.64),末次随访JOA评分(15.4±0.70),差异有统计学意义(P<0.05)。结论术前通过MRI判断上颈椎肿瘤类型,对符合手术指征的患者行Ⅰ期单侧后入路保留椎板切除上颈椎神经鞘膜瘤,术后疗效确切,可避免术后轴性痛,预后良好。

Objective To evaluate clinical outcomes and anatomy of single-stage one-side lamina retaining posterior approach for resection of C1/2 schwannoma. Methods From Jan 2009 to Jan 2014, C1/2 schwannoma cases admitted in our department were selected according to following indication：（1） Epidural tumor;（2） lateral growth pattern which went through C1/2 lamina space;（3） the diagnosis of schwannoma was suggested by MRI. 9 cases were collected, among which 5 were male and 4 female, and whose average age was 47.2 y （25~74 y）. JOA score, radiological images, operative time, bleeding amount, complications and atlanto-dental interval of lateral cervical X-ray picture at last follow-up were recorded and analyzed. Results All cases were successfully followed up for 6 to 48 month, with an average of 20 months. There was no recurrence, cervical instability and post-operative axial pain reported. At last follow-up, all of the atlanto-dental intervals were less than 2mm. Pre-operative JOA score was improved from 11.3 ± 1.64 to 15.4 ± 0.70 at the final follow-up of 8 neurologically impaired patients, and the difference was significant（P〈0.05）. Conclusion MRI should be used to recognize the tumor pre-operatively. After careful patient selection, the single-stage one-side lamina retaining posterior approach for resection of upper cervical schwannoma has a satisfied clinical outcome, few complications and good prognosis.