32例椎管内神经鞘瘤的诊断及手术治疗

Diagnosis and surgical treatment analysis of 32 cases of intraspinal schwannomas

目的探讨椎管内神经鞘瘤的诊断和手术治疗。方法回顾性分析本科2007年1月~2014年12月32例椎管内神经鞘瘤的临床资料、手术情况。结果 32例均获得随访,随访时间19~72个月,平均25个月。32例均采用后正中入路,实施全椎板切除或半椎板切除减压联合肿瘤切除术,肿瘤均完整切除,术后5例出现脑脊液漏,对症保守治疗后愈合。根据术后疗效评价标准,优良率为90.6%。结论 MRI检查是确诊椎管内神经鞘瘤的最有价值的手段,详细的病史采集和体格检查是防止早期病例漏诊的基本措施。手术切除是处理此类肿瘤的有效手段,但是需注意术中操作技巧、避免医源性神经损害。

Objective To evaluate the diagnosis and surgical treatment method of intraspinal schwannomas. Methods To retrospective study clinical data and surgical treatment of 32 cases with intraspinal schwannomas from Jan 2007 to Dec 2014 at Department of Orthopedics of Guangzhou Hospital of Integrated Chinese and Western Medicine and Department of Spine Surgery of the First Affiliated Hospital of Sun Yat-Sen University. Results 32 patients had been followed up after the operation from 19 to 72 months, average for 25 months. 32 cases ofintraspinal schwannomas was completely resected through a posteromedial approach and total or unilateral laminectomy. After treatment, 5 patients affected leakage ofcerebrospinal fluid which were cured ultimately by conservative treatment. According to the evaluation criterion, the excellent and good rate was 90.6%. Conclusion MRI is the most valuable method to determine the intraspinal schwa- unomas. Careful medical history collection and physical examination were basic measures for avoiding early missed di- agnosis. Surgical resection ofIntraspinal schwannoma is the most effective therapy, but proper operation must be taken to avoid iatrogenic injury of spinal nerve.