显微手术治疗椎管内神经鞘瘤的疗效

Therapeutic effect of microsurgical treatment of schwannoma in the spinal canal

目的观察显微手术治疗椎管内神经鞘瘤的疗效。方法回顾性分析2014-06至2016-06手术治疗经病理明确证实为神经鞘瘤的56例患者临床资料,该组病例均一期完成手术,其中半椎板入路12例,全椎板入路44例(Ⅱb和Ⅲb型共3例均位于颈椎,行前后联合手术)。常规椎板复位,用钛钉、钛板固定,3例行钉棒系统内固定及植骨融合术。观察治疗后疼痛情况、视觉模拟评分(visual analogue scale,VAS)、自觉感觉障碍面积、美国脊髓损伤协会(American Spinal Injury Association,ASIA)肢体感觉以及运动功能评分。结果 55例肿瘤全切除,1例肿瘤近全切除,术后病理证实为恶性神经鞘瘤。随访时间为6~24个月,平均20.15个月。术后疼痛明显改善者49例,VAS评分由术前的(7.92±1.03)分降至术后6个月的(3.25±1.12)分,差异有统计学意义(P<0.05);术后自觉感觉障碍面积增大者11例,ASIA感觉评分由术前的(225.31±2.53)分降至术后6个月的(213.76±1.76)分,差异有统计学意义(P<0.05);肢体运动功能改善25例,ASIA运动评分由术前的(93.46±1.58)分提高至术后6个月的(96.02±1.29)分(P<0.05)。复查增强MRI,仅恶性神经鞘瘤患者6个月复查时提示肿瘤复发,并接受再次手术治疗,其余均无复发;无继发脊柱后突畸形。结论椎管内神经鞘瘤经显微手术治疗,采用适合个体的手术策略,可取得较好的临床疗效。

Objective To summarize the clinical features of and microsurgical experience from fifty-six cases of schwannoma in the spinal canal. Methods The clinical data of fifty-six patients with neurilemmoma confirmed by pathology between June 2014 and June 2016 was retrospectively analyzed. All the patients in this group received surgery in one phase,twelve of whom were treated by semi-laminae and forty-four by the total laminar approach. Conventional laminae were used for resetting while titanium nails and plates were used for fixation. Three of the cases underwent screw-rod system fixation and fusion. Post-treatment pain,VAS(Visual Analogue Scale）,areas of sensory disturbances,limb sensory and motor function scores of ASIA(American Spinal Injury Association） were observed. Results Fifty-five of these cases received total resection,and one case underwent near total resection. Postoperative pathology confirmed malignant schwannoma. Follow-up time ranged from 6 to 24 months with an average of 20. 15 months. In forty-nine of these cases,there was significant improvement of postoperative pain,and the VAS decreased from 7. 92 ± 1. 03 before surgery to 3. 25 ± 1. 12 at 6 months after surgery(P 〈 0. 05）. The area of postoperative sensory disturbances increased in eleven cases. The sensory score of ASIA decreased from 225. 31 ± 2. 53 to 213. 76 ± 1. 76(P 〈 0. 05） at 6 months after operation. The motor function of ASIA improved in twenty-five cases. ASIA motor score increased from 93. 46 ± 1. 58 preoperatively to 96. 02 ± 1. 29 at postoperative 6 months(P 〈0. 05）. Reexamination via enhanced MRI showed that tumor recurred in patients with malignant schwannomas and a second surgery was conducted. There was no recurrence in other cases and no secondary kyphosis deformity occurred. Conclusions The personalized microsurgical approach to schwannomas in the spinal canal is highly effective.