半椎板入路显微手术切除椎管内髓外硬膜下肿瘤的效果分析

Microsurgery via hemilaminectomy for extramedullary and subdural tumors(report of 38 cases)

目的探讨半椎板入路显微手术切除椎管内髓外硬膜下肿瘤的方法及疗效。方法回顾性分析2016年1月至2018年12月采用半椎板入路显微手术切除的38例椎管内髓外硬膜下肿瘤的临床资料。结果肿瘤全切除35例,次全切除3例(肿瘤与周围神经组织粘连紧密)。术后病理示神经鞘瘤29例、脊膜瘤6例、表皮样囊肿2例、副神经节瘤1例。术后随访6~36个月,平均19.3个月;MRI复查显示复发1例,未见椎体滑脱及脊柱畸形发生;术后6个月Frankel分级:改善34例,不变3例,恶化1例。结论半椎板入路显微手术切除椎管内髓外硬膜下肿瘤,不但能够充分显露肿瘤,而且保留椎板后弓的完整性,脊柱稳定性良好。

Objective To investigate the operative method and clinical outcomes of microsurgery via hemilaminectomy for extramedullary and subdural tumors.Methods The clinical data of 38 patients with intraspinal extramedullary and subdural tumors,of whom,36 were treated by microsurgery via hmilaminectomy and 2 by total laminectomy because of the large tumors and their abundant blood supply,analyzed were analyzed retrospectively.The surgical outcomes were evaluated by Frankel classification before and after the operation.Results The tumors were totally resected in 35 patients and subtotally in 3 patients due to the close adhesion between the tumors and peripheral nerve tissues.The postoperative pathological examination showed that 38 extramedullary and subdural tumors included 29 schwannomas,6 meningiomas,2 epidermoid cysts and 1 paraganglioma.The neurological function was improved in 34 patients,unchanged in 3 and worsened in 1 according to Frankel classification after the surgery.Conclusions The resection of intraspinal extramedullary and subdural tumors by microsurgery through hemilaminectomy can not only fully expose the tumors,but also it can preserve the integrity of the posterior arch of the lamina and the spinal stability is good.