椎管哑铃形肿瘤的个体化显微外科治疗分析

Individualized microsurgical analysis of spinal dumbbell tumors

目的探讨椎管哑铃肿瘤的个体化手术入路及显微外科治疗策略。方法回顾性分析2015年1月至2018年12月西安交通大学一附院神经外科收治的26例椎管哑铃形肿瘤的临床资料,依据Toyama肿瘤分型选择个体化的手术入路,结合患者术前、术中脊柱失稳因素实施脊柱内固定。对比术前、术后美国脊髓损伤学会(ASIA)感觉及运动评分,评估治疗效果。结果26例椎管哑铃肿瘤均达到了一期全切。其中,神经鞘瘤20例,节细胞神经瘤3例,脊膜瘤2例,神经纤维瘤1例。术后患者的神经功能症状都得到不同程度的改善,无一例出现运动功能障碍的加重。术后1月ASIA感觉评分为(219.34±1.62)分,ASIA运动评分为(98.61±1.25)分,均较术前明显提高(P<0.001)。随访6~52个月,平均28个月,未见肿瘤复发及脊柱畸形发生。结论依据椎管哑铃肿瘤特点分型并制订个体化的手术入路,结合现代显微外科技术,可达到肿瘤的一期全切;术前、术中准确评估脊柱的稳定性,合理选择脊柱内固定,对于预防患者术后脊柱畸形,提升生活质量至关重要。

Objective To explore the individualized surgical approach and microsurgical treatment of spinal dumbbell tumors.Methods We made a retrospective analysis of the clinical data of 26 cases of spinal dumbbell tumors resected at the Neurosurgery Department of The First Affiliated Hospital of Xi'an Jiaotong University from January 2015 to December 2018.Individualized surgical approach was selected by the Toyama tumor classification and spinal internal fixation was conducted according to the patients'spinal instability before and during the operation.The sensory and motor scores of the American Spinal Cord Injury Association(ASIA)were compared before and after the surgery in order to evaluate the therapeutic effect.Results All the 26 cases of spinal dumbbell tumors underwent single stage resection.There were 20 cases of schwannoma,3 cases of ganglion neuroma,2 cases of spinal meningioma,and 1 case of neurofibroma.The neurological symptoms of the patients were improved to different extent after the operation,and there was no increase in motor dysfunction.The ASIA sensory score was 219.34±1.62 and the ASIA motor score was 98.61±1.25 at 1 month after the surgery,and both of them were significantly higher than those before surgery(P<0.001).The follow-up period was 6-52 months,with an average of 28 months.No tumor recurrence or spinal deformity was observed.Conclusion Single stage micro-resection of spinal dumbbell tumors could be achieved by modern microsurgical technology and individualized surgical approach according to tumor characteristics.Based on accurate evaluation of the stability of the spine before and during the operation,reasonable selection of spinal internal fixation are crucial for preventing postoperative spinal deformity and improve patients'quality of postoperative life.