枕骨大孔区神经鞘瘤后正中入路显微手术方法及疗效的研究

Microsurgical treatment of schwannoma in foramen magnum via posterior median approach

目的探讨后正中入路显微切除枕骨大孔区神经鞘瘤的手术方法、要点及疗效。方法回顾性分析23例枕骨大孔区神经鞘瘤患者的临床资料。根据肿瘤的部位分为单纯腹侧型(3例)、单纯背外侧型(15例)和哑铃型(5例),均采用后正中入路手术,不同分型肿瘤采用不同操作方法切除肿瘤。术中行电生理监测保护神经功能。结果本组患者中,肿瘤全切除19例,次全切除4例。术后神经损害症状完全缓解者16例,部分缓解5例,无缓解或加重2例,随访0.5~10年(平均5.4年)均有不同程度恢复;术后均无出现感染、脑脊液漏并发症,无死亡病例。结论后正中入路显微手术切除枕骨大孔区神经鞘瘤的疗效良好。枕骨大孔区骨质磨除、肿瘤包膜合理松解、充分瘤内减压及神经血管零牵拉的操作方法可提高手术的效果及安全性。

Objective To investigate the main points of microresection of schwannoma in the foramen magnum region by posterior median approach.Methods The clinical data of 23 patients with schwannoma in foramen magnum were analyzed retrospectively.According to the tumor site,there were 3 of ventral type,15 of dorsolateral type and 5 of dumbbell type.All patients were operated by posterior median approach.Different types of tumors were resected by different methods.Intraoperative electrophysiological monitoring was performed to protect nerve function.Results Of all the cases,total resection of tumor was performed in 19 and subtotal resection was performed in 4.16 showed complete relief of the pain and numbless of neck,shoulder and upper limb.5 showed incomplete relief after the operation and totally relief in the follow up period(0.5-10 years,5.4 years on average).No other complications as intracranial infection or deaths showed in the following-up period.Conclusions Posterior median approach is an effective and safe method for microsurgical resection of schwannoma in the foramen magnum of the occipital region.The safety of surgery can be improved by bone grinding in the foramen magnum area,reasonable release of tumor capsule,intratumor decompression and zero-traction of nerve vessels.