“四分区法”个体化入路显微手术治疗颈椎椎旁神经源性肿瘤

Four-regions Partition Method Individualized Surgical Approaches for Cervical Paravertebral Neurogenic Tumors

目的探讨“四分区法”及个体化入路在显微手术治疗颈椎椎旁神经源性肿瘤中的应用价值。方法回顾性分析我科2013年1月~2018年12月显微手术治疗颈椎椎旁神经源性肿瘤42例资料。根据“四分区法”,肿瘤位于Ⅰ区6例,Ⅱ区5例,Ⅲ区5例,Ⅳ区7例,Ⅰ和Ⅱ区6例,Ⅰ、Ⅱ和Ⅲ区2例,Ⅱ和Ⅲ区3例,Ⅲ和Ⅳ区6例,Ⅱ、Ⅲ和Ⅳ区1例,Ⅰ、Ⅱ、Ⅲ和Ⅳ区1例。根据肿瘤主体所在节段及区域选择手术入路,采用后方旁正中入路12例,后侧方入路2例,颌下入路2例,胸锁乳突肌前入路9例,胸锁乳突肌后入路7例,锁骨上入路6例,经口腔入路1例,胸锁乳突肌前后联合入路2例,胸锁乳突肌后联合后方旁正中入路1例。术中行神经电生理监测。结果42例肿瘤均完全切除,病理诊断神经鞘瘤32例,神经纤维瘤10例。术后3例声音嘶哑,1周恢复,1例上肢肌力下降,3个月恢复,无其他并发症。术后随访12~84个月,中位数48.5月,无肿瘤复发。结论术前对颈椎椎旁肿瘤进行分区,根据分区个体化选择入路行显微手术安全有效。

Objective To evaluate the efficiency of a new“four-regions”partition method individualized surgical approach for cervical paravertebral neurogenic tumors(CPVNT).Methods This was a retrospective study of 42 patients who accepted microsurgical treatment for CPVNT at our department between January 2013 and December 2018.According to the“four-regions”partition method,the tumors were located in RⅠin 6 cases,RⅡin 5 cases,RⅢin 5 cases,RⅣin 7 cases,RⅠand RⅡin 6 cases,RⅠ,RⅡand RⅢin 2 cases,RⅡand RⅢin 3 cases,RⅢand RⅣin 6 cases,RⅡ,RⅢand RⅣin 1 case,and RⅠ,RⅡ,RⅢand RⅣin 1 case.Individualized surgical approaches were selected based on the segment and region of the tumor,including 12 cases of posterior paramedian approach(PPMA),2 cases of posterolateral approach(PLA),2 cases of submandibular approach(SMA),9 cases of anterior sternocleidomastoid approach(ASCMA),7 cases of posterior sternocleidomastoid approach(PSCMA),6 cases of supraclavicular approach(SCA),1 case of trans-oral approach(TOA),2 cases of combined ASCMA and PSCMA,and 1 case of combined PSCMA and PPMA.Intraoperative nerve electrophysiological monitoring was performed.Results All the 42 tumors were resected totally,including 32 cases of schwannoma and 10 cases of neurofibroma pathologically.Hoarseness was found in 3 patients and disappeared after one week,motor defict of upper extremity was found in 1 patient postoperatively and recovered after 3 months.No recurrence was found through magnetic resonance imaging during 12-84 months follow-up(median,48.5 months).Conclusion Individualized surgical approaches based on the new partition method are effective in surgical treatment of CPVNT.