颈前后联合入路手术治疗椎间孔骑跨型臂丛神经鞘瘤

Microsurgery through combined anterior and posterior cervical approach for patients with intra-and extral-spinal dumbbell-shaped brachial plexus schwannoma

目的 探讨颈前后联合入路手术治疗椎间孔骑跨型臂丛神经鞘瘤的疗效。方法 回顾性分析2018年9月至2021年6月收治的7例椎间孔骑跨型臂丛神经鞘瘤的临床资料,其中6例采用颈部锁骨上窝臂丛神经肿瘤切除术联合后路颈椎管内肿瘤切除术,1例采用颈部锁骨上下窝臂丛神经肿瘤切除术联合后路颈椎管内肿瘤切除术。结果 术中未使用椎体融合、钉棒系统内固定等,颈椎各关节未破坏,颈部活动能力较术前无受限。7例肿瘤均全切除,术后病理检查均证实为神经鞘瘤。术后无脑脊液漏。5例术后症状改善;2例术后同侧肢体肌力下降,药物治疗后恢复至术前水平。7例术后随访9~27个月,平均14.7个月;影像学检查未见肿瘤复发,术后患侧肢体肌力未见下降,无新增神经功能缺失,肌电图示臂丛神经损害好转。结论 对于椎间孔骑跨型臂丛神经鞘瘤,颈前后联合入路手术可以完整切除肿瘤,无需行颈椎内固定,创伤小,可获得良好疗效。

Objective To investigate the clinical efficacy of microsurgery through combined anterior and posterior cervical(CAPC) approach for the patients with intra-and extral-spinal dumbbell-shaped brachial plexus schwannoma(IES-DS-BPC).Methods The clinical data of 7 patients with IES-DS-BPC who underwent microsurgery through CAPC approach from September 2018to June 2021 were retrospectively analyzed. Results Of 7 patients, 6 patients underwent cervical supraclavicular fossa BPC resection combined with posterior cervical intraspinal tumor resection, and 1 underwent cervical supraclavicular fossa BPC resection combined with posterior cervical intraspinal tumor resection. Total tumor resection was achieved in all the patients. Postoperative pathological examination showed schwannoma in all the patients. Symptoms were improved in 5 patients after the operation, and were worsened in 2patients whose symptoms were recovered to the preoperative status after conservative treatment. The follow up(range, 9~27 months;average, 14.7 months) showed no tumor recurrence, no decrease in muscle strength, and no new nerve dysfunction in all the aptients, and improvement of brachial plexus damage on electromyography. Conclusions For the patients with IES-DS-BPC, microsurgery through CAPC approach, with less surgical injury and good curative effect, can completely remove the tumor without cervical internal fixation.