显微手术治疗高颈段椎管内肿瘤

Evaluation of Microneurosurgery in Patients with Tumors in Upper Cervical Vertebral Canal

目的 探讨应用显微手术治疗高颈段椎管内肿瘤的方法及疗效。 方法 回顾性总结我院近十年来收治并施行显微手术的 36例高颈段椎管内肿瘤病例。 结果 行镜下大部分肿瘤切除 10例 (包括 6例星形细胞瘤 ,3例包裹并紧密粘连椎动脉的哑铃形神经鞘瘤和 1例转移性肺癌 ) ,镜下全切肿块 2 6例。出院时恢复良好 2 7例 ,症状改善 3例 ,无明显改善 2例 ,加重 2例 ,住院期间死亡 2例。 结论 应注意识别高颈段椎管内肿瘤的相关症状和体征 ,对可疑病人尽早行MRI检查 ,避免漏诊、误诊。一旦影像学诊断成立 ,应尽早显微手术 ,即使有呼吸、大小便功能障碍也不是手术的绝对禁忌。应综合选择手术入路 ,应用显微操作 ,重视微创原则 ,保护重要组织 ,维持或重建脊柱稳定 。

Objective To explore the methods and outcomes of microneurosurgery in patients with tumors in the upper cervical canal. Methods Thirty-six cases with tumors in the upper cervical vertebral canal who had received microneurosurgery from May 1993 to March 2002 were analyzed retrospectively. Results In this series,6 astrocytomas and 3 dumbbell tumors as well as 1 pulmonary metastasis tumor were subtotaly removed; others underwent total removal under microscope. Complete recovery ensued in 27 patients when departure, 3 patients got improved. Unchangable or worsening of preoperative neurological deficits was observed in either 2 patients, and 2 patients died during hospitalization.Conclusions It is very important to discover the related clinical manifestations of tumors in the upper cervical vetebral canal in out-patient department. All the suspected patients should undergo MR imaging. The earlier diagnosis and microsurgical treatment will give the patients better operative outcome. Dyspnea and dysfunction of bowel movement and micturition are not considered as absolute operative contraindications. Appropriate approaches, microsurgical techniques varied with the pathological types of the tumors,and principle of minimal invasion can make the operation safer. Stability of the cervical spines and the craniocervical junction should be attached to importance by the neurosurgeons.