前外侧及后外侧入路切除颅颈交界区脊(延)髓前方及侧方肿瘤附18例临床分析

Anterolateral and posterolateral approaches to resect tumors anterior and lateral to the spinal cord(or oblongata)at the craniocervical junction:Clinical analysis of 18 cases

目的对前外侧及后外侧入路治疗颅颈交界区脊(延)髓前方及侧方肿瘤的手术方法、手术指征进行讨论。方法18例病例包括10例脑膜瘤,7例神经鞘瘤及1例转移瘤。手术方法包括前外侧入路1例,后外侧入路16例(20次),前外侧+后正中入路1例。结果肿瘤全切16例(其中3例复发后又行1～2次手术),部分切除2例,1例在C1～2关节切除后行内固定。本组无手术死亡。结论后外侧入路可用于处理颅颈交界区脊(延)髓前方或侧方硬膜下肿瘤及部分哑铃型肿瘤,安全显露并控制椎动脉的方法为沿C1后弓骨膜下由内向外分离。前外侧入路可用于C1横突侧方或椎前间隙的病变,与后正中入路联合可用于多数哑铃型肿瘤,显露椎动脉的方法为首先找到C1横突,然后沿上、下斜肌及肩胛提肌分离出C1～2之间及C1后弓上方的椎动脉。术后MRI复查十分重要,对复发良性肿瘤建议再手术。

Objective To discuss the operative methods and indications for18tumors located anterior and lateral to the spinal cord(or oblongata)of the craniocervical junction.Methods 18surgical treated cases included10meningiomas,7neurinomas and1metastasis.The anterolateral approach was applied in1case,combined anterolateral and posterior midline approach in1case,the posterolateral approach was used in16cases(20times).Results The tumor was resected totally in16cases(among them,3recurrent cases were reoperated one or two times),partially in2cases.In1case,internal fix ation of the C 1～2 junction after resection was used.There was no operative mortality.Conclusions The posterolateral approach could be used to deal with the intradural tumors anterior or lateral to the spinal cord(or oblongata)and part of the dumbbell type tumors of the craniocervical junction.The safe exposure and control of the vertebral artery are managed by subperiosteal dissection along the posterior arch of axis interolaterally.The anterolateral approach is suitable to remove the tumors located in the prevertebral space or lateral to the transverse process of axis,incorporated with posterior midline approach,it is also a good choice for majority of dumbbell tumors.By localizing the transverse process of axis,and dissecting the superior,inferior oblique muscles and levator scapulae inserted on it,the vertebral artery between C1and C2,and above the posterior arch of C1could be exposed.Postoperative MR is very important,and reoperation can be recommended for recurrent benign tumors located in the craniocervical junction.[