脊髓功能区神经鞘瘤手术治疗

Surgical management of schwannomas in spinal eloquent areas

目的探讨脊髓功能区神经鞘瘤临床特点及手术治疗方法。方法回顾分析58例脊髓功能区神经鞘瘤患者临床资料,其中起源于颈膨大者16例,术中行四肢运动诱发电位、体感诱发电位和上肢肌电图监测;起源于腰膨大和脊髓圆锥者42例,术中监测下肢运动诱发电位、体感诱发电位,以及下肢和肛门括约肌肌电图。经脊柱后正中入路行半椎板或全椎板切除术,切除侧方关节突者术中辅助经后路钉棒内固定。结果所有患者均于显微镜下获得肿瘤全切除,术后无新发神经功能缺损。术前42例伴疼痛症状患者,术后39例症状消失、3例明显缓解;17例肢体无力和2例便秘患者,术后症状明显缓解;22例术后遗留受累神经根支配区域麻木、不适感;术后随访3~12个月,神经功能缺损症状明显缓解,肿瘤无复发。结论对于起源于颈腰膨大或脊髓圆锥等脊髓功能区的神经鞘瘤,术中神经电生理监测可减少神经功能缺损并发症的发生。

ObjectiveTo investigate the clinical characteristics and surgical management of schwannomas in spinal eloquent areas.MethodsClinical data of 58 patients with schwannomas in spinal eloquent areas was retrospectively studied. All the tumors were excised by microsurgery assisted with intraoperative neurophysiological monitoring. If the tumor originated from cervical enlargement, somatosensory evoked potentials(SEPs) and motor evoked potentials(MEPs) of both upper and lower extremities and EMG of upper extremities were performed. If the tumor originated from intumescentia lumbalis and conus medullaris, SEPs and MEPs of lower extremities and EMG of lower extremities and sphincter ani were performed. All the tumors were excised through posterior median approach. Laminectomy or hemilaminectomy was chosen according to the size and location of tumors. The internal fixation was accepted for the reconstruction of spinal stability if facetectomy was performed. The intraoperative neurophysiological monitoring could be helpful during the procedure of internal fixation. ResultsTotal resection was achieved in all of the 58 patients. There was no new neurological deficit after surgery. The preoperative pain symptoms in 42 patients disappeared in 39 patients and relieved obviously in 3 patients after operation. Twenty two patients had numbness on the involved nerve root dominate regions, and maybe it was concerned with the resection of tumors and parent nerve roots. The preoperative weakness symptoms in 17 patients and constipation symptoms in 2 patients were significantly improved when discharge. One patient with severe weakness of bilateral lower extremities and 2 patients with sphincter dysfunction were transferred to Physiatry Department when their condition became stable. During the follow up period of 3-12 months, the preoperative neurological deficit improved significantly and there was no tumor recurrence.ConclusionThe intraoperative neurophysiological monitoring can reduce the rate of neurological complications for schwannomas originated from spinal eloquent areas, such as intumescentia lumbalis and conus medullaris.