前路颈动脉鞘内外联合入路手术治疗Toyama Ⅱb和Ⅲb型颈椎管内外哑铃形肿瘤

Anterior through medial and lateral of the carotid sheath approach for Toyama Ⅱb and Ⅲb inner and outer cervical spinal canal dumbbell tumors

中文关键词:  哑铃形肿瘤  颈动脉鞘  Toyama分型  手术  疗效

英文关键词:Dumbbell tumors  Carotid sheath  Toyama classification  Surgical treatment  Effect

中文摘要:

  【摘要】 目的：探讨经前路颈动脉鞘内外联合入路手术治疗Toyama Ⅱb和Ⅲb型颈椎管内外哑铃形肿瘤的效果及手术技巧。方法：2006年2月~2010年10月对17例Toyama Ⅱb和Ⅲb型颈椎管内外哑铃形肿瘤患者采用经前路颈动脉鞘内外联合入路手术切除肿瘤、髂骨或钛网支撑植骨并钛板内固定重建颈椎稳定性，其中男9例，女8例，年龄34～53岁，平均43.6岁。Toyama Ⅱb型9例，Ⅲb型8例。术前脊髓神经功能Frankel分级：C级3例，D级10例，E级4例。随访观察患者症状和神经功能改善情况。结果：17例患者均一期手术切除椎管内外肿瘤，手术过程顺利，手术时间90～170min，平均130min；失血量150～700ml，平均280ml。1例术后即刻出现前臂神经症状加重，予激素及脱水剂治疗3d后症状缓解，未出现其他严重并发症。17例随访10～48个月，平均18个月，患者局部疼痛和神经症状均有明显改善或缓解，末次随访时，7例患者脊髓神经功能Frankel分级改善1级，3例改善2级。1例恶性神经鞘瘤患者术后1年出现局部肿瘤复发而再次行后路手术切除，其余患者随访期间肿瘤无复发。结论：Toyama Ⅱb和Ⅲb 型颈椎管内外哑铃形肿瘤可经前路颈动脉鞘内外联合入路一次手术切除，手术创伤小，瘤体切除彻底，并发症少。

英文摘要:

  【Abstract】　Objectives: To analyze the treatment effect and surgical technique in the treatment of the Toyama Ⅱb and Ⅲb inner and outer cervical spinal canal dumbbell tumors by the anterior through medial and lateral of the carotid sheath approach.　Methods：　Between February 2006 and October 2010, 17 cases suffering from Toyama Ⅱb and Ⅲb inner and outer cervical spinal canal dumbbell tumors undergoing anterior through medial and lateral of the carotid sheath approach were reviewed retrospectively.　There were 9 males and 8 females with the age at the time of surgery ranging from 34 to 53 years(mean,　43.6 years). There were 9 cases of Toyama Ⅱb and 8 cases of Toyama Ⅲb. According to Frankel classification, there were 4 grade E, 10 grade D and 3 grade C.　The neurological function and clinical symptoms were used to evaluate the surgical outcome. Results: All tumors were removed successfully. All operations were completed successfully. Overall, mean operative time averaged at 130min(range, 90-170min), mean estimated blood loss(EBL) was 280ml(range, 150-700ml). 　Apart from one case immediately got a transient forearm nerve symptoms increasing, and released with hormone dehydration drugs in 3 days. There was no other serious complication. 17 cases were followed up from 10 to 48 months(on an average of 18 months). Pain and neurological deficit relieved significantly, and at final follow-up, 7 cases had Frankel level improved 1 level, and 3 cases had it improved 2 levels. 1 case with malignant schwannoma occurred local recurrence in 1 year of postoperation and received second operation.　Conclusions： Toyama Ⅱb and Ⅲb inner and outer cervical spinal canal dumbbell tumors can be surgically resected by the anterior through medial and lateral of the carotid sheath approach, this surgical technique is beneficial to minimal wound, tumor completely removal， and less compli-cations.