颈椎节细胞神经瘤的临床特点与手术治疗

Clinical manifestation and surgical treatment of ganglioneuroma of cervical spine

中文关键词:  节细胞神经瘤  颈椎  颈椎肿瘤  显微外科手术

英文关键词:Ganglioneuroma  Cervical spine  Spine tumor  Microsurgery

中文摘要:

  【摘要】 目的：总结颈椎节细胞神经瘤的临床特点，探讨其手术治疗效果。方法：2001年6月~2007年7月我院手术治疗颈椎节细胞神经瘤患者10例，男5例，女5例，年龄28~65岁，平均45.1岁。6例以根性疼痛为主要表现，4例以肿瘤压迫平面以下肌力下降为主要表现，3例患者有与肿瘤所在水平相关的感觉障碍平面。MRI检查显示肿瘤在T1WI呈低信号、T2WI呈高信号，增强后有强化；在轴位像上肿瘤位于髓外-硬膜内外者3例，其中2例沿椎间孔呈哑铃形生长，7例肿瘤位于硬脊膜外-椎间孔内外呈哑铃形；C1~C2水平者4例，C3~C4 1例，C4~C5 1例，C5~C6 3例，C4~C6 1例。2例肿瘤主体位于髓外-硬膜下者采用常规双侧椎板切除显露，8例肿瘤主体位于椎间孔者采用患侧半椎板-小关节突切除显露，于显微镜下行肿瘤分离切除。2例哑铃形肿瘤椎管外部分较大，附加后外侧入路切除椎旁部分。结果：肿瘤全切除9例，次全切除1例。术后病理检查可见成熟或未成熟的肿瘤性节细胞散在或成束穿插于肿瘤性雪旺氏细胞间质中，肿瘤中可见正常的神经纤维呈束状排列。术后发生脑脊液漏2例，经对症处理后治愈。术前6例神经根痛患者，术后4例症状缓解或消失，2例无变化。术前4例上、下肢运动障碍者，术后3例改善，1例无变化。随访2.1~7.2年，平均4.1年，末次随访时脊髓功能状态按McCormick分级标准评价，好转8例，不变2例。随访期间1例次全切除患者术后2年肿瘤原位硬膜下复发，再次手术切除，另9例无复发。结论：颈椎节细胞神经瘤临床上以根性疼痛及感觉运动障碍为主要表现，肿瘤形态大多数为骑跨椎间孔呈哑铃形生长，肿瘤主体多位于硬膜外。手术全切除后预后良好。

英文摘要:

  【Abstract】 Objective：To investigate the clinical manifestation and surgical outcome of ganglioneuroma of cervical spine.Method：From June 2001 to July 2007，10 patients with cervical spine ganglioneuromas treated surgically were analyzed retrospectively.There were 5 males and 5 females with an average age of 45.1 years（range，28-65 years）.Clinically，6 patients presented with radicular neuralgia，and 4 patients with motor deficit below the mass level，3 patients showed sensory deficit below the lesion on physical examination.MRI revealed low density signal on T1 weighted，and high density signal on T2 weighted images with apparent intensification.3 cases had lesion in the space of extramedullary-subdural/epidural and 2 of them presented as dumbbell shaped across neural foramen.7 cases had tumors sited in extradural and across neural foramen.4 tumors located at the level of C1-C2，1 at C3-C4，1 at C4-C5，3 at C5-C6 and 1 at C4-C6.The surgical protocols included hemilaminectomy and facetactomy in 8 dumbbell shaped tumors which occupied the most neural foramen region，and conventional laminectomy in 2 cases which occupied the dural sac alone.Posterolateral procedures were performed in 2 cases for removal of the para-spinal part of dumbbell shaped tumor due to their extensive involvement.All tumors were dissected microscopically.Result：10 operations had been performed with 9 en bloc and 1 subtotal resection.Pathological results showed mature or degenarative ganglion cells in neoplastic Schwann stroma，normal spindle shaped cells were evidenced in tumor tissue.CSF leakage was noted in 2 patients.4 of 6 patients with neuralgia prior operation achieved pain relief while the others remained no change.Among the 4 patients with four limbs motor deficit prior operation，3 patients improved and 1 patient remained no change.The follow-up ranged from 2.1 year to 7.2 years（average，4.1 years）.8 patients had neurological function improved and 2 remained no change which was evaluated by McCormick scale for spinal function status at final follow-up.During the follow-up，only 1 patient experienced tumor recurrence at the same site 2 years later which was removed after reoperation.Conclusion：Cervical spine ganglioneuroma presents with chronic radicular neuralgia，sensory and motor deficit.The tumor presenting as dumbbell shaped across neural foramen mostly sites in the extradural space.Surgical excision en bloc is reliable.