上颈椎椎管内外哑铃型神经鞘瘤的临床特点和手术方案

Clinical characteristics and surgical treatment of upper cervical intra- and extraspinal dumbbell-shaped schwannoma

中文关键词:  上颈椎  哑铃型神经鞘瘤  临床特点  手术方案

英文关键词:Upper cervical vertebra  Dumbbell-shaped schwannoma  Clinical characteristics  Operation plan

中文摘要:

  【摘要】 目的：分析上颈椎椎管内外哑铃型神经鞘瘤的临床特点，探讨其不同临床症状、影像学特征及治疗方案。方法：回顾性分析2022年1月～2024年6月南部战区总医院脊柱外科收治的上颈椎椎管内外哑铃型神经鞘瘤患者14例，男9例，女5例，平均年龄43.64±11.96岁（25～61岁）。根据上颈椎肿瘤位置、大小、范围及与周围重要组织结构的关系，分析临床治疗相关数据，探讨手术治疗方案，术后定期复查颈椎X线、CT及MRI检查、评估肿瘤完整切除情况和是否复发、上颈椎的稳定性和内固定有无松动断裂的情况。应用颈椎日本骨科协会（Japanese Orthopaedic Association，JOA）评分、视觉模拟量表（visual analogue scale，VAS）评分评价脊髓神经功能恢复情况和疼痛改善情况。结果：所有患者均一期完整切除肿瘤，手术治疗前后JOA评分（10.14±1.55 vs 13.86±1.06，P=0.005）及VAS评分（2.42±1.29 vs 0.64±0.71，P=0.000）差异均有统计学意义。14例患者肿瘤组织病理学结果均为神经鞘瘤，随访6个月～2年，未见肿瘤复发，神经症状明显改善，未出现上颈椎不稳表现。结论：上颈椎椎管内外哑铃型神经鞘瘤均可优先考虑一期后路肿瘤完整切除，若上颈椎重要颈椎稳定组织结构破坏，需行上颈椎固定融合，保证肿瘤切除后上颈椎的稳定性。

英文摘要:

  【Abstract】 Objectives: To analyze the clinical characteristics of upper cervical vertebrae with dumbbell schwannoma, and to explore its clinical symptoms, imaging features, and treatment plans. Methods: A retrospective analysis was performed on 14 patients with upper cervical intra- and extraspinal dumbbell-shaped schwannoma admitted to the Spinal Surgery Department of Southern Theater General Hospital from January 2022 to June 2024, including 9 males and 5 females, aged 43.64±11.96 years(25-61 years). According to the location, size, scope of the tumor, and relationship with the surrounding important tissue structure in upper cervical spine, the relevant clinical treatment data were analyzed and the surgical treatment plan was discussed. Cervical X-ray, CT and MRI examinations were regularly performed after surgery to evaluate the conditions of complete resection of tumor and recurrence, the stability of the upper cervical spine and whether the internal fixation was loose or broken. The recovery of spinal nerve function and pain improvement were evaluated by the Japanese Orthopaedic Association(JOA) and visual analogue scale(VAS) scores. Results: All the patients underwent complete tumor resection in one stage, and the postoperative JOA score(10.14±1.55 vs 13.86±1.06, P=0.005) and VAS score(2.42±1.29 vs 0.64±0.71, P=0.000) were statistically different from those before surgery. Postoperative tumor histopathology was confirmed as schwannoma in all the 14 patients. The follow-up time was 6 months to 2 years. No recurrence of tumor was found, neurological symptoms were significantly improved, and no upper cervical instability appeared. Conclusions: For patients with intra- and extra-spinal dumbbell-shaped schwannoma in the upper cervical spine, complete resection of the tumor in one stage of posterior approach can be given priority. If the important stable tissue structure of the upper cervical spine is destroyed, upper cervical spine fixation and fusion should be performed to ensure the stability of upper cervical spine after tumor resection.