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

English Keywords:Dumbbell tumors  Carotid sheath  Toyama classification  Surgical treatment  Effect

English Abstract:

  【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.