脊髓功能区神经鞘瘤手术治疗

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1、中国现代神经疾病杂志2013年11月第13卷第11期ChinJContempNeurolNeurosurg,November2013,Vol.13,No.11·931··椎管内肿瘤神经外科临床研究·脊髓功能区神经鞘瘤手术治疗陈永杰陈赞菅凤增【摘要】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

2、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。【关键词】神经鞘瘤；脊髓；监测，手术中；电生理学SurgicalmanagementofschwannomasinspinaleloquentareasCHENYong⁃jie,CHENZan,JIANFe

3、ng⁃zengDepartmentofNeurosurgery,XuanwuHospital,CapitalMedicalUniversity,Beijing100053,ChinaCorrespondingauthor:JIANFeng⁃zeng(Email:jianfz@vip.sina.com)【Abstract】ObjectiveToinvestigatetheclinicalcharacteristicsandsurgicalmanagementofschwannomasinspinaleloquentareas.MethodsClinicaldataof58patientswith

4、schwannomasinspinaleloquentareaswasretrospectivelystudied.Allthetumorswereexcisedbymicrosurgeryassistedwithintraoperativeneurophysiologicalmonitoring.Ifthetumororiginatedfromcervicalenlargement,somatosensory⁃evokedpotentials(SEPs)andmotor⁃evokedpotentials(MEPs)ofbothupperandlowerextremitiesandEMGofu

5、pperextremitieswereperformed.Ifthetumororiginatedfromintumescentialumbalisandconusmedullaris,SEPsandMEPsoflowerextremitiesandEMGoflowerextremitiesandsphincteraniwereperformed.Allthetumorswereexcisedthroughposteriormedianapproach.Laminectomyorhemilaminectomywaschosenaccordingtothesizeandlocationoftum

6、ors.Theinternalfixationwasacceptedforthereconstructionofspinalstabilityiffacetectomywasperformed.Theintraoperativeneurophysiologicalmonitoringcouldbehelpfulduringtheprocedureofinternalfixation.ResultsTotalresectionwasachievedinallofthe58patients.Therewasnonewneurologicaldeficitaftersurgery.Thepreope

7、rativepainsymptomsin42patientsdisappearedin39patientsandrelievedobviouslyin3patientsafteroperation.Twenty⁃twopatientshadnumbnessontheinvolvednerverootdominateregions,andmaybeitwasconcernedwiththeresec