Sridhar K, Ramamurthi R, Vasudevan M C, Ramamurthi B
Dr A. Lakshmipathi Neurosurgical Centre, VHS Medical Centre, India.
Br J Neurosurg. 1998 Oct;12(5):430-3. doi: 10.1080/02688699844637.
Traditionally, spinal extramedullary tumours are approached by a wide multilevel laminectomy and a midline dural incision. This exposure may result in immediate or delayed instability of the spine, and exposes the spinal cord to the possibility of inadvertent injury during surgery. To avoid these complications the authors have, in 27 patients, used a limited unilateral approach to remove extramedullary tumours. The approach entails bone removal which is limited to the lateral half of the lamina on the side of the tumour and may or may not include the medial part of the facet joint. A lateral dural flap exposes the tumour without exposing the cord. Extraspinal extensions of the lesion may be approached by extending the laminectomy further laterally to the facet joint. This technique has been used in the cervical, thoracic and the lumbar spine to radically remove the lesion in all cases. There were no complications. The authors conclude that extramedullary lesions of the spine can be removed radically by this approach which allows direct access without cord or root retraction, and with little disturbance to the normal anatomy.
传统上，脊髓外肿瘤的手术方法是广泛的多节段椎板切除术和中线硬脊膜切开术。这种暴露方式可能导致脊柱立即或延迟不稳定，并使脊髓在手术过程中面临意外损伤的风险。为避免这些并发症，作者对27例患者采用了有限的单侧入路来切除脊髓外肿瘤。该入路需要去除肿瘤侧椎板外侧半的骨质，可能包括也可能不包括小关节的内侧部分。外侧硬脊膜瓣可暴露肿瘤而不暴露脊髓。病变的椎体外延伸部分可通过将椎板切除术进一步向外侧延伸至小关节来处理。该技术已用于颈椎、胸椎和腰椎，所有病例均能彻底切除病变。无并发症发生。作者得出结论，通过这种入路可以彻底切除脊柱的髓外病变，该入路可直接进入而无需牵拉脊髓或神经根，且对正常解剖结构的干扰很小。
