Vecil Giacomo G, McCutcheon Ian E, Mendel Ehud
Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, 1515 Holcombe Blvd., Unit 442, Houston, TX 77030, USA.
Acta Neurochir (Wien). 2008 Dec;150(12):1295-300; discussion 1300. doi: 10.1007/s00701-008-0154-8. Epub 2008 Nov 18.
Resection of giant thoracic schwannomas is challenging and usually requires a staged approach. The resection of the intraspinal component, usually via laminectomy, is done in one sitting and the intrathoracic component, via thoracotomy, follows at another. We describe the complete resection of a massive multi-compartmental thoracic schwannoma by an extended lateral parascapular approach.
The tumor, which presented with local pain and scapular displacement, had intrathoracic paraspinal (10 x 5 x 4 cm), posterolateral upper thoracic paramuscular (19 x 7 x 4 cm), foraminal, and epidural components. It was removed at a single sitting, via a posterior extended lateral parascapular approach that did not require staged procedures, multiple incisions, or repositioning of the patient. This operation included resection of the thoracic, foraminal, and intraspinal components and posterior stabilization with pedicle screws and rods. There were no postoperative neurological complications.
The extended lateral parascapular approach allows complete resection of giant multi-compartment schwannomas of the thoracic spine that extend from the canal into the thoracic cavity. It also permits posterior stabilization through the same incision used for tumor removal.
巨大胸段神经鞘瘤的切除具有挑战性，通常需要分阶段进行。脊髓内部分的切除通常通过椎板切除术一次完成，而胸内部分则通过开胸术在另一个阶段进行。我们描述了通过扩大的外侧肩胛旁入路完整切除巨大的多节段胸段神经鞘瘤。
该肿瘤表现为局部疼痛和肩胛骨移位，具有胸内椎旁（10×5×4cm）、胸上段后外侧肌旁（19×7×4cm）、椎间孔和硬膜外成分。通过后外侧扩大肩胛旁入路一次性将其切除，该入路无需分阶段手术、多个切口或患者重新定位。该手术包括切除胸段、椎间孔和脊髓内成分，并使用椎弓根螺钉和棒进行后路稳定。术后无神经并发症。
扩大的外侧肩胛旁入路能够完整切除从椎管延伸至胸腔的巨大多节段胸段神经鞘瘤。它还允许通过用于肿瘤切除的同一切口进行后路稳定。
