Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA.
Eur Spine J. 2010 Feb;19(2):242-56. doi: 10.1007/s00586-009-1160-0. Epub 2009 Oct 2.
Sixteen Stanford University Medical Center (SUMC) patients with foraminal nerve sheath tumors had charts reviewed. CyberKnife radiosurgery was innovative in management. Parameters were evaluated for 16 foraminal nerve sheath tumors undergoing surgery, some with CyberKnife. Three neurofibromas had associated neurofibromatosis type 1 (NF1). Eleven patients had one resection; others had CyberKnife after one (two) and two (three) operations. The malignant peripheral nerve sheath tumor (MPNST) had prior field-radiation and adds another case. Approaches included laminotomy and laminectomies with partial (three) or total (two) facetectomies/fusions. Two cases each had supraclavicular, lateral extracavitary, retroperitoneal and Wiltze and costotransversectomy/thoracotomy procedures. Two underwent a laminectomy/partial facetectomy, then CyberKnife. Pre-CyberKnife, one of two others had a laminectomy/partial facetectomy, then total facetectomy/fusion and the other, two supraclavicular approaches. The MPNST had a hemi-laminotomy then laminectomy/total facetectomy/fusion, followed by CyberKnife. Roots were preserved, except in two. Of 11 single-operation-peripheral nerve sheath tumors, the asymptomatic case remained stable, nine (92%) improved and one (9%) worsened. Examinations remained intact in three (27%) and improved in seven (64%). Two having a single operation then CyberKnife had improvement after both. Of two undergoing two operations, one had symptom resolution post-operatively, worsened 4 years post-CyberKnife then has remained unchanged after re-operation. The other such patient improved post-operatively, had no change after re-operation and improved post-CyberKnife. The MPNST had presentation improvement after the first operation, worsened and after the second surgery \and CyberKnife, the patient expired from tumor spread. In conclusion, surgery is beneficial for pain relief and function preservation in foraminal nerve sheath tumors. Open surgery with CyberKnife is an innovation in these tumors' management.
16 例斯坦福大学医学中心（SUMC）椎间孔神经鞘瘤患者的病历进行了回顾。CyberKnife 放射外科在治疗中具有创新性。评估了 16 例接受手术治疗的椎间孔神经鞘瘤患者的参数，其中一些患者接受了 CyberKnife 治疗。3 例神经纤维瘤与 1 型神经纤维瘤病（NF1）相关。11 例患者进行了一次切除；其他患者在一次（2 次）和两次（3 次）手术后接受 CyberKnife 治疗。恶性外周神经鞘瘤（MPNST）之前曾接受过放疗，增加了另一个病例。入路包括椎板切开术和椎板切除术，部分（3 例）或全部（2 例）关节突切除术/融合术。每个病例各有 2 例锁骨上、外侧腔外、腹膜后和 Wiltse 和肋横突切除术/胸廓切开术。2 例患者接受了椎板切除术/部分关节突切除术，然后接受了 CyberKnife 治疗。在进行 CyberKnife 治疗之前，其中 2 例中的 1 例患者接受了椎板切除术/部分关节突切除术，然后进行了全关节突切除术/融合术，另 1 例患者接受了 2 例锁骨上入路。MPNST 行半椎板切除术，然后行椎板切除术/全关节突切除术/融合术，随后行 CyberKnife 治疗。除 2 例外，所有神经根均得以保留。在 11 例单次手术治疗的外周神经鞘瘤患者中，无症状病例保持稳定，9 例（92%）患者改善，1 例（9%）患者恶化。3 例患者的检查结果保持完整（27%），7 例患者（64%）改善。2 例患者行 2 次手术，2 次手术后均有改善。2 例患者行 2 次手术，1 例术后症状缓解，CyberKnife 治疗 4 年后恶化，再次手术后无变化。另 1 例患者术后改善，再次手术后无变化，CyberKnife 治疗后改善。MPNST 在第一次手术后症状改善，第二次手术后和 CyberKnife 治疗后恶化，患者因肿瘤扩散死亡。总之，手术对椎间孔神经鞘瘤的疼痛缓解和功能保存有益。CyberKnife 开放性手术是这些肿瘤治疗的创新方法。
