Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan.
Neurosurgery. 2009 Dec;65(6):1178-81; discussion 1181. doi: 10.1227/01.NEU.0000360131.78702.9B.
Although an anterolateral approach is an ideal approach to the anterior part of the cervical spinal canal, it is not often used because of various technical difficulties. This article presents the case of a patient with an intradural schwannoma ventrolateral to the spinal cord and describes the technique, anterolateral surgery without fixation, that was used to remove it.
A 71-year-old man presented with neck pain and easy fatigability of the legs. Magnetic resonance imaging showed an intradural tumor ventrolateral to the spinal cord at the C3 level. The diagnosis was a schwannoma.
A right anterolateral approach was selected for the resection. In the dissection between the sternocleidomastoid muscle and the internal jugular vein, the accessory nerve was retracted with the fat tissue. At C3, the prevertebral aponeurosis was laterally retracted to protect the sympathetic chain. The C3 transverse process was rongeured, and the vertebral artery was shifted laterally with the venous plexus. The C2-C3 uncovertebral joint and the right third of the C3 body were removed (partial corpectomy). The tumor was easily found in the dural sac and was totally removed. The surgical wound was closed in a watertight fashion. No fixation was necessary. The symptoms improved after the operation.
The anterolateral approach is one of the best approaches for resecting ventrally located intradural lesions because it allows minimally invasive surgery. Control and protection of the accessory nerve, sympathetic chain, and vertebral artery are the keys to success.
尽管前外侧入路是颈椎管前部分的理想入路，但由于各种技术困难，该入路并不常用。本文介绍了一例脊髓腹外侧硬脊膜内神经鞘瘤患者，并描述了用于切除该肿瘤的前外侧非固定手术技术。
一名 71 岁男性因颈部疼痛和腿部易疲劳就诊。磁共振成像显示 C3 水平脊髓腹侧有硬脊膜内肿瘤。诊断为神经鞘瘤。
选择右侧前外侧入路进行切除。在胸锁乳突肌和颈内静脉之间的解剖过程中，用脂肪组织牵拉副神经。在 C3 水平，将椎前筋膜向外侧牵拉以保护交感链。C3 横突锉磨，静脉丛将椎动脉向外侧移位。切除 C2-C3 钩椎关节和 C3 体的右侧三分之一（部分椎体切除术）。硬脊膜囊内的肿瘤很容易被发现并被完全切除。手术切口严密缝合，无需固定。术后症状改善。
前外侧入路是切除腹侧硬脊膜内病变的最佳入路之一，因为它允许进行微创外科手术。副神经、交感链和椎动脉的控制和保护是手术成功的关键。
