Hussein Hesham A, Goda Hazem A
The Departments of Surgical Oncology, National Cancer Institute, Cairo University.
J Egypt Natl Canc Inst. 2009 Mar;21(1):12-22.
To achieve adequate excision of paravertebral neurogenic tumors with intra spinal extension, safe decompression of spinal cord and preservation of spine stability.
From Nov. 2000 till July 2009 sixteen patients of paravertebral neurogenic tumors with intraspinal extension (dumbbell tumors) were operated upon by combined team work of surgical oncology and neurosurgery at the National Cancer Institute and at Kasr- Al Einy Hospitals, Cairo University. All patients had CT with guided biopsy and MRI to evaluate extent of tumor bone invasion, intraspinal component, to decide surgical approach and the need for spine fixation. Patients were referred postoperatively to I.C.U for stabilization of general condition. Follow-up with radiology was done for a period from 3-36 month.
The group of patients were 9 males and 7 females with age range 1.5-47 year, 8 patients had tumors in post. Mediastinum, 7 in the retroperitoneal space and one in the cervicothoracic inlet. Benign schwannoma were diagnosed in 5 cases, malignant schwannoma in 3, neurofibromatosis in one case, neuroblastoma in 3 cases, ganglioneuroblastoma in 2 cases and ganglioneuroma in 2 cases. Anterior transthoracic resection through posterolateral thoracotomy was used in 6 cases, anterior transabdominal resection was done in 6 cases through midline or transverse incisions. Combined anterior and posterior approach was used in 3 cases while Posterior approach was done in one case using medial para scapular incision. Delivery of the tumor was done in 8 cases, widening of the intervertebral foramina in 3 cases, costotransversectomy with lateral laminectomy in 3 cases while posterior laminectomy and total vertebrectomy was done in one case. We fixed the spine in 3 cases using Z-plate and screws, lateral plates and screws with either iliac crest or isobone graft. All cord compression manifestations improved postoperatively with perfect spine stability. Morbidity was detected in 3 cases in the form of (graft and plate infection in posterior approach case, and limited spine mobility in 2 cases) while mortality of local and distant recurrence within 16-19 month was registered in 3 cases.
Para vertebral neurogenic tumors with intra spinal extension could be diagnosed and evaluated with very high accuracy using C-T in adjunct with MRI. C-T guided biopsy can select patients with pathological diagnosis that could be sensitive to pre operative chemotherapy and/or radiotherapy to facilitate surgery. Adequate surgical resection is feasible in a combined team work with different surgical approaches and possible spine fixation.
Para vertebral - Neurogenic tumors - Intra spinal extension - Surgical approach.
实现对伴有椎管内延伸的椎旁神经源性肿瘤的充分切除，安全减压脊髓并保持脊柱稳定性。
2000年11月至2009年7月，开罗大学国家癌症研究所和卡斯尔 - 艾因伊医院的外科肿瘤学和神经外科联合团队对16例伴有椎管内延伸的椎旁神经源性肿瘤（哑铃形肿瘤）患者进行了手术。所有患者均接受了CT引导下活检和MRI检查，以评估肿瘤对骨质的侵犯范围、椎管内成分，从而决定手术入路以及是否需要脊柱固定。患者术后被转至重症监护病房以稳定全身状况。进行了为期3至36个月的放射学随访。
该组患者中男性9例，女性7例，年龄范围为1.5至47岁。8例患者的肿瘤位于后纵隔，7例位于腹膜后间隙，1例位于颈胸入口处。诊断为良性神经鞘瘤5例，恶性神经鞘瘤3例，神经纤维瘤病1例，神经母细胞瘤3例，神经节神经母细胞瘤2例，神经节瘤2例。6例患者采用经后外侧开胸的前路经胸切除术，6例患者经中线或横切口进行前路经腹切除术。3例采用前后联合入路，1例采用肩胛旁内侧切口的后路手术。8例患者完整切除肿瘤，3例患者扩大椎间孔，3例患者行肋骨横突切除并侧方椎板切除术，1例患者行后路椎板切除及全椎体切除术。3例患者使用Z形钢板和螺钉、侧方钢板和螺钉并取自体髂嵴或异体骨进行脊柱固定。术后所有脊髓受压表现均得到改善，脊柱稳定性良好。3例患者出现并发症（1例后路手术患者发生植骨和钢板感染，2例患者脊柱活动受限），3例患者在16至19个月内出现局部和远处复发死亡。
使用CT联合MRI能够非常准确地诊断和评估伴有椎管内延伸的椎旁神经源性肿瘤。CT引导下活检可以筛选出对术前化疗和/或放疗敏感的病理诊断患者，以利于手术。通过不同手术入路和可能的脊柱固定的联合团队协作，充分的手术切除是可行的。
椎旁 - 神经源性肿瘤 - 椎管内延伸 - 手术入路
