Department of Clinical Neurological Sciences, Division of Neurosurgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
Spine (Phila Pa 1976). 2011 Jul 1;36(15):E1018-26. doi: 10.1097/BRS.0b013e31820019f9.
Retrospective Case Series.
To determine if extradural, intradural extramedullary, and intramedullary spinal neoplasms can be safely resected through a minimally invasive corridor.
The use of minimally invasive approaches for resection of spinal neoplasms has been described for intradural schwannomas and ependymomas. We demonstrate that this approach can be extended to the resection of a variety of extradural, intradural and intramedullary spinal tumors.
We undertook a retrospective review of all patients presenting with clinical and radiographic evidence of spinal neoplasm that subsequently underwent a minimally invasive approach for resection of the tumor using the METRx MAST QUADRANT Retractor System (Medtronics, Memphis, TN). Primary endpoints analyzed include completeness of resection, postoperative neurologic status, operative time, blood loss, postoperative pain, length of hospital stay, and operative complications.
Two cervical, seven thoracic and 13 lumbar neoplasms were identified in 20 patients operated on between September 2005 and May 2009. Mean intraoperative time was 210 minutes, blood loss 428 mL and average length of hospital stay was 3 days. Four patients required postoperative patient-controlled analgesia for pain control and an average of 5.8 doses of narcotic were given per patient. Two patients developed postoperative complications. Fifteen of 22 tumors (68%) were completely resected, with only one patient requiring repeat operation for residual tumor. All but one patient were improved from preoperative status at 6 months.
Intramedullary, intradural and extradural spinal neoplasms can be resected through a minimally invasive approach without increased risk for adverse neurologic outcome. This technique may be an appropriate alternative to the open approach for well-circumscribed extramedullary lesions spanning one or two spinal levels. With increasing experience, reduced operative time, blood loss, complications, length of hospital stay, postoperative pain, and spinal instability may be seen.
回顾性病例系列。
确定硬膜外、硬脊膜外髓外和髓内脊柱肿瘤是否可以通过微创通道安全切除。
已经描述了使用微创方法切除脊髓肿瘤，包括硬脊膜内神经鞘瘤和室管膜瘤。我们证明，这种方法可以扩展到切除各种硬膜外、硬脊膜内和髓内脊柱肿瘤。
我们对所有有临床和影像学证据表明患有脊柱肿瘤的患者进行了回顾性分析，这些患者随后使用 METRx MAST QUADRANT 牵开器系统（Medtronics，Memphis，TN）进行了微创肿瘤切除术。分析的主要终点包括切除的完整性、术后神经状态、手术时间、失血量、术后疼痛、住院时间和手术并发症。
在 2005 年 9 月至 2009 年 5 月期间，对 20 名患者进行了手术，共发现 2 个颈椎、7 个胸椎和 13 个腰椎肿瘤。术中平均时间为 210 分钟，失血量为 428 毫升，平均住院时间为 3 天。4 名患者需要术后患者自控镇痛以控制疼痛，每名患者平均使用 5.8 剂麻醉剂。2 名患者发生术后并发症。22 个肿瘤中有 15 个（68%）完全切除，只有 1 名患者因残留肿瘤需要再次手术。所有患者除 1 人外，术后 6 个月的状态均有所改善。
通过微创方法可以切除髓内、硬脊膜内和硬脊膜外脊柱肿瘤，而不会增加不良神经后果的风险。对于局限于一个或两个脊柱水平的边界清楚的髓外病变，这种技术可能是开放手术的一种合适替代方法。随着经验的增加，手术时间、失血量、并发症、住院时间、术后疼痛和脊柱不稳定的减少可能会出现。
