Yu Yong, Hu Fan, Zhang Xiaobiao, Gu Ye, Xie Tao, Ge Junqi
Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China.
J Spinal Disord Tech. 2014 Aug;27(6):E199-204. doi: 10.1097/BSD.0b013e318299f606.
Retrospective analysis of 9 cases of C2 schwannomas who were treated microsurgically with hemi-semi-laminectomy approach.
To review the clinical data and describe several operative nuances and pearls from our experience about the hemi-semi-laminectomy approach that provided successful resection of C2 schwannomas.
Compared with hemi-laminectomy, the hemi-semi-laminectomy is a more minimally invasive approach for excising spinal neurinomas, which can preserve as much of the mechanically relevant bone structures and facet joints as possible. There are no previous reports about the resection of C2 schwannomas with the hemi-semi-laminectomy approach.
Between June 2006 and February 2011, a consecutive series of 9 patients underwent surgery for C2 schwannomas. All patients were treated microsurgically with a midline posterior hemi-semi-laminectomy approach. Data regarding age, sex, duration and type of symptoms, topographical locations, and surgical results were investigated retrospectively.
Of the 9 C2 schwannomas, 8 were located both intradurally and extradurally (dumbbell shaped), and 1 was located extradurally. The initial symptom was numbness of the extremity in 7 patients, neck pain in 1 patient, and clumsiness of the upper extremity in 1 patient. The average duration from initial symptom to surgery was 7.9 months. The average follow-up time was 39.6 months. There were no major surgical complications and tumor recurrence during the follow-up period. Remarkable neurological recovery was observed in 9 patients.
The hemi-semi-laminectomy is a more minimally invasive approach that can preserve as much of the mechanically relevant bone structures as possible, so that the integrity of the arch of the atlas and the lamina of C2 can be maintained. This approach can provide sufficient field for the resection of the C2 schwannomas that do not extend to the ventral side of the vertebral artery in the anterolateral direction. The minimally invasive access and the remarkable results associated with this approach make it a valid alternative in selected cases.
对9例采用半椎板切除术入路显微手术治疗的C2神经鞘瘤患者进行回顾性分析。
回顾临床资料，并描述我们在半椎板切除术入路治疗C2神经鞘瘤成功切除方面的一些手术细节和要点。
与半椎板切除术相比，半椎板切除术是一种更微创的切除脊髓神经鞘瘤的方法，它可以尽可能多地保留与力学相关的骨骼结构和小关节。此前尚无关于采用半椎板切除术入路切除C2神经鞘瘤的报道。
2006年6月至2011年2月，连续9例患者接受了C2神经鞘瘤手术。所有患者均采用后正中半椎板切除术入路进行显微手术。对患者的年龄、性别、症状持续时间和类型、肿瘤位置以及手术结果进行回顾性研究。
9例C2神经鞘瘤中，8例位于硬膜内和硬膜外（哑铃形），1例位于硬膜外。首发症状为7例患者肢体麻木，1例患者颈部疼痛，1例患者上肢笨拙。从首发症状到手术的平均时间为7.9个月。平均随访时间为39.6个月。随访期间无重大手术并发症及肿瘤复发。9例患者均有明显的神经功能恢复。
半椎板切除术是一种更微创的方法，可尽可能多地保留与力学相关的骨骼结构，从而保持寰椎弓和C2椎板的完整性。该入路可为未向椎动脉前外侧腹侧延伸的C2神经鞘瘤切除提供足够的手术视野。这种微创入路及其显著的手术效果使其在某些病例中成为一种有效的选择。
