Sen C N, Sekhar L N
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania.
Neurosurgery. 1990 Aug;27(2):197-204. doi: 10.1097/00006123-199008000-00004.
Meningiomas and neurofibromas are the most common intradural extramedullary tumors of the foramen magnum and cervical spine. Many of these tumors are located ventral or ventrolateral to the spinal cord and medulla. Posterior approaches, although adequate for the management of most of these tumors, can sometimes result in incomplete removal of the tumor and exacerbation of the neurological deficits. Although the transoral and transcervical approaches provide a direct route to the tumor, the exposure of the lateral margins in the case of large tumors is inadequate. In addition, because of the removal of vertebral bodies, subsequent fusion may be necessary. In the present report, an extreme lateral approach to the foramen magnum and cervical spine for the removal of intradural tumors is described. The approach provides a lateral exposure of the tumor-cord/stem interface, thus permitting safe dissection without retraction of the cord. The entire longitudinal and lateral extent of the tumor and also its extradural extension can be can be managed by this approach. This approach can be considered in such a group of patients harboring entirely ventral or recurrent tumors for which the conventional posterior approach has failed. Six patients who underwent this procedure are described to illustrate its application.
脑膜瘤和神经纤维瘤是枕骨大孔和颈椎最常见的硬脊膜内髓外肿瘤。这些肿瘤许多位于脊髓和延髓的腹侧或腹外侧。后路手术虽然对大多数此类肿瘤的治疗足够，但有时会导致肿瘤切除不完全和神经功能缺损加重。虽然经口和经颈入路可提供直达肿瘤的途径，但对于大型肿瘤，其外侧边缘的暴露并不充分。此外，由于椎体的切除，后续可能需要融合。在本报告中，描述了一种用于切除枕骨大孔和颈椎硬脊膜内肿瘤的极外侧入路。该入路可从外侧暴露肿瘤-脊髓/脑干界面，从而允许在不牵拉脊髓的情况下进行安全分离。通过该入路可以处理肿瘤的整个纵向和横向范围及其硬膜外延伸。对于那些传统后路手术失败的完全腹侧或复发性肿瘤患者，可以考虑采用这种入路。描述了6例接受该手术的患者以说明其应用。
