Ito Kiyoshi, Aoyama Tatsuro, Kuroiwa Masafumi, Horiuchi Tetsuyoshi, Hongo Kazuhiro
Department of Neurosurgery, Shinshu University School of Medicine , Matsumoto , Japan.
Br J Neurosurg. 2014 Jun;28(3):324-9. doi: 10.3109/02688697.2013.835372. Epub 2013 Sep 12.
Total removal of neurinomas is generally an achievable goal that yields good results; however, dumbbell-shaped neurinomas often present challenges for complete resection. Some extensive surgical approaches for complete removal have been reported to lead to severe complications. Therefore, the surgical strategy for dumbbell-shaped neurinomas is controversial.
Twelve patients with dumbbell-shaped neurinomas were surgically treated in our hospital over 5 years. We adopted a posterior approach to remove the intracanalicular portion of the neurinomas as completely as possible, intentionally leaving the foraminal portion unresected to prevent bony and vascular insult. We investigated the postoperative surgical results and complications and the regrowth rate of the remnant lesions.
Postoperative residual tumours were identified in 6 of the 12 patients. The perioperative neurological findings between the two groups were almost the same. The recurrence rate was low. Severe surgery-related complications occurred in only one patient with mild and temporary motor weakness.
Our strategy demonstrated low rates of recurrence and complications compared with those accompanying the extensive alternative approaches that have been reported previously. Our case series showed that subtotal removal of dumbbell-shaped neurinomas using a posterior approach is a safer, more effective, and more minimally invasive treatment.
神经鞘瘤的完全切除通常是一个可以实现的目标，且能产生良好的效果；然而，哑铃形神经鞘瘤的完整切除往往具有挑战性。据报道，一些用于完全切除的广泛手术方法会导致严重并发症。因此，哑铃形神经鞘瘤的手术策略存在争议。
5年间，我院对12例哑铃形神经鞘瘤患者进行了手术治疗。我们采用后路入路尽可能彻底地切除神经鞘瘤的椎管内部分，有意不切除椎间孔部分以防止骨质和血管损伤。我们调查了术后的手术结果、并发症以及残余病变的复发率。
12例患者中有6例术后发现有残余肿瘤。两组围手术期的神经学表现几乎相同。复发率较低。仅1例患者出现与手术相关的严重并发症，表现为轻度且短暂的运动无力。
与先前报道的广泛替代方法相比，我们的策略显示出较低的复发率和并发症发生率。我们的病例系列表明，采用后路入路次全切除哑铃形神经鞘瘤是一种更安全、更有效且创伤更小的治疗方法。
