Gu Bon Sub, Park Jin Hoon, Roh Sung Woo, Jeon Sang Ryong, Jang Jun-Won, Hyun Seung-Jae, Rhim Seung Chul
Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, Korea.
Eur Spine J. 2015 Oct;24(10):2114-8. doi: 10.1007/s00586-014-3458-9. Epub 2014 Jul 14.
Spinal dumbbell-shaped schwannoma is common neoplasm, usually occurring in the cervical spine. Posterior or anterolateral approaches are frequently used to remove this benign tumor. We analyzed how much amount of tumor could be possible to be totally removed with posterior approach.
Surgery was performed on 41 cases of cervical, dumbbell-shaped subaxial schwannomas with both intra- and extraforaminal involvement. The same surgeon performed all the procedures. Mean follow-up was 42.5 months (24-108 months). A combined anterolateral and posterior approach was used if the extraforaminal tumor was larger than 10 mm. A posterior approach and unilateral facet removal were used if it was smaller than 10 mm. We performed MRI and serial dynamic X-rays for postoperative 2 years.
We used the posterior approach with facetectomy in 35 cases and the combined approach in six. Complete removal was achieved with the combined approach in all six, and with the posterior approach in 28 of 35 cases. With the posterior approach, the extraforaminal dimension of totally resected tumors ranged from 3 to 5.4 mm. Subtotal resection was limited to extraforaminal tumors larger than 5.7 mm. On follow-up, instability on dynamic X-ray was not observed before 24 months in any patient after unilateral facetectomy.
Total removal of intra- and extraforaminal cervical subaxial schwannomas could be possible using a posterior approach with facet removal if the size of extraforaminal tumor was less than 5.4 mm.
脊髓哑铃形神经鞘瘤是一种常见的肿瘤，通常发生于颈椎。后入路或前外侧入路常用于切除这种良性肿瘤。我们分析了采用后入路能够完全切除多少肿瘤。
对41例累及椎间孔内外的颈椎哑铃形轴下神经鞘瘤患者进行手术。所有手术均由同一位外科医生完成。平均随访时间为42.5个月（24 - 108个月）。如果椎间孔外肿瘤大于10 mm，则采用前外侧联合后入路；如果小于10 mm，则采用后入路并单侧切除小关节。术后2年进行MRI和系列动态X线检查。
我们对35例患者采用后入路并切除小关节，对6例患者采用联合入路。6例采用联合入路的患者均实现了完全切除，35例采用后入路的患者中有28例实现了完全切除。采用后入路时，完全切除肿瘤的椎间孔外尺寸范围为3至5.4 mm。次全切除仅限于椎间孔外肿瘤大于5.7 mm的情况。随访发现，单侧切除小关节后的任何患者在24个月前动态X线检查均未发现不稳定情况。
如果椎间孔外肿瘤大小小于5.4 mm，采用后入路并切除小关节有可能完全切除颈椎轴下神经鞘瘤的椎间孔内外部分。
