Tola S, De Angelis M, Bistazzoni S, Chiaramonte C, Esposito V, Paolini S
Department of Neurology and Psychiatry, University of Rome "Sapienza", Rome, Italy; Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Italy.
Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Italy; Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, School of Medicine and Surgery "Federico II", Naples, Italy.
Clin Neurol Neurosurg. 2016 Sep;148:35-41. doi: 10.1016/j.clineuro.2016.06.015. Epub 2016 Jun 21.
To demonstrate the effectiveness and safety of hemilaminectomy in spinal-meningioma surgery, with special attention to ventral lesions. We also describe technical tips to enhance surgical-corridor width.
A total of 20 patients (14 female and 6 male) underwent hemilaminectomy for resection of a spinal meningioma between January 2005 and December 2015. Preoperative magnetic resonance imaging defined the tumor location (16 thoracic, 3 cervical, 1 lumbar) and the dural-attachment site (4 ventral, 11 ventrolateral, 3 lateral, 2 posterior). Pre- and postprocedural functional status was evaluated according to McCormick's classification. Intraoperative neurophysiological monitoring was employed in all patients.
The unilateral approach allowed for complete resection (Simpson grade I-II resection) in 18 patients (90%), including tumors with a ventral dural attachment. In most patients (n=13), monosegmental hemilaminectomy was performed, a single patient required hemilaminectomy of 3 levels, while the remaining 6 patients underwent hemilaminectomy of 2 levels. No patients experienced either worsening of neurological status or procedure-related complications. All patients who had preoperative pain reported postoperative improvement.
The goal of surgery for spinal tumors is to achieve gross tumor removal while minimizing morbidity. In our experience, hemilaminectomy is an effective surgical approach, even in patients with ventral- and ventrolateral spinal meningiomas. The procedure offers several advantages in terms of early patient mobilization and rehabilitation, management of postoperative pain, and preservation of spinal stability while achieving positive functional outcomes.
证明半椎板切除术在脊髓脑膜瘤手术中的有效性和安全性，特别关注腹侧病变。我们还描述了增加手术通道宽度的技术要点。
2005年1月至2015年12月期间，共有20例患者（14例女性，6例男性）接受了半椎板切除术以切除脊髓脑膜瘤。术前磁共振成像确定了肿瘤位置（16例胸段，3例颈段，1例腰段）和硬脑膜附着部位（4例腹侧，11例腹外侧，3例外侧，2例后侧）。根据麦考密克分类法评估术前和术后的功能状态。所有患者均采用术中神经生理监测。
单侧入路使18例患者（90%）实现了完全切除（辛普森I-II级切除），包括硬脑膜腹侧附着的肿瘤。大多数患者（n = 13）进行了单节段半椎板切除术，1例患者需要进行3个节段的半椎板切除术，其余6例患者进行了2个节段的半椎板切除术。没有患者出现神经功能恶化或与手术相关的并发症。所有术前有疼痛的患者术后均报告症状改善。
脊髓肿瘤手术的目标是在将发病率降至最低的同时实现肿瘤大体切除。根据我们的经验，半椎板切除术是一种有效的手术方法，即使对于腹侧和腹外侧脊髓脑膜瘤患者也是如此。该手术在早期患者活动和康复、术后疼痛管理以及保持脊柱稳定性同时取得积极功能结果方面具有诸多优势。
