Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA; Department of Neurosurgery, Spine Group Arizona, HonorHealth Osborn Hospital, Scottsdale, Arizona, USA.
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
World Neurosurg. 2018 Jan;109:e770-e777. doi: 10.1016/j.wneu.2017.10.078. Epub 2017 Nov 21.
Since the first resections of intradural extramedullary neoplasms, neurosurgeons have tended to preserve as much of the integrity of the spine as possible while ensuring a safe corridor to resect these lesions. A dimensional analysis of intradural lesions superimposed on a dimensional analysis of the thoracic canal would provide the anatomic basis for a minimal access approach. The authors report the results of such an analysis on a series of patients with intradural extramedullary lesions.
A retrospective analysis was undertaken of 26 thoracic intradural extramedullary lesions managed with open or minimally invasive resection. The size of each lesion was measured in the rostrocaudal, lateral, and anteroposterior dimensions and then averaged and compared with reported dimensions of the thoracic spinal canal.
The mean (range) dimensions of the surgically resected thoracic lesions were 18.6 mm (10-25 mm) for rostrocaudal, 13.0 mm (7-18 mm) for lateral, and 13.6 mm (9-17 mm) for anteroposterior. No patient had any evidence of thoracic canal remodeling.
Thoracic intradural extramedullary lesions become symptomatic as they approach the limits of the thoracic canal, resulting in an inherent dimensional limitation in the rostrocaudal, lateral, and anteroposterior dimensions. Displacement of the spinal cord by the lesion to one side further favors a minimally invasive unilateral approach. A paraspinal unilateral hemilaminectomy approach with a 35 × 20 mm exposure centered over the lesion offers a safe surgical corridor for resection while preserving the posterior tension band, facet complexes, and paraspinal musculature.
自首次切除硬脊膜外髓内肿瘤以来，神经外科医生一直倾向于在确保切除这些病变的安全通道的同时，尽可能保持脊柱的完整性。对硬脊膜内病变进行三维分析，并与胸椎管的三维分析叠加，可为微创入路提供解剖学基础。作者报告了一系列硬脊膜外髓内病变患者的此类分析结果。
对 26 例采用开放式或微创切除治疗的胸段硬脊膜外髓内病变进行回顾性分析。测量每个病变在前后、侧向和前后方向的大小，然后取平均值并与报告的胸椎管尺寸进行比较。
手术切除的胸段病变的平均（范围）尺寸为 18.6 毫米（10-25 毫米）用于前后方向，13.0 毫米（7-18 毫米）用于侧向，13.6 毫米（9-17 毫米）用于前后方向。没有患者出现胸椎管重塑的证据。
胸段硬脊膜外髓内病变在接近胸椎管极限时会出现症状，从而导致其在前后、侧向和前后方向上存在固有尺寸限制。病变对脊髓的单侧移位进一步有利于微创单侧入路。以病变为中心的脊柱旁单侧半椎板切除术，采用 35×20mm 的暴露，可提供安全的手术通道进行切除，同时保留后张力带、小关节复合体和脊柱旁肌肉。
