Zhuang Yuandong, Cai Gangfeng, Fu Chaofeng, Zhang Weiqiang, Zhao Wei, Wang Rui, Wang Chunhua, Shi Songsheng, Chen Chunmei
Department of Neurosurgery, Union Hospital of Fujian Medical University, Fujian Institute of Neurosurgery, Fuzhou, Fujian 350001, P.R. China.
Oncol Lett. 2017 Dec;14(6):7873-7879. doi: 10.3892/ol.2017.7203. Epub 2017 Oct 18.
The aim of the present study was to investigate the efficacy of combining paraspinal keyhole surgery with a tubular retractor system for the microsurgical removal of lumbar intraspinal extramedullary schwannomas. A retrospective analysis was conducted of 56 patients with lumbar intraspinal extramedullary schwannomas who were treated using the microsurgical paraspinal keyhole approach with a tubular retractor system. The mean ± standard deviation was calculated for the following parameters: Surgery time (96.21±14.64 min), hemorrhagic volume (28.54±9.72 ml), bed rest (2.55±0.5 days) and hospital stay (5.68±0.72 days). Two patients presented with cerebrospinal fluid leakage and one patient exhibited a nerve root injury. At a 6-month follow-up visit, postoperative Japanese Orthopedic Association (JOA) and visual analog scale (VAS) scores were evaluated. The mean ± standard deviation JOA scores were 12.00±2.07 for preoperative, 14.73±2.05 for 1 week postoperative, 20.07±2.32 for 3 months postoperative and 21.75±2.18 for 6 months postoperative. The improvement rate was 16.07, 47.48 and 59.77%, respectively. The mean ± standard deviation VAS scores were 6.64±1.31 for preoperative, 3.82±1.51 for 1 week postoperative, 2.11±1.17 for 3 months postoperative and 1.50±1.51 for 6 months postoperative. The JOA and VAS scores improved significantly (P<0.05). Magnetic resonance imaging and computed tomography were performed preoperatively, immediately following surgery and at the 6-month postoperative visit to confirm the efficacy of the resections and evaluate spinal stability. No residual tumors were identified at follow-up. No alterations in the stability of the spine were observed postoperatively. The combination of the microsurgical paraspinal keyhole approach with the tubular retractor system was successful in treating lumbar intraspinal extramedullary schwannomas. The surgical approach was associated with decreased hemorrhages, decreased duration of hospital stay, faster recovery and improved postoperative maintenance of spinal stability.
本研究的目的是探讨椎旁锁孔手术联合管状牵开器系统显微切除腰椎髓外硬膜下神经鞘瘤的疗效。对56例采用显微椎旁锁孔入路联合管状牵开器系统治疗的腰椎髓外硬膜下神经鞘瘤患者进行回顾性分析。计算以下参数的平均值±标准差：手术时间（96.21±14.64分钟）、出血量（28.54±9.72毫升）、卧床休息时间（2.55±0.5天）和住院时间（5.68±0.72天）。2例出现脑脊液漏，1例出现神经根损伤。在术后6个月随访时，评估术后日本矫形外科学会（JOA）评分和视觉模拟量表（VAS）评分。术前JOA评分平均值±标准差为12.00±2.07，术后1周为14.73±2.05，术后3个月为20.07±2.32，术后6个月为21.75±2.18。改善率分别为16.07%、47.48%和59.77%。术前VAS评分平均值±标准差为6.64±1.31，术后1周为3.82±1.51，术后3个月为2.11±1.17，术后6个月为1.50±1.51。JOA和VAS评分均有显著改善（P<0.05）。术前、术后即刻及术后6个月行磁共振成像和计算机断层扫描，以确认切除效果并评估脊柱稳定性。随访未发现残留肿瘤。术后未观察到脊柱稳定性改变。显微椎旁锁孔入路联合管状牵开器系统成功治疗腰椎髓外硬膜下神经鞘瘤。该手术方法具有出血少、住院时间短、恢复快及术后脊柱稳定性维持良好的特点。
