Zairi Fahed, Troux Camille, Sunna Tarek, Karnoub Mélodie-Anne, Boubez Ghassan, Shedid Daniel
Department of Neurosurgery, Lille University Hospital, Lille, France.
Department of Neurosurgery, Lille University Hospital, Lille, France.
Clin Neurol Neurosurg. 2018 May;168:91-96. doi: 10.1016/j.clineuro.2018.03.005. Epub 2018 Mar 5.
The surgical management of dumbbell tumors of the lumbar spine remains controversial, because of their large volume and complex location, involving both the spinal canal and the retro peritoneum. While sporadically reported, our study aims to confirm the value of minimally invasive posterior access for the complete resection of large lumbar dumbbell tumors.
In this prospective study, we included all consecutive patients who underwent the resection of a voluminous dumbbell tumor at the lumbar spine through a minimally invasive approach, between March 2015 and August 2017. There were 4 men and 4 women, with a mean age at diagnosis of 40.6 years (range 29-58 years). The resection was performed through a trans muscular tubular retractor by the same surgical team. Operative parameters and initial postoperative course were systematically reported. Clinical and radiological monitoring was scheduled at 3 months, 1 year and 2 years.
The mean operative time was 144 min (range 58-300 minutes) and the mean estimated blood loss was 250 ml (range 100-500 ml). Gross total resection was achieved in all patients. No major complication was reported. The mean length of hospital stay was 3.1 days (range 2 to 6 days). Histological analysis confirmed the diagnosis of grade 1 schwannoma in all patients. The mean follow up period was 14.9 months (range 6 to 26 months), and 5 patients completed at least 1-year follow-up. At 6 months the Macnab was excellent in 6 patients, good in one patient and fair in one patient because of residual neuropathic pain requiring the maintenance of a long-term treatment. No tumor recurrence was noted to date.
Lumbar dumbbell tumors can be safely and completely resected using a single-stage minimally invasive procedure, in a trained team.
腰椎哑铃形肿瘤的手术治疗仍存在争议，因其体积大且位置复杂，涉及椎管和腹膜后间隙。虽有零星报道，但本研究旨在证实微创后路入路在完整切除大型腰椎哑铃形肿瘤中的价值。
在这项前瞻性研究中，我们纳入了2015年3月至2017年8月间所有通过微创方法在腰椎行巨大哑铃形肿瘤切除术的连续患者。其中男性4例，女性4例，诊断时平均年龄40.6岁（范围29 - 58岁）。手术由同一手术团队通过经肌肉管状牵开器进行。系统记录了手术参数和术后初期病程。计划在3个月、1年和2年进行临床和影像学监测。
平均手术时间为144分钟（范围58 - 300分钟），平均估计失血量为250毫升（范围100 - 500毫升）。所有患者均实现了肿瘤全切除。未报告重大并发症。平均住院时间为3.1天（范围2至6天）。组织学分析证实所有患者均为1级神经鞘瘤。平均随访期为14.9个月（范围6至26个月），5例患者完成了至少1年的随访。6个月时，Macnab评估6例患者为优，1例为良，1例为可，因残留神经性疼痛需长期治疗。至今未发现肿瘤复发。
在训练有素的团队中，使用单阶段微创方法可安全、完整地切除腰椎哑铃形肿瘤。
