Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
Neurosurgery. 2018 Mar 1;82(3):365-371. doi: 10.1093/neuros/nyx253.
To date, the traditional approach to intraspinal tumors has been open laminectomy or laminoplasty followed by microsurgical tumor resection. Recently, however, minimally invasive approaches have been attempted by some.
To investigate the feasibility and safety of minimally invasive surgery (MIS) for primary intradural spinal tumors.
Medical charts of 83 consecutive patients treated with MIS for intradural spinal tumors were reviewed. Patients were followed up during the study year, 2015, by either routine history/physical examination or by telephone consultation, with a focus on tumor status and surgery-related complications.
Mean age at surgery was 53.7 yr and 52% were female. There were 49 schwannomas, 18 meningeomas, 10 ependymomas, 2 hemangioblastomas, 1 neurofibroma, 1 paraganglioma, 1 epidermoid cyst, and 1 hemangiopericytoma. The surgical mortality was 0%. In 87% of cases, gross total resection was achieved. The complication rate was 11%, including 2 cerebrospinal fluid leakages, 1 asymptomatic pseudomeningocele, 2 superficial surgical site infections, 1 sinus vein thrombosis, and 4 cases of neurological deterioration. There were no postoperative hematomas, and no cases of deep vein thrombosis or pulmonary embolism. Ninety-three percent of patients were ambulatory and able to work at the time of follow-up.
This study both demonstrates that it is feasible and safe to remove select, primary intradural spinal tumors using MIS, and augments the previous literature in favor of MIS for these tumors.
迄今为止，传统的椎管内肿瘤治疗方法是开放性椎板切除术或椎板成形术，然后进行显微肿瘤切除术。然而，最近一些人尝试了微创方法。
探讨微创外科（MIS）治疗原发性硬脊膜内脊髓肿瘤的可行性和安全性。
回顾了 83 例接受 MIS 治疗的硬脊膜内脊髓肿瘤患者的病历。在研究年度 2015 年，通过常规病史/体格检查或电话咨询对患者进行随访，重点关注肿瘤状况和与手术相关的并发症。
手术时的平均年龄为 53.7 岁，52%为女性。其中 49 例为神经鞘瘤，18 例为脑膜瘤，10 例为室管膜瘤，2 例为血管母细胞瘤，1 例为神经纤维瘤，1 例为副神经节瘤，1 例为表皮样囊肿，1 例为血管外皮细胞瘤。手术死亡率为 0%。在 87%的病例中实现了大体全切除。并发症发生率为 11%，包括 2 例脑脊液漏，1 例无症状假性脑膜膨出，2 例浅表手术部位感染，1 例窦静脉血栓形成和 4 例神经功能恶化。无术后血肿，无深静脉血栓形成或肺栓塞病例。93%的患者在随访时能够行走和工作。
本研究既证明了使用 MIS 切除选择的原发性硬脊膜内脊髓肿瘤是可行和安全的，也增加了以前关于这些肿瘤的 MIS 的文献。
