Dekker Simone E, Ostergard Thomas A, Glenn Chad A, Cox Efrem, Bambakidis Nicholas C
Department of Neurological Surgery, Neurological Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Ohio.
Oper Neurosurg. 2019 Mar 1;16(3):392. doi: 10.1093/ons/opy204.
This operative video demonstrates a posterior cervical laminoplasty for the resection of a cervical intradural extramedullary meningioma. In addition, the natural history, treatment options, and potential complications are discussed. The patient is a 68-yr-old male who presented with left-hand grip weakness and paresthesias. Magnetic resonance imaging (MRI) demonstrated an enhancing mass that displacing the spinal cord anteriorly and causing severe flattening of the cord at C4 and C5. The patient underwent a posterior cervical laminoplasty for tumor resection. Removal of the dorsal elements with a high-speed drill was performed at C3, C4, and C5. A midline durotomy was performed and a large extra-axial intradural tumor was encountered. The tumor was resected en bloc and specimens were sent for permanent pathological analysis. The dura was closed in a watertight fashion using 6-0 Prolene sutures. The laminoplasty was performed by using titanium miniplates and screws to reconstruct the dorsal bony elements, and the wound was closed in layers using sutures. There were no complications. Final pathology was consistent with a WHO grade I meningioma. Postoperative MRI demonstrated gross total resection. The patient's perioperative course was uncomplicated and his preoperative weakness completely resolved by time of discharge.
这段手术视频展示了用于切除颈椎硬膜内髓外脑膜瘤的后路颈椎椎板成形术。此外，还讨论了其自然病史、治疗选择和潜在并发症。患者为一名68岁男性，表现为左手握力减弱和感觉异常。磁共振成像（MRI）显示一个强化肿块，将脊髓向前推移，并导致C4和C5水平的脊髓严重扁平。患者接受了后路颈椎椎板成形术以切除肿瘤。在C3、C4和C5水平用高速钻去除背侧结构。进行中线硬脊膜切开术，发现一个巨大的硬膜外硬膜内肿瘤。肿瘤被整块切除，标本送去进行永久病理分析。使用6-0普理灵缝线以防水方式缝合硬脊膜。通过使用钛微型钢板和螺钉重建背侧骨质结构进行椎板成形术，并用缝线分层关闭伤口。无并发症发生。最终病理结果与世界卫生组织I级脑膜瘤一致。术后MRI显示肿瘤全切。患者围手术期过程顺利，出院时术前的无力症状完全消失。
