Dekker Simone E, Glenn Chad A, Ostergard Thomas A, Smith Mickey L, Rothstein Brian D, Ray Abhishek, Bambakidis Nicholas C
Department of Neurological Surgery, Neurological Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Oper Neurosurg (Hagerstown). 2019 May 1;16(5):640. doi: 10.1093/ons/opy238.
This 3-dimensional operative video illustrates resection of a lumbar schwannoma in a 57-yr-old female who presented with right lower extremity numbness, paresthesias, as well as a long history of lower back pain with rest. On magnetic resonance imaging (MRI), there was evidence of an intradural extramedullary enhancing lesion at L5, nearly completely encompassing the spinal canal. This video demonstrates the natural history, treatment options, surgical procedure, risks, and complications of treatment of these types of tumors. The patient underwent a posterior lumbar laminectomy with a midline dural opening for tumor resection. The tumor was encountered intradurally and electromyography recording confirmed that the tumor arose from a lumbar sensory nerve root. The sensory root was then divided and the tumor was then removed. The mass was removed en bloc and histopathologic analysis was consistent with a schwannoma. Postoperative MRI demonstrated gross total resection of the patient's neoplasm with excellent decompression of the spinal cord. The patient had an uneventful postoperative course with full recovery and complete resolution of her back pain and leg paresthesias.
这段三维手术视频展示了一名57岁女性腰椎神经鞘瘤的切除过程。该患者出现右下肢麻木、感觉异常，并有长期休息时的下背部疼痛病史。磁共振成像（MRI）显示L5水平有硬膜内髓外强化病变，几乎完全包绕椎管。本视频展示了这类肿瘤的自然病程、治疗选择、手术过程、风险及治疗并发症。患者接受了后路腰椎椎板切除术，经中线切开硬膜以切除肿瘤。在硬膜内发现肿瘤，肌电图记录证实肿瘤起源于腰感觉神经根。随后切断感觉神经根并切除肿瘤。肿瘤被完整切除，组织病理学分析结果符合神经鞘瘤。术后MRI显示患者肿瘤全切，脊髓减压良好。患者术后恢复顺利，背部疼痛和腿部感觉异常完全缓解。
