Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, New York.
Oper Neurosurg (Hagerstown). 2021 Jan 13;20(2):E133. doi: 10.1093/ons/opaa314.
This video demonstrates the microsurgical removal of an intramedullary spinal cord hemangioblastoma through an anterior cervical approach. While most spinal hemangioblastomas arise from the dorsal or dorsolateral pial surface and can be safely resected through a posterior approach,1,2 ventral tumors can present a significant challenge to safe surgical removal.3-5 This patient presented with a progressively symptomatic ventral pial based hemangioblastoma at the C5-6 level with large polar cysts extending from C3 to T1. The tumor was approached through a standard anterior cervical exposure with a C5 and C6 corpectomy. Following midline durotomy, the tumor was identified and complete microsurgical resection was achieved. The principles and techniques of tumor resection are illustrated and described in the video. Following tumor resection and dural closure, a fibular allograft was inserted into the corpectomy defect and a C4-C7 fixation plate was placed. The patient was maintained in a supine position for 36 h. He was discharged home on postoperative day 3 in a cervical collar. The patient did well with near-complete recovery of neurological function. Postoperative magnetic resonance imaging at 6 wk showed a substantial resolution of the polar cysts and no evidence of residual tumor. The patient featured in this video consented to the procedure.
本视频演示了通过前路颈椎入路切除脊髓内血管母细胞瘤。虽然大多数脊髓血管母细胞瘤起源于背侧或背外侧软膜表面，可以通过后路安全切除，但 1,2 腹侧肿瘤的安全切除存在重大挑战。3-5 本例患者因 C5-6 水平腹侧软膜基底部血管母细胞瘤出现进行性症状，伴有从 C3 延伸至 T1 的大极囊。肿瘤通过标准前路颈椎暴露和 C5 和 C6 椎体切除术进行治疗。中线硬脊膜切开后，确定肿瘤并完成完整的显微镜下切除。视频中展示并描述了肿瘤切除的原则和技术。肿瘤切除和硬脊膜闭合后，将腓骨同种异体移植物插入椎体切除术缺损中，并放置 C4-C7 固定板。患者保持仰卧位 36 小时。术后第 3 天，患者佩戴颈托出院。患者神经功能几乎完全恢复，预后良好。术后 6 周的磁共振成像显示极囊明显消退，无肿瘤残留证据。视频中的患者同意进行该手术。
