Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Oper Neurosurg (Hagerstown). 2022 Aug 1;23(2):e95-e101. doi: 10.1227/ons.0000000000000260. Epub 2022 May 9.
Paraspinal lumbar schwannomas are primarily located outside of the spinal canal with minimal extension into the neural foramen. Approaching these tumors through a traditional posterior approach can be challenging given their lateral location to the spine and is likely to require extensive bony removal and potential destabilization of the spine. Alternatives approaches have been identified that may circumvent the need for extensive bony removal.
To examine the use of the paramedian Wiltse approach for giant extraspinal tumors and compare the approach with other nonposterior approaches.
We present 2 cases in which the paramedian Wiltse approach is used to effectively approach large paraspinal schwannomas and achieve complete tumor resection without destabilization of the spine.
The paramedian Wiltse approach along with expandable retractors systems were able to achieve complete resection of the giant paraspinal schwannomas. Neural preservation was able to be achieved in one case which was facilitated by the exposure achieved through the posterior paramedian corridor that allowed for visualization of the proximal and distal ends of the tumor.
The paramedian Wiltse approach is an ideal approach to target large extraspinal schwannomas for complete resection and potential neural preservation without the need for destabilization of the spine.
椎旁腰椎神经鞘瘤主要位于椎管外，很少向神经孔延伸。由于这些肿瘤位于脊柱的外侧，通过传统的后路方法接近它们可能具有挑战性，并且可能需要广泛的骨切除和潜在的脊柱不稳定。已经确定了替代方法，可能无需广泛的骨切除。
研究使用旁正中 Wiltse 入路治疗巨大椎旁肿瘤，并将该入路与其他非后路入路进行比较。
我们介绍了 2 例使用旁正中 Wiltse 入路有效接近大型椎旁神经鞘瘤并实现完全肿瘤切除而不导致脊柱不稳定的病例。
旁正中 Wiltse 入路联合可扩张牵开器系统能够实现巨大椎旁神经鞘瘤的完全切除。通过允许观察肿瘤近端和远端的后路旁正中通道实现的暴露，在 1 例中实现了神经保护。
旁正中 Wiltse 入路是一种理想的方法，可以在不破坏脊柱稳定性的情况下，完全切除和潜在地保留神经，以治疗大型椎旁神经鞘瘤。
