Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Department of Surgery, Box Hill Hospital, Eastern Health, Box Hill, Australia.
Oper Neurosurg (Hagerstown). 2023 May 1;24(5):483-491. doi: 10.1227/ons.0000000000000570. Epub 2023 Jan 26.
Schwannoma, a benign peripheral nerve sheath tumor, is perhaps only secondary to degenerative pathology as the most common lesion at neural foramen. The surgical dilemma here is either risking nerve injury because of inadequate exposure or the need for internal fixation because of facet joint sacrifice.
To evaluate the feasibility and safety of management of foraminal schwannomas by percutaneous full-endoscopic technique.
A single-center retrospective review was conducted on patients who underwent full-endoscopic resection of neural foraminal schwannomas. Tumors were grouped into either medial type or lateral type based on relevant location to the neural foramen, and respective surgical approaches were adopted. Data including preoperative neurological status, tumor size, surgery time, the extension of resection, and clinical outcomes were collected. The learning curve was plotted as surgical time/tumor size against case number.
A total of 25 patients were treated between May 2015 and March 2022. Gross total resection was achieved in 24 patients, and near-total resection in 1 case, with 1 patient experienced transient voiding difficulty. No tumor recurrence or spinal instability was detected in the short-term follow-up (median follow-up 22 months, range 3 months-6 years). Surgical efficiency improved with the number of cases operated on and remained stable after the initial 10 cases.
Percutaneous full-endoscopic technique is a safe and minimally invasive technique for the resection of foraminal schwannomas.
神经鞘瘤是一种良性周围神经鞘肿瘤，可能只是神经孔处最常见病变的继发退行性病变。这里的手术难题是由于暴露不足而有损伤神经的风险，或者由于关节突关节切除而需要内固定。
评估经皮全内镜技术治疗神经孔神经鞘瘤的可行性和安全性。
对 2015 年 5 月至 2022 年 3 月期间接受全内镜神经孔神经鞘瘤切除术的患者进行单中心回顾性研究。根据肿瘤与神经孔的相关位置，将肿瘤分为内侧型或外侧型，并采用相应的手术入路。收集的数据包括术前神经状态、肿瘤大小、手术时间、切除范围和临床结果。将手术时间/肿瘤大小与病例数作图绘制学习曲线。
共治疗了 25 例患者。24 例患者达到全切除，1 例患者达到近全切除，1 例患者出现短暂性排尿困难。在短期随访中（中位随访时间为 22 个月，范围为 3 个月至 6 年）未发现肿瘤复发或脊柱不稳定。手术效率随着手术病例数的增加而提高，在最初的 10 例手术后保持稳定。
经皮全内镜技术是治疗神经孔神经鞘瘤的一种安全、微创的技术。
