Pecker J, Vallee B, Desplat A, Guegan Y
Neurochirurgie. 1980;26(2):165-70.
The authors report six cases of tumours limited to the cervical inter-vertebral foramen. The patients presented with cervico-brachial neuralgias occasionally accompanied by radicular sensitivo-motor impairment. Radiographs and tomographs of the cervical spine demonstrated enlargement of the intervertebral foramen with bone proliferation depending on the etiology and provided in easy diagnosis in all the cases. A myelogram showed the absence of extension into the spinal canal thus allowing distinction from the group of dumbell tumors. In the six cases vertebral angiography gave information regarding the vascularisation and relationships of the tumour. The histological diagnosis was different in each case : neurofibroma, chordoma, osteochondroma, osteoma, osteoblastoma and an aneurysmal bone cyst. The same surgical approach was used in the six cases. Neither a laminectomy with facettectomy, nor a classical antero-lateral approach allow for a satisfactory exposition of the tumor. On the contrary a lateral interscalenic approach including dissection of the brachial plexus lead to a trouble free excision. This approach was precised by anatomical dissections.
作者报告了6例局限于颈椎椎间孔的肿瘤病例。患者表现为颈臂神经痛,偶尔伴有神经根感觉运动障碍。颈椎X线片和断层扫描显示椎间孔扩大,伴有取决于病因的骨质增生,所有病例均易于诊断。脊髓造影显示肿瘤未延伸至椎管,从而可与哑铃形肿瘤相鉴别。6例患者均行椎动脉造影,以了解肿瘤的血管供应及与周围组织的关系。各病例的组织学诊断各不相同:神经纤维瘤、脊索瘤、骨软骨瘤、骨瘤、成骨细胞瘤和动脉瘤样骨囊肿。6例均采用相同的手术入路。单纯椎板切除加小关节突切除或经典的前外侧入路均不能满意地显露肿瘤。相反,采用包括臂丛神经解剖的外侧斜角肌间隙入路可顺利切除肿瘤。该入路由解剖学分离加以明确。