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目的探讨颈椎管内外哑铃形肿瘤的临床特点、Toyama分型及手术治疗策略。方法回顾分析我院2008年8月至2011年8月期间治疗的5例颈椎哑铃形肿瘤患者的临床表现、影像学特征、病理类型、手术治疗方法和预后。肿瘤节段位于C_(1～2)2例,C_(3～5)1例,C_(4～6)1例,C_(5～7)1例。神经鞘瘤5例。采用Toyama方法分型,ⅡB型1例,ⅢA型1例,Ⅳ型1例,Ⅵ型2例;IF分期Ⅰ期2例,Ⅱ期3例;TF分期Ⅰ期3例,Ⅱ期2例。2例行颈后正中入路,2例行颈前右侧入路,1例行颈前左侧入路。结果肿瘤均完全切除,无椎动脉损伤,无神经功能障碍加重。患者局部疼痛和神经症状均有明显改善,术后即刻出现单侧上肢一过性瘫痪1例,经激素及脱水药物治疗5d后缓解;脑脊液漏1例,保守治疗后闭合;未见颈椎反屈畸形,无术后感染病例。随访6个月至2年,平均9个月。所有患者神经功能均有不同程度恢复,其中3例患者神经功能完全恢复。所有病例均未见局部复发。结论颈椎管内外哑铃形肿瘤可通过Tovama分型选择合适的手术方式和入路,减小对颈髓、椎动脉、神经根损伤风险,并且肿瘤可一次性手术切除。
Objective To investigate the clinical features, Toyama classification and surgical treatment of dumbbell tumors in and outside cervical spinal canal. Methods The clinical manifestations, imaging features, pathological types, surgical treatment and prognosis of 5 patients with dumbbell-shaped cervical tumors treated in our hospital from August 2008 to August 2011 were retrospectively analyzed. The tumor segments were located in C_ (1 ~ 2) in 2 cases, C_ (3 ~ 5) in 1 case, C_ (4 ~ 6) in 1 case and C_ (5 ~ 7) in 1 case. Schwannoma in 5 cases. According to the Toyama method, 1 case of type IIB, 1 case of type IIA, 1 case of type IV and 2 cases of type VI; 2 cases of stage I and 2 cases of stage IF; 3 cases of stage I and 2 cases of stage II. 2 cases of middle posterior approach, 2 cases of right anterior cervical approach, 1 case of left anterior cervical approach. Results The tumors were completely resected, without vertebral artery injury, no increase in neurological dysfunction. Patients with local pain and neurological symptoms were significantly improved immediately after the unilateral upper limb paralysis occurred in 1 case, hormone and dehydration after 5d treatment to ease; a case of cerebrospinal fluid leakage, closed after conservative treatment; no cervical reverse flexion Deformity, no postoperative infection. Followed up for 6 months to 2 years, an average of 9 months. All patients had different degrees of neurological recovery, of which 3 patients with complete recovery of nerve function. No cases of any local recurrence. Conclusion To dumbbell tumors in cervical spinal canal can be selected by Tovama classification appropriate surgical approach and approach to reduce the risk of cervical cord, vertebral artery, nerve root injury, and the tumor can be a one-time surgical resection.