目的探讨单一入路手术治疗巨大侵袭性脊柱神经鞘瘤的方法、疗效与安全性。方法回顾性分析自2013-01—2016-01采用单一入路手术治疗的11例巨大侵袭性脊柱神经鞘瘤。1例颈椎肿瘤行前路手术,2例颈椎肿瘤行后外侧入路手术。胸腰椎肿瘤4例中3例行后路手术,1例行前路手术。骶椎肿瘤4例行后路手术。结果本组手术时间120~290(210±55)min,术中出血量150~1 200(537±306)ml。1例S1神经根结扎后下肢肌力下降,双侧S4神经根结扎后出现二便功能障碍,术后半年逐渐恢复。本组均获得4~28(13.2±6.8)个月随访,所有患者均未发现肿瘤复发和转移,内固定位置良好。术前痛区VAS评分1~8(4.5±2.0)分,末次随访时VAS评分1~3(1.8±0.6)分;末次随访时疼痛较术前明显缓解,差异有统计学意义(P<0.05)。术前7例有神经功能障碍者ASIA评分:左侧39~49(44.5±3.9)分,右侧40~49(45.7±3.0)分;末次随访ASIA评分:左侧42~49(46.7±2.5)分,右侧45~49(47.4±1.4)分;手术前后ASIA评分差异无统计学意义(P>0.05)。结论单一入路手术能够完整切除巨大侵袭性脊柱神经鞘瘤,彻底减压并重建脊柱稳定性,疗效确切,并发症少。 Objective To investigate the method, efficacy and safety of a single approach for the treatment of giant invasive schwannoma. Methods Retrospective analysis of 11 cases of giant invasive schwannoma of the spinal cord treated with single approach from 2013-01-2016-01. One case of cervical tumor underwent anterior surgery and two cases of cervical tumor underwent lateral approach. Thoracolumbar tumors in 4 cases of 3 cases of posterior surgery, 1 case of anterior surgery. 4 cases of sacral tumors after posterior surgery. Results The operation time ranged from 120 to 290 (210 ± 55) min and the intraoperative blood loss was from 150 to 1 200 (537 ± 306) ml. One case of S1 nerve root ligation muscle strength decreased, bilateral S4 nerve root ligation after the second defecation dysfunction, gradually recovered after six months. All patients were followed up for 4 to 28 (13.2 ± 6.8) months. All patients had no tumor recurrence and metastasis, and all the patients had good internal fixation. VAS score was 1 ~ 8 (4.5 ± 2.0) in preoperative pain area and 1 ~ 3 (1.8 ± 0.6) at the last follow-up. Pain was significantly relieved at the last follow-up, with significant difference (P <0.05 ). The ASIA scores of the 7 patients with neurological dysfunction before surgery were 39-49 (44.5 +/- 3.9) on the left and 40-49 (45.7 +/- 3.0) on the right, respectively; ASIA score on the final follow-up was 42-49 ) Points on the right and 45-49 (47.4 ± 1.4) points on the right. There was no significant difference in ASIA scores before and after surgery (P> 0.05). Conclusion The single operation can completely remove the huge aggressive schwannoma of spinal cord, relieve pressure completely and rebuild the stability of the spine. The curative effect is exact and there are few complications.