摘要：

目的 探讨单纯后正中入路切除突入胸腔的椎管内外沟通性巨大“哑铃”形肿瘤的手术方法和效果。方法 采用单纯后正中入路分块切除12 例突入胸腔的椎管内外沟通性巨大“ 哑铃” 形肿瘤。结果 所有患者均全切除肿瘤，其中1 例合并T₅ 水平椎管内施万细胞瘤，予同期切除并行脊柱内固定融合术。平均手术时间195 min，术中出血量205 ml，术后病理学检查证实施万细胞瘤9 例、神经纤维瘤1 例、脊膜瘤1 例、海绵状血管瘤1 例。术后平均随访18 个月，神经根性疼痛和脊髓受压症状均获不同程度缓解，无新发神经功能缺损症状，无肿瘤复发。结论 突入胸腔的椎管内外沟通性巨大“哑铃”形肿瘤可采用单纯后正中入路、沿肋骨间隙进入、分块切除肿瘤，无需开胸，亦无需辅助切口。

关键词: 脊髓肿瘤, 椎管, 胸椎, 神经外科手术

Abstract:

Objective  To study the surgical technique and effect of purely posterior midline approach resection for large intra- and extra-spinal dumbbell tumors that extended into the thoracic cavity.  Methods  Retrospectively analyze 12 cases of large intra- and extra-spinal dumbbell tumors that extended into the thoracic cavity and were resected through posterior midline approach. The clinical features and common surgical approaches of dumbbell tumors in literature were introduced to explore the advantages of purely posterior midline approach.  Results  There were 12 patients (5 males and 7 females) with the age between 34-58 years old (average 45 years old). Eleven cases underwent first operation and one case underwent reoperation. There were 4 Eden type Ⅱ tumors, 5 Eden type Ⅲ tumors, and 3 Eden type Ⅳtumors with average size 4.50 cm × 4.00 cm × 3.00 cm. All cases were achieved total resection by purely posterior midline approach and one case received spinal fixation at the same time, with operation time ranged from 120-315 min (average 195 min) and average blood loss of 205 ml. Postoperative pathological findings included schwannoma in 9 patients, neurofibroma in one patient, meningioma in one patient and cavernous hemangioma in one patient. The follow-up period was 6-26 months (average 18 months) after operation, and all patients recovered well. Preoperative symptoms like root pain, spinal cord compression were relieved to various degrees. Neither new neurological defects nor tumor recurrence was found.  Conclusions  Most of the intra- and extra-spinal dumbbell tumors that extend into thoracic cavity are schwannoma. Correctly preoperative radiographic assessment, purely posterior midline approach with piecemeal resection in the intercostal space can achieve total tumor resection in most cases without thoracotomy or assisted incision.

Key words: Spinal cord neoplasms, Spinal canal, Thoracic vertebrae, Neurosurgical procedures