摘要： 目的 探讨颈段椎管内外“哑铃”形肿瘤的临床特点及手术方法。方法 回顾分析11 例经手术治疗的颈段椎管内外“哑铃”形肿瘤患者临床资料，男性7 例，女性4 例。经颈椎后路行肿瘤显微切除者9 例，其中行半椎板切除4 例（包括1 例颈胸交界区Ⅲ期肿瘤和1 例Ⅳ期肿瘤，均行颈椎后路钉棒系统内固定术），全椎板切开肿瘤切除后微钛片、钛钉椎板复位2 例，经椎板间入路切除3 例；其余2 例经颈椎后路半椎板切除联合前外侧入路手术切除肿瘤。结果 所有患者均经Ⅰ期显微手术全切除肿瘤（神经鞘瘤10 例、节细胞神经瘤1 例）。术后除1 例感觉麻木面积略增大外，其余患者临床症状与体征明显改善，神经根性疼痛明显减轻或完全消失，肢体运动障碍改善。术后平均随访21 个月，无一例肿瘤残留或复发，亦无脊柱畸形。结论 颈段椎管内外“哑铃”形肿瘤术前可根据肿瘤外科分期和部位制定详细的手术方案，通过Ⅰ期显微手术切除。以半椎板入路为主，必要时可采取颈椎前后联合入路手术，影响颈椎稳定性者需同时行辅助内固定。

关键词: 颈椎, 椎管, 肿瘤, 显微外科手术

Abstract: Objective To investigate the clinical characteristics and surgical treatment strategy of intra- and extra-spinal dumbbell-shaped tumors in cervical spine. Methods Clinical data of 11 patients with intra- and extra-spinal dumbbell-shaped tumors in cervical spine were retrospectively studied. Male was in 7 cases, female in 4 cases. The tumors were in stageⅠin 4 cases, Ⅱ in 2 cases, Ⅲ in 4 cases and Ⅳ in one case. The tumors were resected via posterior midline approach alone in 9 cases, among whom unilateral hemilaminectomy was performed in 4 cases (screw fixation via posterior approach was performed for fusion of lesion segments after tumor resection in 2 cases, one was stage Ⅳ tumor, another one was stage Ⅲ tumor in cervicothoracic junction), total laminotomy and reduction by titanium miniplates and screws in 2 cases, and via interlaminar approach in 3 cases. Posterior midline approach combined with anterior lateral approach was performed in the rest 2 cases. Results Tumors were one-stage totally resected in all of the cases. Histological types of the tumors included schwannoma in 10 cases, and ganglioneuroma in one case. The numbness area was enlarged in one case, and the motor function improved in other cases. All of the patients were followed-up from 8 months to 3.50 years with an average of 21 months. No tumor relapse and spinal deformity were found. Conclusion Most cases of intra- and extra-spinal dumbbell-shaped tumors can be treated with one-stage microsurgery. The surgical treatment strategy can be reached according to the location and surgical staging of tumors. Unilateral hemilaminectomy technique is useful to maintain the stability of the cervical spine for most of tumors. Combined approach is needed in some of the tumors and fixation should be implemented in the case of stability of cervical spine damaged after tumor resection.

Key words: Cervical vertebrae, Spinal canal, Neoplasms, Microsurgery