摘要： 目的 探讨颅颈交界区神经鞘瘤的临床特点及外科手术治疗原则。方法 共29 例颅颈交界区神经鞘瘤患者经后正中入路行肿瘤切除术，术前影像学观察肿瘤未影响脊柱稳定性者仅行肿瘤切除术；肿瘤侵蚀破坏骨质、造成脊柱失稳者同期行枕颈融合内固定术。结果 29 例患者均达显微镜下肿瘤全切除，术后病理证实为神经鞘瘤。术后枕颈部疼痛症状明显缓解，其中13 例枕颈部麻木感者术后3 个月随访时症状完全消失；无一例肢体麻木、肌无力症状加重，无新发神经功能缺损、脑脊液漏和死亡病例。术后均获3 ~ 24 个月随访，未见肿瘤复发及脊柱畸形和椎体滑脱。结论 颅颈交界区神经鞘瘤采取经后正中入路即可全切除肿瘤；对于肿瘤侵蚀破坏骨质而影响脊柱稳定性的患者，术中需辅助枕颈融合内固定术。

关键词: 神经鞘瘤, 脊髓, 寰枢关节, 内固定术（非MeSH 词）, 外科手术

Abstract: Objective  To investigate the clinical characteristics and surgical management of schwannomas in the craniocervical junction region.  Methods  Clinical data of 29 patients with craniocervical schwannomas was retrospectively studied. According to MRI examination, tumors in 3 cases were located in anterolateral region of the spinal cord and tumors in 26 patients were located in posterolateral side of the spinal cord. Among the 29 patients, 4 patients had intra- and extra-spinal schwannomas. All the tumors were excised through posterior approach. The extent of bone window was to the lateral side of the spinal cord. If spinal stability was destroyed by osteotomy intraoperatively or by bone erosion of the tumor preoperatively, internal fixation of occipitocervical fusion was performed after tumor excision.  Results  Total resection was achieved in all of the 29 patients, and postoperative pathological result was schwannoma. The pain of the back of neck and occipital region was relieved after operation and numbness of neck and occipital region in 13 patients disappeared in the follow-up of 3 months. There was no new neurological defect, no cerebrospinal fluid fistula and no dead patient. During the follow-up period of 3-24 months, there was no tumor recurrence and no spinal spondylolisthesis or deformity.  Conclusion  Total resection of tumor can be achieved by posterior approach for schwannomas in the craniocervical region. If spinal stability was destroyed by the tumor, internal fixation will be performed.

Key words: Neurilemmoma, Spinal cord, Atlanto-axial joint, Internal fixation (not in MeSH), Surgical procedures, operative