患者病史介绍
经前外侧入路行C1～2椎管外肿瘤切除术
经后正中入路行C1～2椎管内肿瘤切除术视频：颈椎椎管“哑铃”形肿瘤分型及手术疗效分析
Topic: Analysis of classification and surgical treatment of cervical dumbbell⁃shaped tumors
作者：刘家刚，陈海锋，胡瑜，黄思庆
Authors: LIU Jia-gang, CHEN Hai-feng, HU Yu, Huang Si-qing
原文链接：中国现代神经疾病杂志, 2013, 13(11):941-945
Associated with: Chinese Journal of Contemporary Neurology and Neurosurgery, 2013, 13(11):941-945
病史介绍：男性患者，26岁。主因进行性左侧肢体乏力、伴行走不稳3个月入院。
临床诊断：寰枢椎（C1-2）占位性病变。
术后病理诊断：神经鞘瘤。
神经系统检查：神志清楚，语言流利。左上肢肌力2级、左下肢3级，右侧肢体肌力4级，双侧Babinski征阳性。
影像学检查：颈椎增强MRI显示，巨大占位性病灶自右侧咽旁间隙经寰枢椎椎间孔突入椎管内，压迫延髓腹侧。颈椎三维CT重建未见寰枢椎骨质破坏。
Medical history: A 26-year-old male came to clinic for progressive weakness of left extremities and unstable walking for 3 months.
Clinical diagnosis: C1-2 space-occupying lesion.
Postoperative pathological diagnosis: schwannoma. Cervical enhanced MRI showed a huge space-occupying lesion protruded to the inside of spinal through atlantoaxial foramen from right parapharyngeal gap, compressing ventral medulla. Cervical three-dimensional CT reconstruction revealed no bony destruction of vertebrae.
视频2：该例患者寰枢椎椎管“哑铃”形神经鞘瘤（考虑来自枢椎神经感觉支）属于Ⅲ型，即椎管内外均衡型。未见寰枢椎脱位及骨性破坏，颈椎稳定性良好，术中无需辅助内固定。经前外侧-后正中入路联合入路，先切除椎管外肿瘤，于椎间孔处离断肿瘤。
Video 2: This case with atlantoaxial spinal canal dumbbell-shaped schwannoma (considered from axial sensory nerve) belongd to Type Ⅲ, with equalization of intravertebral and paravertebral. No atlantoaxial dislocation and bone destruction was found, and because of good cervical stability, surgery was performed without auxiliary internal fixation. Through combined anterolateral-posterior approach, extravertebral tumor was firstly removed, and tumor was interrupted at the intervertebral foramen.
视频3：采取前外侧-后正中入路联合入路。经后正中入路切开半椎板，显露椎管内肿瘤，显微镜下全切除肿瘤及载瘤神经，保留蛛网膜完整，避免脑脊液漏及蛛网膜下隙血性脑脊液的刺激。
Video 3: Take combined anterolateral-posterior approach. Cut open half lamina through posterior midline approach to expose intraspinal tumor. Total resection of tumor and parent nerve under the microscope was performed, retaining the integrity of arachnoid and avoiding leakage of cerebrospinal fluid and subarachnoid bloody cerebrospinal fluid stimulation.
Topic: Analysis of classification and surgical treatment of cervical dumbbell⁃shaped tumors
作者：刘家刚，陈海锋，胡瑜，黄思庆
Authors: LIU Jia-gang, CHEN Hai-feng, HU Yu, Huang Si-qing
原文链接：中国现代神经疾病杂志, 2013, 13(11):941-945
Associated with: Chinese Journal of Contemporary Neurology and Neurosurgery, 2013, 13(11):941-945
病史介绍：男性患者，26岁。主因进行性左侧肢体乏力、伴行走不稳3个月入院。
临床诊断：寰枢椎（C1-2）占位性病变。
术后病理诊断：神经鞘瘤。
神经系统检查：神志清楚，语言流利。左上肢肌力2级、左下肢3级，右侧肢体肌力4级，双侧Babinski征阳性。
影像学检查：颈椎增强MRI显示，巨大占位性病灶自右侧咽旁间隙经寰枢椎椎间孔突入椎管内，压迫延髓腹侧。颈椎三维CT重建未见寰枢椎骨质破坏。
Medical history: A 26-year-old male came to clinic for progressive weakness of left extremities and unstable walking for 3 months.
Clinical diagnosis: C1-2 space-occupying lesion.
Postoperative pathological diagnosis: schwannoma. Cervical enhanced MRI showed a huge space-occupying lesion protruded to the inside of spinal through atlantoaxial foramen from right parapharyngeal gap, compressing ventral medulla. Cervical three-dimensional CT reconstruction revealed no bony destruction of vertebrae.
视频2：该例患者寰枢椎椎管“哑铃”形神经鞘瘤（考虑来自枢椎神经感觉支）属于Ⅲ型，即椎管内外均衡型。未见寰枢椎脱位及骨性破坏，颈椎稳定性良好，术中无需辅助内固定。经前外侧-后正中入路联合入路，先切除椎管外肿瘤，于椎间孔处离断肿瘤。
Video 2: This case with atlantoaxial spinal canal dumbbell-shaped schwannoma (considered from axial sensory nerve) belongd to Type Ⅲ, with equalization of intravertebral and paravertebral. No atlantoaxial dislocation and bone destruction was found, and because of good cervical stability, surgery was performed without auxiliary internal fixation. Through combined anterolateral-posterior approach, extravertebral tumor was firstly removed, and tumor was interrupted at the intervertebral foramen.
视频3：采取前外侧-后正中入路联合入路。经后正中入路切开半椎板，显露椎管内肿瘤，显微镜下全切除肿瘤及载瘤神经，保留蛛网膜完整，避免脑脊液漏及蛛网膜下隙血性脑脊液的刺激。
Video 3: Take combined anterolateral-posterior approach. Cut open half lamina through posterior midline approach to expose intraspinal tumor. Total resection of tumor and parent nerve under the microscope was performed, retaining the integrity of arachnoid and avoiding leakage of cerebrospinal fluid and subarachnoid bloody cerebrospinal fluid stimulation.
ISSN: 1672-6731