Objective: To explore the application and key points of microchannel approaches in resection of cervical intraspinal tumors.
Methods: A retrospective analysis was performed on 51 cases of cervical spinal canal tumors from February 2017 to March 2020. Among them, 5 cases were located epidural space, 6 cases were located epidural and subdural space, and 40 cases were located under the subdural extramedullary space(6 cases were located on the ventral side of the spinal cord). The maximum diameter ranged from 0.5 to 3.0 cm. The clinical manifestations included neck, shoulder or upper limb pain 43 cases, sensory disturbance (numbness) in 22 cases, and limb weakness in 8 cases. The microchannel keyhole technique was used to expose the tumor, and the tumor was resected microscopically.
Results: In this study, 35 patients underwent hemilaminectomy, 12 patients underwent interlaminar fenestration, 2 patients underwent medial 1/4 facetectomy on the basis of hemilaminectomy or interlaminar fenestration. Two tumors were resected through anatomy space (no bone was resected). The degree of tumor resection included total resection in 50 cases and subtotal resection in 1 case. The type of the tumor included 36 schwannomas, 12 meningiomas, 2 enterogenic cysts and 1 dermoid cyst. There was no infection and cerebrospinal fluid leakage postoperatively. Limb numbness occurred in 7 patients. The average follow-up time was 15 months (3 to 36 months). No deformity such as cervical instability or kyphosis was found. The tumor had no recurrence.
Conclusion: The cervical spinal canal is relatively wide, cervical tumors with no more than three segments can be fully exposed by means of microchannel technology. Besides intramedullary or malignant tumors, they can be microsurgically removed. Preservation of the skeletal muscle structure of cervical spine is beneficial to recover the anatomy and function of cervical spine. The electrophysiological monitoring helps to avoid spinal cord or nerve root injury.
目的: 探讨微通道技术在颈椎管肿瘤微创切除手术中的应用。
方法: 选择2017年2月至2020年3月于北京大学第三医院神经外科因颈椎管肿物行微创切除手术的51例患者的病例资料进行回顾性分析，其中5例患者肿物位于硬膜外，6例位于硬膜内外，40例位于髓外硬膜下(6例位于脊髓腹侧)。肿物最大径0.5~3.0 cm。患者临床表现包括颈肩部或上肢疼痛43例，感觉障碍(麻木)22例，肢体无力8例。所有患者均采用微通道锁孔技术进行肿瘤显露，显微镜下进行肿瘤切除手术。
结果: 35例切除半侧椎板，12例采用半侧椎板间开窗，2例在半椎板切除或半侧椎板间开窗基础上切除内侧1/4小关节，经解剖间隙(未切除骨质)2例。肿瘤切除程度包括50例全部切除和1例次全切除。肿瘤性质包括36例神经鞘瘤，12例脊膜瘤，2例肠源性囊肿和1例皮样囊肿。术后无感染、脑脊液漏。7例患者出现肢体麻木。平均随访时间15个月(3~36个月)，未发现颈椎不稳或后突等畸形，肿瘤均无复发。
结论: 颈椎管较为宽大，不超过三个节段的颈椎管肿瘤可借助微通道技术进行充分显露，除髓内或恶性肿瘤外，可显微外科切除。患者术后更多颈椎正常结构和肌肉附着得到保留，有利于颈椎保持正常功能，神经电生理监测的辅助有助于避免脊髓或神经损伤。
Keywords: Cervical intraspinal tumor; Hemilaminectomy; Interlaminar fenestration; Microchannel; Selective laminectomy; Stability.