椎管哑铃形肿瘤的个体化显微外科治疗分析

Objective： To explore the individualized surgical approach and microsurgical treatment of spinal dumbbell tumors. Methods： We made a retrospective analysis of the clinical data of 26 cases of spinal dumbbell tumors resected at the Neurosurgery Department of The First Affiliated Hospital of Xi'an Jiaotong University from January 2015 to December 2018. Individualized surgical approach was selected by the Toyama tumor classification and spinal internal fixation was conducted according to the patients' spinal instability before and during the operation. The sensory and motor scores of the American Spinal Cord Injury Association (ASIA) were compared before and after the surgery in order to evaluate the therapeutic effect. Results： All the 26 cases of spinal dumbbell tumors underwent single stage resection. There were 20 cases of schwannoma, 3 cases of ganglion neuroma, 2 cases of spinal meningioma, and 1 case of neurofibroma. The neurological symptoms of the patients were improved to different extent after the operation, and there was no increase in motor dysfunction. The ASIA sensory score was 219.34±1.62 and the ASIA motor score was 98.61±1.25 at 1 month after the surgery, and both of them were significantly higher than those before surgery (P<0.001). The follow-up period was 6-52 months, with an average of 28 months. No tumor recurrence or spinal deformity was observed. Conclusion： Single stage micro-resection of spinal dumbbell tumors could be achieved by modern microsurgical technology and individualized surgical approach according to tumor characteristics. Based on accurate evaluation of the stability of the spine before and during the operation, reasonable selection of spinal internal fixation are crucial for preventing postoperative spinal deformity and improve patients' quality of postoperative life.