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目的:探讨手术治疗椎管内髓外硬膜下神经鞘瘤的疗效及术后脑脊液漏的处理办法。方法:2000年1月～2006年6月采用后路手术治疗髓外硬膜下神经鞘瘤患者29例,男17例,女12例,年龄24～65岁,平均44.6岁。颈段10例,胸段5例,腰、骶段14例。全部病例术中均切断肿瘤累及的神经根,其中18例采用脊柱内固定及后外侧植骨融合术。观察患者肿瘤切除及术后脑脊液漏发生情况。结果:29例患者中,27例获肿瘤全切,2例大部切除。所有患者术后均出现脑脊液漏,其中未采用内固定的患者引流3～5d夹闭引流管,8例愈合,3例经局部缝合后愈合;采用内固定的患者脑脊液漏持续时间较长,引流11～14d拔管并缝合引流口后愈合。术后平均随访27个月,26例患者的症状全部或部分缓解,3例术后神经症状加重,末次随访时2例恢复至术前状态,1例未能恢复。肿瘤全切除患者未见复发迹象,部分切除者残余肿瘤无明显增大。结论:手术切除治疗椎管内髓外硬膜下神经鞘瘤可取得较好疗效;对脊柱稳定性破坏较多者术中需使用内固定重建脊柱稳定性,但可能导致脑脊液漏持续时间延长,增加发生感染风险。
Objective: To investigate the efficacy of surgical treatment of spinal extramedullary schwannoma and the treatment of postoperative cerebrospinal fluid leakage. Methods: From January 2000 to June 2006, 29 patients with extramedullary subdural schwannoma were treated by posterior approach. There were 17 males and 12 females, aged from 24 to 65 years (average 44.6 years). 10 cases of cervical, 5 cases of thoracic, lumbar, sacral 14 cases. All the cases were cut off the tumor involved nerve root surgery, of which 18 cases of spinal fixation and posterolateral fusion. Observation of patients with tumor resection and postoperative cerebrospinal fluid leakage situation. Results: Among the 29 patients, 27 cases were completely resected by tumor and 2 cases were mostly resected. All patients had cerebrospinal fluid leakage after operation, in which patients who did not receive internal fixation had drainage tube occluded for 3 to 5 days, 8 cases healed, 3 cases healed after partial suture, and cerebrospinal fluid leakage was longer and drainage 11 ~ 14d extubation and suture drainage after healing. The patients were followed up for an average of 27 months. The symptoms of 26 patients were relieved completely or partially. The neurological symptoms in 3 patients were aggravated. Two patients recovered to preoperative status at the last follow - up, and 1 patient failed to recover. Tumor resection showed no signs of recurrence in patients with partial resection of residual tumor was no significant increase. Conclusion: Surgical resection of spinal extramedullary schwannoma can achieve better curative effect. For patients with more severe spinal failure, internal fixation should be used to reconstruct the spinal stability, but it may lead to prolonged duration of cerebrospinal fluid leakage, Increase the risk of infection.