颈脊神经肿瘤伴椎旁扩散的治疗特点

Ye. I. Slynko, O. O. Potapov, Y. Derkach
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摘要

介绍。我们的目的是评估周围神经鞘肿瘤患者的手术治疗结果,明确其结构和延伸模式的特殊性,并确定周围神经肿瘤的预后不利形态学特征。材料和方法。本研究基于对2008年至2018年在我院神经外科手术的65例患者的病历进行回顾性分析。手术指征为颈椎肿瘤进展导致神经系统症状恶化,经神经影像学检查(脊柱造影、CT、SCT、MRI)证实。手术入路的选择取决于肿瘤位置与硬脑膜、神经结构、骨骼的关系等因素。讨论:周围神经鞘肿瘤患者手术治疗的预期效果取决于许多因素:肿瘤的定位、肿瘤扩展方向、治疗的根治性和肿瘤的组织学变异。脊神经肿瘤很常见,占脊柱定位肿瘤的48%。绝大多数此类肿瘤导致脊髓及其神经根的压迫,并导致相当多的神经症状。确定手术策略和手术途径的选择是实现长期缓解的重要组成部分。选择合适的入路可以完全切除肿瘤,减少干预时间,减少失血,减少肿瘤切除过程中对神经结构的损伤。
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PECULIARITIES OF TREATMENT OF PATIENTS WITH TUMORS OF CERVICAL SPINAL NERVES WITH PARAVERTEBRAL SPREAD
Introduction. We aimed to evaluate the results of surgical treatment of patients with peripheral nerve sheath tumors with specification of the peculiarities of their structure and extension pattern, and to determine prognostically unfavorable morphological features in tumors of peripheral nerves. Materials and methods. The study is based on a retrospective analysis of the medical records of 65 patients who were operated in our Neurosurgical Department during 2008 to 2018. The indication for the operation was worsening of neurological symptoms as a result of the tumor process in the cervical spine, verified by methods of neuroimaging (spondylography, CT, SCT, MRI). The choice of the surgical access depended on such factors as the tumor location regarding to the dura mater and the nervous structures, bones. Discussion: the expected response to surgical treatment in patients with peripheral nerve sheath tumors depends on many factors: localization, directions of neoplasm extension, radical nature of the treatment and the histological variant of the tumor. The tumors of the spinal nerves are quite common and form up to the 48% of all tumors of the spinal localization. The overwhelming majority of such tumors leads to the compression of the spinal cord and its nerve roots, and to considerable neurological symptomatology. Determining the tactics of surgery and the choice of surgical access is an important component for achieving long remission. The choice of an adequate approach makes it possible to totally remove the tumor, reduces the time of intervention, blood loss, injuries to the nervous structures during removal of the tumor.
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