微创切除椎管内腰椎根部许旺瘤

Chien-Ching Lee, Hao-Yu Chuang, C. Chang, Hung-Lin Lin, Cheng-Hsin Cheng
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摘要

背景和重要性 这篇视频文章报道了一例罕见的右侧 L5/S1 腔根部裂孔瘤病例,介绍了该病的自然病程、影像学检查结果、治疗方案、手术过程,并强调了一些可能出现的手术并发症。临床表现 磁共振成像(MRI)显示右侧 L5/S1 水平有一个硬膜内、髓外、强化良好的肿块。手术过程包括右侧最小L5/S1椎板切除术/后方椎板切除术,以打开右侧L5根部。为防止脊柱不稳,手术保留了面关节。打开右侧L5/S1孔后,肿瘤沿着根部被找到。术中进行了肌电图(IOM)检查,以发现患者是否有神经损伤。打开硬脑膜后,在 IOM 监测下小心地将肿瘤与正常的根神经分离。用微型钳将肿块逐块切除。结论 组织病理学检查确诊为分裂瘤。患者术后恢复顺利,右腿疼痛和麻木症状轻微。
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Minimally Invasive Resection of a Foraminal Lumbar Root Schwannoma
Background and Importance This video article reports a rare case of a right L5/S1 foraminal root schwannoma that presents the natural course of the disease, imaging findings, treatment protocol, operative procedure, and highlights some of the possible surgical complications. Clinical Presentation Magnetic resonance imaging (MRI) revealed an intradural, extramedullary, well-enhanced mass at the right L5/S1 level. The operative procedure involved a right minimal L5/S1 laminotomy/foraminotomy posteriorly to open the right L5 root. The facet joints were preserved to prevent spinal instability. The tumor was located along the root after opening the right L5/S1 foramen. Intraoperative electromyography (IOM) was conducted to detect any nerve injury in the patient. After opening the dura, the tumor was carefully separated from the normal root nerve under IOM monitoring. The mass was removed piece-by-piece using mini-forceps. Conclusion Histopathological examination confirmed the diagnosis of a schwannoma. The patient recovered without incident after surgery with minimal soreness and numbness in the right leg.
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