[1]吴超 马长城** 林国中 杨军 于涛 司雨.“四分区法”个体化入路显微手术治疗颈椎椎旁神经源性肿瘤[J].中国微创外科杂志,2021,01(2):107-111.
　Wu Chao,Ma Changcheng,Lin Guozhong,et al.Fourregions Partition Method Individualized Surgical Approaches for Cervical Paravertebral Neurogenic Tumors[J].Chinese Journal of Minimally Invasive Surgery,2021,01(2):107-111.
点击复制

“四分区法”个体化入路显微手术治疗颈椎椎旁神经源性肿瘤()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年2期
页码:
107-111
栏目:
临床研究
出版日期:
2021-02-25

文章信息/Info

Title:
Fourregions Partition Method Individualized Surgical Approaches for Cervical Paravertebral Neurogenic Tumors
作者:
吴超 马长城** 林国中 杨军 于涛 司雨
（北京大学第三医院神经外科，北京100191）
Author(s):
Wu Chao;  Ma Changcheng;  Lin Guozhong;  et al.
Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
关键词:
颈椎; 椎旁肿瘤; 神经源性肿瘤; 显微外科手术; 手术入路
Keywords:
Cervical spine; Paravertebral tumor; Neurogenic tumor; Microneurosurgery; Surgical approach
文献标志码:
A
摘要:
目的探讨“四分区法”及个体化入路在显微手术治疗颈椎椎旁神经源性肿瘤中的应用价值。 方法回顾性分析我科2013年1月~2018年12月显微手术治疗颈椎椎旁神经源性肿瘤42例资料。根据“四分区法”，肿瘤位于Ⅰ区6例，Ⅱ区5例，Ⅲ区5例，Ⅳ区7例，Ⅰ和Ⅱ区6例，Ⅰ、Ⅱ和Ⅲ区2例，Ⅱ和Ⅲ区3例，Ⅲ和Ⅳ区6例，Ⅱ、Ⅲ和Ⅳ区1例，Ⅰ、Ⅱ、Ⅲ和Ⅳ区1例。根据肿瘤主体所在节段及区域选择手术入路，采用后方旁正中入路12例，后侧方入路2例，颌下入路2例，胸锁乳突肌前入路9例，胸锁乳突肌后入路7例，锁骨上入路6例，经口腔入路1例，胸锁乳突肌前后联合入路2例，胸锁乳突肌后联合后方旁正中入路1例。术中行神经电生理监测。结果42例肿瘤均完全切除，病理诊断神经鞘瘤32例，神经纤维瘤10例。术后3例声音嘶哑，1周恢复，1例上肢肌力下降，3个月恢复，无其他并发症。术后随访12~84个月，中位数48.5月，无肿瘤复发。结论术前对颈椎椎旁肿瘤进行分区，根据分区个体化选择入路行显微手术安全有效。
Abstract:
ObjectiveTo evaluate the efficiency of a new “fourregions” partition method individualized surgical approach for cervical paravertebral neurogenic tumors (CPVNT).MethodsThis was a retrospective study of 42 patients who accepted microsurgical treatment for CPVNT at our department between January 2013 and December 2018. According to the “fourregions” partition method, the tumors were located in RⅠ in 6 cases, RⅡ in 5 cases, RⅢ in 5 cases, RⅣ in 7 cases, RⅠ and RⅡ in 6 cases, RⅠ, RⅡ and RⅢ in 2 cases, RⅡ and RⅢ in 3 cases, RⅢ and RⅣ in 6 cases, RⅡ, RⅢ and RⅣ in 1 case, and RⅠ, RⅡ, RⅢ and RⅣ in 1 case. Individualized surgical approaches were selected based on the segment and region of the tumor, including 12 cases of posterior paramedian approach (PPMA), 2 cases of posterolateral approach (PLA), 2 cases of submandibular approach (SMA), 9 cases of anterior sternocleidomastoid approach (ASCMA), 7 cases of posterior sternocleidomastoid approach (PSCMA), 6 cases of supraclavicular approach (SCA), 1 case of transoral approach (TOA), 2 cases of combined ASCMA and PSCMA, and 1 case of combined PSCMA and PPMA. Intraoperative nerve electrophysiological monitoring was performed.ResultsAll the 42 tumors were resected totally, including 32 cases of schwannoma and 10 cases of neurofibroma pathologically. Hoarseness was found in 3 patients and disappeared after one week, motor defict of upper extremity was found in 1 patient postoperatively and recovered after 3 months. No recurrence was found through magnetic resonance imaging during 12-84 months followup (median, 48.5 months).ConclusionIndividualized surgical approaches based on the new partition method are effective in surgical treatment of CPVNT.

参考文献/References:

[1]Ijichi K,Kawakita D,Maseki S,et al.Functional nerve preservation in extracranial head and neck schwannoma surgery.JAMA Otolaryngol Head Neck Surg,2016,142(5):479-483.
[2]Montano N,D’Alessandris QG,D’Ercole M,et al.Tumors of the peripheral nervous system:analysis of prognostic factors in a series with longterm followup and review and review of the literature.J Neurosurg,2016,125(2):363-371.
[3]高俊潇,邱前辉.头颈部神经鞘瘤的诊断与手术治疗.国际耳鼻咽喉头颈外科杂志,2019,43(4):216-219.
[4]Liu T,Liu H,Zhang JN,et al.Surgical strategy for spinal dumbbell tumors:a new classification and surgical outcomes.Spine (Phila Pa 1976),2017,42(12):E748-E754.
[5]吴超,马长城,王振宇,等.臂丛神经鞘瘤的分区、分型和显微外科治疗.中国微创外科杂志,2017,17(12):1060-1063.
[6]董益鹏，刘藏，张晶，等.颈前入路治疗颈部椎管外周围神经源性肿瘤的体会.中华神经外科杂志，2017,33(2)：138-141.
[7]Gosk J,Gutkowska O,Mazurek P,et al.Peripheral nerve tumors:30year experience in the surgical treatment.Neurosurg Rev,2015,38(3):511-520.
[8]Bradlrey PJ,Bradley PT,Olsen KD.Update on the management of parapharyngeal tumours.Curr Opin Otolaryngol Head Neck Surg,2011,19(2):92-98.
[9]Pang KP,Goh CH,Tan HM.Parapharyngeal space tumors:an 18 year review.Laryngol Otol,2002,116:170-175.
[10]Cage TA,Yuh EL,Hou SW,et al.Visualization of nerve fibres and their relationship to peripheral nerve tumors by diffusion tensor imaging.Neurosurg Focus,2015,39(3):E16.
[11]Gallagher TA,Simon NG,Kliot M.Visualizing nerve fibres surrounding a brachial plexus tumor using MR diffusion tensor imaging.Neurology,2016,86(6):582-583.
[12]Grant GA,Goodkin R,Kliot M.Evaluation and surgical management of peripheral nerve problems.Neurosurgery,1999,44(4):825-839.
[13]Raveh E,Segal K,Chaimoff M,et al.Surgical approaches to the parapharyngeal space.Op Tech Otolaryngol Head Neck Surg,1996,7(4):327-332.
[14]Meng LZ,Zhong Q,Fang JG,et al.Early experience in endoscopic transoral resection for parapharyngeal space tumors.Ear Nose Throat J,2018,97(4-5):E5-E9.
[15]De Virgilio A,Park YM,Kim WS,et al.Transoral robotic surgery for the resection of parapharyngeal tumour:our experience in ten patients.Clin Otolaryngol,2012,37(6):483-488.

备注/Memo

备注/Memo:
基金项目：首都临床特色应用研究项目(Z171100001017120)**通讯作者，Email：ma2001612@163.com
更新日期/Last Update: 2021-05-11