[1]林国中吴超司雨马长城**杨军.椎管内硬膜下神经鞘瘤显微手术切除中的载瘤神经保护[J].中国微创外科杂志,2026,01(3):0.
　Lin Guozhong,Wu Chao,Si Yu,et al.Protection of the Tumorbearing Nerve During Microsurgical Resection of Intraspinal Subdural Schwannomas[J].Chinese Journal of Minimally Invasive Surgery,2026,01(3):0.
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椎管内硬膜下神经鞘瘤显微手术切除中的载瘤神经保护()

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

卷:
01
期数:
2026年3期
页码:
0
栏目:
临床研究
出版日期:
2026-03-26

文章信息/Info

Title:
Protection of the Tumorbearing Nerve During Microsurgical Resection of Intraspinal Subdural Schwannomas
作者:
林国中吴超司雨马长城**杨军
(北京大学第三医院神经外科，北京100191)
Author(s):
Lin Guozhong;  Wu Chao;  Si Yu;  et al.
Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
关键词:
神经鞘瘤; 椎管内肿瘤; 载瘤神经
Keywords:
Schwannoma; Intraspinal tumor; Tumorbearing nerve
文献标志码:
A
摘要:
目的探讨椎管内硬膜下神经鞘瘤显微手术中保留载瘤神经的可行性。方法回顾性分析2018年9月~2023年12月55例椎管内硬膜下神经鞘瘤行包膜内切除并保留载瘤神经的临床资料。肿瘤位于腰椎36例，颈椎17例，胸椎2例。均在显微镜下手术，显露肿瘤后，沿神经根长轴纵行切开包膜，包膜下剥离并切除肿瘤，均保留载瘤神经。结果手术均顺利完成。54例实性肿瘤均获全切除，1例囊性变行肿瘤次全切除。手术时间85~180 min，平均109.0 min。术后病理均为神经鞘瘤。术后无感染，无死亡。疼痛视觉模拟评分(Visual Analogue Scale，VAS)术前0~6分，中位数4分，术后1周0分48例，1分7例。2例术后新发节段性感觉减退。术后随访6~60个月，平均25.4月，未见肿瘤复发，未见脊柱不稳定或畸形，2例术后新发感觉减退者术后6个月均恢复正常。结论对于椎管内硬膜下神经鞘瘤，纵行切开包膜行包膜内分块切除，有望保留载瘤神经，改善神经功能预后。
Abstract:
ObjectiveTo explore the feasibility of preserving the tumorbearing nerve during microsurgery for intraspinal subdural schwannomas.MethodsA retrospective analysis was performed on clinical data of 55 patients with intraspinal subdural schwannomas who underwent intralesional resection while preserving the tumorbearing nerve between September 2018 and December 2023. There were 36 cases of lumbar schwannomas, 17 cases of cervical schwannomas, and 2 cases of thoracic schwannomas. All the surgeries were carried out under a microscope. After exposing the tumor, the capsule was longitudinally incised along the long axis of the nerve root, and the tumor was dissected and removed beneath the capsule. The tumorbearing nerve was preserved in all the patients.ResultsAll the operations were successfully accomplished. Among the 55 tumors, 54 were solid which were completely resected, and 1 was cystic degeneration which received a subtotal resection. The operation time was 85-180 min, with an average of 109.0 min. Postoperative pathological examinations confirmed schwannomas in all the patients. There were no postoperative infections or deaths. The Visual Analog Scale (VAS) score was 0-6 (median, 4) before surgery and 0 in 48 patients and 1 in 7 patients at 1 week after surgery. Segmental sensory impairment occurred postoperatively in 2 cases. During the postoperative followups for 6-60 months (average, 25.4 months), no spinal instability, deformity, or tumor recurrence was observed. The 2 patients with sensory impairment recovered at 6 months after surgery.ConclusionFor intraspinal subdural schwannomas, it is promising to preserve part of the tumorbearing nerve by longitudinally incising the capsule and performing piecemeal intralesional resection, which leads to better neurological functional outcomes.

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备注/Memo

备注/Memo:
基金项目：国家自然科学基金(81601200)；首都临床特色应用研究项目(Z171100001017120)；北京大学临床医学+X专项项目(PKU2020LCXQ004)**通讯作者，Email：ma2001612@163.com
更新日期/Last Update: 2026-03-26