Wiltes肌间隙微通道切除腰椎间孔区神经鞘瘤
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1.山东大学,山东省千佛山医院神经外科;2.山东第一医科大学第一附属医院(山东省千佛山医院)神经外科;3.山东第一医科大学第一附属医院(山东省千佛山医院)神经外科

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济南市科技计划项目


Resection of neurilemmoma in lumbar intervertebral foramen area via the microchannel of Wiltes muscle space
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1.Department of Neurosurgery, Shandong Provincial Qianfoshan Hospital, Shandong University;2.Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University;3.Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University &4.amp;5.Shandong Provincial Qianfoshan Hospital

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    摘要:

    [目的]介绍Wiltes肌间隙微通道切除腰椎间孔区神经鞘瘤手术技术和初步临床效果。[方法]回顾本院2例腰椎间孔区神经鞘瘤患者临床资料,结合术前影像确定手术入路与工作通道位置,由Wiltes肌间隙置入14mm工作通道并直达椎板外缘表面,磨除部分椎板外侧峡,切除部分黄韧带,充分显露责任神经根及肿瘤膜性结构,沿肿瘤长轴纵向切开肿瘤包膜,并沿肿瘤边界膜内切除肿瘤,2例患者均未追加脊柱关节内固定及关节融合。[结果]患者均实现一期肿瘤切除,术后患者症状基本消失,次日可下床活动,随访17个月,未发现肿瘤复发及远期手术并发症。[结论]Wiltes肌间隙微通道手术可一期完整切除腰椎间孔区神经鞘瘤,避免术后脊柱不稳定和椎旁软组织损伤,有良好临床应用前景。

    Abstract:

    [Objective] To introduce the surgical technique and preliminary clinical effect of foraminal lumbar schwannoma resection through the microchannel of Wiltse approach. [Methods] The clinical data of 2 patients with foraminal lumbar schwannoma in our hospital was reviewed. The surgical approach and the position of the tubular retractors were determined by combining the preoperative images. A 14 mm tubular retractor was positioned along the Wiltse plane and directly reached the outer edge of the vertebral plate. Part of the lateral isthmus of the vertebral plate was ground off, and part of the ligamentum flavum was removed. The responsible nerve root and tumor membrane structure were fully exposed. The tumor capsule was cut longitudinally along the long axis of the tumor. The membrane was stripped along the tumor boundary and the tumor was completely removed within the membrane. No spinal joint internal fixation and joint fusion were added to the 2 patients. [Results]All patients achieved primary tumor resection. The pathological type was schwannoma. After surgery, the symptoms of the patients basically disappeared. They could get out of bed the next day. The follow-up period exceeded 17 months. No tumor recurrence and long-term complications were found. [Conclusion] Microchannel surgery through Wiltse approach can completely remove foraminal lumbar schwannoma in one stage, avoiding postoperative spinal instability and paravertebral soft tissue damage, which has a great clinical application foreground.

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  • 收稿日期:2022-11-09
  • 最后修改日期:2023-01-06
  • 录用日期:2023-02-27
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