Application of posterior approach for atlantoaxial subdural extramedullary nerve sheath tumors_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Yu ¹ , LI Keke ² ,  AI Fuzhi ¹ , XIA Hong ¹ , WU Zenghui ¹ , MA Xiangyang ¹

1. Department of Spinal Surgery, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China;
2. Department of Spinal Surgery, Huaxin Orthopaedic Hospital, Guangzhou Guangdong, 510100, P.R.China;

Corresponding?author：

AI Fuzhi, Email: spine2000@126.com

Keywords：

Atlantoaxial vertebrae; neurinoma; neurofibroma; posterior approach

DOI：

10.7507/1002-1892.201905004

Video：

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Objective To investigate the procedure and effectiveness of posterior approach for operation of atlantoaxial subdural extramedullary nerve sheath tumors.Methods Between January 2012 and March 2017, 9 patients with atlantoaxial subdural extramedullary nerve sheath tumors were treated, including 7 males and 2 females, aged 25-62 years (mean, 45.4 years). There were 8 cases of neurinoma and 1 case of neurofibroma. The tumors were located at C₁ in 1 case and C_{1, 2} in 8 cases. The disease duration ranged from 5 to 120 months, with an average of 45.9 months. The neural function was rated as grade D in 8 cases and grade E in 1 case according to the American Spinal Injury Association (ASIA) grading system. The Japanese Orthopaedic Association (JOA) score was 12.8±2.5. All patients underwent posterior cervical surgery. The laminae were replanted and fixed in 2 cases. The atlantoaxial or occipitocervical axis was not fixed in all patients.Results The operation time was 90-343 minutes, with an average of 179.2 minutes. The intraoperative blood loss was 50-1 000 mL, with an average of 335.6 mL. No relevant complication occurred after operation. All patients were followed up 6-21 months (mean, 11.1 months). The postoperative X-ray films showed the good stability of the cervical spine. All patients had complete tumor resection and no recurrence. The replanted laminae achieved fusion and the internal fixation was firm. According to ASIA grading system, 3 patients of preoperative ASIA grade D had upgraded to grade E at 3 months after operation, while the remaining patients had no change in grading. The JOA score was 15.1±1.4 at 6 months after operation, which was significantly improved when compared with that before operation (t=4.221, P=0.003).Conclusion The atlantoaxial subdural extramedullary nerve sheath tumor (including the ventral tumor) can be removed completely via posterior approach. The axis lamina can be replanted and fixed with the small titanium plate or lamina screw when necessary, and the atlantoaxial or occipitocervical fixation was not needed.

Citation： ZHANG Yu, LI Keke, AI Fuzhi, XIA Hong, WU Zenghui, MA Xiangyang. Application of posterior approach for atlantoaxial subdural extramedullary nerve sheath tumors. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(12): 1480-1485. doi: 10.7507/1002-1892.201905004 Copy

1.	李德志, 孔德生, 郝淑煜, 等. 2447 例椎管內腫瘤的流行病學特點. 中華神經外科雜志, 2014, 30(7): 653-657.
2.	肖建如, 袁文, 滕紅林, 等. 前、后聯合入路全脊椎切除附加內固定治療頸椎骨腫瘤 39 例報告. 中華外科雜志, 2005, 43(12): 795-798.
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6.	夏虹, 王建華, 尹慶水, 等. 復雜原發性頸椎及頸椎管內腫瘤的外科治療. 中國骨腫瘤骨病, 2008, 7(6): 339-342.
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10.	Gu BS, Park JH, Roh SW, et al. Surgical strategies for removal of intra- and extraforaminal dumbbell-shaped schwannomas in the subaxial cervical spine. Eur Spine J, 2015, 24(10): 2114-2118.
11.	田學豐, 馮春國, 王先祥, 等. 脊柱內固定技術在切除多節段椎管內腫瘤中的應用(附 12 例報道). 中國臨床神經外科雜志, 2016, 21(11): 673-675.
12.	謝天浩, 駱純, 馬廉亭. 頸椎椎管內腫瘤切除術中全椎板切除致頸椎畸形的危險因素及防治措施. 中國臨床神經外科雜志, 2017, 22(1): 58-60.
13.	Lopez AJ, Scheer JK, Leibl KE, et al. Anatomy and biomechanics of the craniovertebral junction. Neurosurg Focus, 2015, 38(4): E2.
14.	Shkarubo AN, Kuleshov AA, Chernov IV, et al. Transoral decompression and stabilization of the upper cervical segments of the spine using custom-made implants in various pathologic conditions of the craniovertebral junction. World Neurosurg, 2018, 109: e155-e163.
15.	Visocchi M, Signorelli F, Liao C, et al. Transoral versus transnasal approach for craniovertebral junction pathologies: never say never. World Neurosurg, 2018, 110: 592-603.
16.	劉通, 劉輝, 張建寧, 等. 椎管啞鈴形腫瘤的顯微外科治療. 中華神經外科雜志, 2016, 32(6): 551-555.
17.	Angevine PD, Kellner C, Haque RM, et al. Surgical management of ventral intradural spinal lesions. J Neurosurg Spine, 2011, 15(1): 28-37.
18.	Brook I. Microbiology and treatment of brain abscess. J Clin Neurosci, 2017, 38: 8-12.
19.	陳彬, 陳治標. 神經電生理監測輔助下顯微手術治療高頸段椎管內腫瘤. 中國臨床神經外科雜志, 2016, 21(10): 596-597.
20.	馬泓, 王冰, 呂國華, 等. 術中神經電生理監測在頸椎管內腫瘤手術中的應用. 中華骨科雜志, 2016, 36(24): 1574-1580.
21.	葉青, 黃武, 賀云松, 等. 椎管后部結構重建椎管成形在椎管內腫瘤手術中的應用. 中國修復重建外科雜志, 2014, 28(8): 965-968.
22.	禚漢杰, 周英杰, 柴旭斌, 等. 超聲骨刀在椎管內腫瘤切除椎管成形術中的應用. 中國修復重建外科雜志, 2019, 33(1): 61-65.
23.	胡博文, 周春光, 楊曦, 等. 經后路超聲骨刀雙側切除齒狀突治療顱底凹陷癥合并不可復性寰樞關節脫位一例. 中國修復重建外科雜志, 2017, 31(12): 1523-1525.

1. 李德志, 孔德生, 郝淑煜, 等. 2447 例椎管內腫瘤的流行病學特點. 中華神經外科雜志, 2014, 30(7): 653-657.
2. 肖建如, 袁文, 滕紅林, 等. 前、后聯合入路全脊椎切除附加內固定治療頸椎骨腫瘤 39 例報告. 中華外科雜志, 2005, 43(12): 795-798.
3. Wen-qing H, Shi-ju Z, Qing-sheng T, et al. Statistical analysis of central nervous system tumors in China. J Neurosurg, 1982, 56(4): 555-564.
4. Notani N, Miyazaki M, Kanezaki S, et al. Surgical management of ventrally located spinal meningiomas via posterior approach. Eur J Orthop Surg Traumatol, 2017, 27(2): 181-186.
5. 楊樹源, 洪國良. 椎管內腫瘤 402 例報告. 中華神經外科雜志, 2000, 16(3): 162-164.
6. 夏虹, 王建華, 尹慶水, 等. 復雜原發性頸椎及頸椎管內腫瘤的外科治療. 中國骨腫瘤骨病, 2008, 7(6): 339-342.
7. Rahme R, Boubez G, Bouthillier A, et al. Acute swan-neck deformity and spinal cord compression after cervical laminectomy. Can J Neurol Sci, 2009, 36(4): 504-506.
8. Fassett DR, Clark R, Brockmeyer DL, et al. Cervical spine deformity associated with resection of spinal cord tumors. Neurosurg Focus, 2006, 20(2): E2.
9. Huang Y, Wang Z, Chen Z, et al. Posterior hemi-/laminectomy and facetectomy approach for the treatment of dumbbell-shaped Schwannomas in the subaxial cervical spine: a retrospective study of 26 cases. Eur Neurol, 2017, 78(3-4): 188-195.
10. Gu BS, Park JH, Roh SW, et al. Surgical strategies for removal of intra- and extraforaminal dumbbell-shaped schwannomas in the subaxial cervical spine. Eur Spine J, 2015, 24(10): 2114-2118.
11. 田學豐, 馮春國, 王先祥, 等. 脊柱內固定技術在切除多節段椎管內腫瘤中的應用(附 12 例報道). 中國臨床神經外科雜志, 2016, 21(11): 673-675.
12. 謝天浩, 駱純, 馬廉亭. 頸椎椎管內腫瘤切除術中全椎板切除致頸椎畸形的危險因素及防治措施. 中國臨床神經外科雜志, 2017, 22(1): 58-60.
13. Lopez AJ, Scheer JK, Leibl KE, et al. Anatomy and biomechanics of the craniovertebral junction. Neurosurg Focus, 2015, 38(4): E2.
14. Shkarubo AN, Kuleshov AA, Chernov IV, et al. Transoral decompression and stabilization of the upper cervical segments of the spine using custom-made implants in various pathologic conditions of the craniovertebral junction. World Neurosurg, 2018, 109: e155-e163.
15. Visocchi M, Signorelli F, Liao C, et al. Transoral versus transnasal approach for craniovertebral junction pathologies: never say never. World Neurosurg, 2018, 110: 592-603.
16. 劉通, 劉輝, 張建寧, 等. 椎管啞鈴形腫瘤的顯微外科治療. 中華神經外科雜志, 2016, 32(6): 551-555.
17. Angevine PD, Kellner C, Haque RM, et al. Surgical management of ventral intradural spinal lesions. J Neurosurg Spine, 2011, 15(1): 28-37.
18. Brook I. Microbiology and treatment of brain abscess. J Clin Neurosci, 2017, 38: 8-12.
19. 陳彬, 陳治標. 神經電生理監測輔助下顯微手術治療高頸段椎管內腫瘤. 中國臨床神經外科雜志, 2016, 21(10): 596-597.
20. 馬泓, 王冰, 呂國華, 等. 術中神經電生理監測在頸椎管內腫瘤手術中的應用. 中華骨科雜志, 2016, 36(24): 1574-1580.
21. 葉青, 黃武, 賀云松, 等. 椎管后部結構重建椎管成形在椎管內腫瘤手術中的應用. 中國修復重建外科雜志, 2014, 28(8): 965-968.
22. 禚漢杰, 周英杰, 柴旭斌, 等. 超聲骨刀在椎管內腫瘤切除椎管成形術中的應用. 中國修復重建外科雜志, 2019, 33(1): 61-65.
23. 胡博文, 周春光, 楊曦, 等. 經后路超聲骨刀雙側切除齒狀突治療顱底凹陷癥合并不可復性寰樞關節脫位一例. 中國修復重建外科雜志, 2017, 31(12): 1523-1525.

Chinese Journal of Reparative and Reconstructive Surgery

Application of posterior approach for atlantoaxial subdural extramedullary nerve sheath tumors

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