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 例椎管内肿瘤的流行病学特点. 中华神经外科杂志, 2014, 30(7): 653-657.
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12.	谢天浩, 骆纯, 马廉亭. 颈椎椎管内肿瘤切除术中全椎板切除致颈椎畸形的危险因素及防治措施. 中国临床神经外科杂志, 2017, 22(1): 58-60.
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17.	Angevine PD, Kellner C, Haque RM, et al. Surgical management of ventral intradural spinal lesions. J Neurosurg Spine, 2011, 15(1): 28-37.
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19.	陈彬, 陈治标. 神经电生理监测辅助下显微手术治疗高颈段椎管内肿瘤. 中国临床神经外科杂志, 2016, 21(10): 596-597.
20.	马泓, 王冰, 吕国华, 等. 术中神经电生理监测在颈椎管内肿瘤手术中的应用. 中华骨科杂志, 2016, 36(24): 1574-1580.
21.	叶青, 黄武, 贺云松, 等. 椎管后部结构重建椎管成形在椎管内肿瘤手术中的应用. 中国修复重建外科杂志, 2014, 28(8): 965-968.
22.	禚汉杰, 周英杰, 柴旭斌, 等. 超声骨刀在椎管内肿瘤切除椎管成形术中的应用. 中国修复重建外科杂志, 2019, 33(1): 61-65.
23.	胡博文, 周春光, 杨曦, 等. 经后路超声骨刀双侧切除齿状突治疗颅底凹陷症合并不可复性寰枢关节脱位一例. 中国修复重建外科杂志, 2017, 31(12): 1523-1525.

1. 李德志, 孔德生, 郝淑煜, 等. 2447 例椎管内肿瘤的流行病学特点. 中华神经外科杂志, 2014, 30(7): 653-657.
2. 肖建如, 袁文, 滕红林, 等. 前、后联合入路全脊椎切除附加内固定治疗颈椎骨肿瘤 39 例报告. 中华外科杂志, 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. 杨树源, 洪国良. 椎管内肿瘤 402 例报告. 中华神经外科杂志, 2000, 16(3): 162-164.
6. 夏虹, 王建华, 尹庆水, 等. 复杂原发性颈椎及颈椎管内肿瘤的外科治疗. 中国骨肿瘤骨病, 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. 田学丰, 冯春国, 王先祥, 等. 脊柱内固定技术在切除多节段椎管内肿瘤中的应用(附 12 例报道). 中国临床神经外科杂志, 2016, 21(11): 673-675.
12. 谢天浩, 骆纯, 马廉亭. 颈椎椎管内肿瘤切除术中全椎板切除致颈椎畸形的危险因素及防治措施. 中国临床神经外科杂志, 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. 刘通, 刘辉, 张建宁, 等. 椎管哑铃形肿瘤的显微外科治疗. 中华神经外科杂志, 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. 陈彬, 陈治标. 神经电生理监测辅助下显微手术治疗高颈段椎管内肿瘤. 中国临床神经外科杂志, 2016, 21(10): 596-597.
20. 马泓, 王冰, 吕国华, 等. 术中神经电生理监测在颈椎管内肿瘤手术中的应用. 中华骨科杂志, 2016, 36(24): 1574-1580.
21. 叶青, 黄武, 贺云松, 等. 椎管后部结构重建椎管成形在椎管内肿瘤手术中的应用. 中国修复重建外科杂志, 2014, 28(8): 965-968.
22. 禚汉杰, 周英杰, 柴旭斌, 等. 超声骨刀在椎管内肿瘤切除椎管成形术中的应用. 中国修复重建外科杂志, 2019, 33(1): 61-65.
23. 胡博文, 周春光, 杨曦, 等. 经后路超声骨刀双侧切除齿状突治疗颅底凹陷症合并不可复性寰枢关节脱位一例. 中国修复重建外科杂志, 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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