Wiltes肌间隙通道切除腰椎间孔区神经鞘瘤△

Resection of schwannoma in lumbar interforaminal area under a channel through Wiltse intermuscular space

摘要:

[目的]介绍 Wiltes 肌间隙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]对 2 例腰椎间孔区神经鞘瘤患者行上述手术治疗。依据术前影像确定手术入路与工作通道位置，由 Wiltes 肌间隙置入 14 mm 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。[结果]2 例患者均一期手术完整肿瘤切除，术后症状基本消失，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。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcomes of total resection of schwannoma in lum- bar interforaminal area under a channel through Wiltse intermuscular space. [Methods] Two patients were treated by the abovementioned operation for lumbar interforaminal schwannoma. After location of the surgical approach and working channel according to the preoperative images, a working channel 14 mm in diameter was inserted through Wiltes muscle space to reach the outer surface of the laminae. The later- al laminae were partially resected, and the ligamentum yellow was removed, the responsible nerve roots and tumor membranous structures were fully exposed, the tumor envelope was cut longitudinally along the long axis of the tumor, and the tumor was totally excised along the boundary membrane. [Results] Both patients underwent complete tumor resection in one stage smoothly, got symptoms relief completely af- ter surgery, and resumed ambulation the next day. During the follow-up lasted for 17 months, no tumor recurrence or long-term surgical complications were found. [Conclusion] The surgical procedure by a channel through Wiltse intermuscular space does completely remove the lumbar interforaminal schwannoma in one stage, avoid postoperative spinal instability and paravertebral soft tissue injury.