The Application Of The Unilateral Hemilaminectomy Approach In The Remowal Of Extramedullary Spinal Tumors

Objective:Summarize the advantages and efficacy of the unilateral hemilaminectomy surgery approach in the removal of spinal dural extramedullary tumors.Method:Relevant information from home and abroad, and on the basis of existing anatomical studies, combine from2011to2014by hemilaminectomy microsurgical resection of tumor clinical data of24cases of spinal cases performed a retrospective analysis, and with the2008-2014approach using laminectomy surgery31cases were retrospectively analyzed and compared,summary semi-laminectomy surgery.All procedures were performed under general anesthesia, some patient took c-arm x-ray in operation for location. In the next sudden spike in the middle of the drill about0.5cm skin incision, the incision length of about5cm. Under a microscope, half laminectomy retractor or double joint mastoid retractor retractor skin, and then along the spine and vertebral dissection use the electric knife to isolate, exposing the lower edge of the upper lamina, the lower flange joints, interspinous ligament, yellow ligament and the corresponding half lamina roots, in addition to high-speed grinding mill turn corresponding half lamina (depending on the size of the tumor extension or appropriate under the extension), exposed nerve roots and dura, about the size of1.5-2.0cm formation of bone window while excision local epidural fat, revealing the dura, such as extramedullary tumors are silk hanging dura dura and the arachnoid longitudinal incision,before cutting the inner dural under the microscope or neuroendoscopic around whether the bone window dural venous plexus, to avoid venous plexus bleeding. After the tumor revealed, for smaller tumors give complete resection, if a large tumor, first remove intracapsular part to reduce pressure, and then slowly careful disdociate tumor capsule and the dura or nerve, spinal adhesions in the nerve, do complete excise the tumor. Hemostasis and sutured dura, can give gelatin sponge to prevent bleeding, then suture the incision.Results:24cases of complete tumor resection in microsurgery, and without postoperative indwelling drainage tube, no intraoperative and postoperative complications. Postoperative histopathological results showed:16cases of schwannoma, meningioma8cases. The operation time was80-180min, the average time in bed three days after surgery, mean postoperative hospital stay was9.67±2.42days,20patients obtained3months follow-up of12months, after surgery, patients with existing symptoms such as limb pain, fatigue and sensory disorders all disappeared.Conclusions:The advantages of the unilateral hemilaminectomy approach for spinal tumors:(1) Semi-laminectomy resection surgery to remove the spinal tumor, preserves the interspinous ligament and facet joints, better to keep the spine anatomy, and thus better to keep the stability of the spine.(2)A11tumors were completely removed, no residue and recurrence.(3)Semi-laminectomy only can prevent iatrogenic spinal instability, and can effectively prevent rear dural tissue and adhesions, to avoid secondary spinal stenosis, it is useful to neurological recovery and conducive to long-term stability of the spine.(4) Shorter operative time, reduce blood loss, resection is not more than three vertebral segments, without postoperative indwelling drainage, meanwhile avoid leakage of cerebrospinal fluid and intracranial infection.(5) Without external fixation surgery, postoperative3-4d can get out of bed, to avoid the complications of internal fixation, reducing the cost of surgery.(6) In addition to intramedullary tumors, wide base and dumbbell-shaped tumor, resection exposed space can meet the most basic spinal tumors.