Clinical Application Of Hemi-lamellar Microsurgical Approach In The Treatment Of Schwannoma

OBJECTIVE: To summarize the clinical manifestations,imaging features and hemi-lamina microsurgery in the spinal canal schwannomas.METHODS: Department of Neurosurgery,the First Affiliated Hospital of Guangxi Medical University and the Second Affiliated Hospital,January 2015-December 2015 Treatment and postoperative pathology were diagnosed as 25 cases of spinal nerve sheath tumors by hemi-lamellar microsurgery patients The clinical data were retrospectively analyzed.The operative time,intraoperative blood loss,tumor resection rate,hospitalization time,postoperative cerebrospinal fluid leakage,postoperative JOA score and VAS score of each segment of the vertebral body were followed up.Situation and other information to study,combined with literature review,to sum up.RESULTS: 25 cases of spinal cord schwannoma patients,including 14 cases of male patients,11 cases of female patients,aged 12-62 years,mean 40.80 ±13.79 years old,The operation time was 60-480 min,the average was(234.64± 91.93)min,the bleeding volume was 50-600 ml,mean(300.00 ± 126.66)ml,hospital stay 13-34 days,average(21.28 ± 5.26)days.Most of the first symptoms of root pain,with the progression of the disease,the emergence ofone side or bilateral skin weakness or numbness or shallow sensory loss in 11 cases,the emergence of side or bilateral skin pain in 6 cases,4 cases of low back pain symptoms,limbs Fatigue or numbness or shallow sensory loss in 3 cases,1case of sphincter disorder.All patients underwent MRI and showed better lesions.Twenty-five patients underwent surgical treatment of hemi-lamellar microsurgery.The total resection rate was 100%.Postoperative pathology was confirmed as schwannoma.Postoperative cerebrospinal fluid leakage did not occur.The JOA score of the cervical spine was 8.875 ± 1.4577,and the JOA score of the cervical spine was 14.375 ± 1.479,the difference was statistically significant(t =-29.103,P = 0.000).The JOA score of thoracic surgery was5.208 ± 0.6201,and the score of JOA was 8.875 ± 0.6077 after thoracic surgery.The difference was statistically significant(t =-19.501,P = 0.000).Lumbar preoperative JOA score 12.800 ± 3.5637,lumbar postoperative JOA score 23.400 ± 2.7019,the difference was statistically significant(t =-9.842,P = 0.001).The JOA score of the spinal cord schwannomas was 6.56 ± 0.712,and the JOA score of the cervical spine was 1.72 ± 0.678,the difference was statistically significant(t = 32.435,P = 0.000).Postoperative symptoms were significantly improved compared with preoperative,follow-up 6-12 months were not found recurrence of the tumor,no spine instability and deformity.ONCLUSION: MRI findings of the spinal nerve sheath tumors are characteristic,helpful in diagnosis,and have further guidance for further treatment.Hemi-lamellar microsurgical resection of the spinal cord schwannoma has a small trauma,quick recovery,to maximize the stability of the spine to maintain the advantages of better efficacy,is a safe and effective surgical approach,worthy of clinical promotion.However,due to the scope of exposure restrictions,the use of hemi-lamellar microsurgical resection of spinalcanal tumors to master their indications,select the appropriate cases,the huge tumor within the spinal canal and multiple tumors should be carefully selected.