The New Zoning Method And Treatment Of Spinal Schwannoma

Background:Schwannoma occurs predominantly next to the spine,with "dumb-bell shape"growth,enlarged intervertebral foramen,compression of neighboring bone,sclerotic bands,relatively clear boundaries,and relatively slow tumor growth.The key of the treatment of spinal schwannoma is the complete resection of the tumor under a good operative field of vision.A good operative field of vision is closely related to the choice of surgical approach.However,there is no uniform surgical approach for spinal schwannomas.Objective:To explore a new type of spinal schwannoma zoning in order to better guide the surgical approach and improve the efficiency of surgery.Methods:A retrospective analysis of 53 cases of spinal schwannoma diagnosed in our hospital from December 2009 to December 2017 in our hospital,including 8 cases of cervical vertebrae,13 cases of thoracic vertebrae and 32 cases of lumbar vertebrae.According to the maximum cross-section of the tumor on the CT or MRI of the spine,and the anatomic characteristics of different segments of the spine,the four regions from A to D are divided,and different regions need to adopt different surgical approaches.Results:Twenty-five patients were treated with posterior approach only,21 patients were treated with anterior approach only,and 7 patients were treated with both anterior and posterior approaches.Twenty-six patients did not use internal fixation,and 27 patients received internal fixation during surgery.The tumors of all patients were completely resected and the operation time was 47?375 minutes,with an average of 143 minutes.Among them,the anterior-posterior approach was more than 300 minutes.The intraoperative blood loss was from 50 to 2400 ml,with an average of 412 ml.All the patients were followed up without any loss of follow-up.The follow-up time ranged from 3 to 72 months(33 months on average),and the follow-up period of more than 2 years accounted for about 64.2%(34 patients).Postoperative pleural effusion and pulmonary infection occurred in 4 cases,cerebrospinal fluid leakage in 2 cases,hypoglossal nerve injury in 1 case,spinal instability in 1 case,and internal fixation in the second stage.At the final follow-up,52 patients had markedly improved symptoms,1 had symptoms before surgery,and 1 had recurrence.Conclusion:The new schwannomas zoning method is simple and feasible,can effectively guide the preoperative preparation of appropriate surgical approach,and achieve better exposure of the tumor.So,tumors can be completely removed,and intraoperative and postoperative complications can be reduced.When the stability of the spine is affected during tumor resection,internal fixation is required for reconstruction.