【摘要】 目的 探讨椎管内硬膜下神经鞘瘤显微手术中保留载瘤神经的可行性。方法 回顾性分析2018年9月～2023年12月55例椎管内硬膜下神经鞘瘤行包膜内切除并保留载瘤神经的临床资料。肿瘤位于腰椎36例，颈椎17例，胸椎2例。均在显微镜下手术，显露肿瘤后，沿神经根长轴纵行切开包膜，包膜下剥离并切除肿瘤，均保留载瘤神经。结果 手术均顺利完成。54例实性肿瘤均获全切除，1例囊性变行肿瘤次全切除。手术时间85～180 min,平均109.0 min。术后病理均为神经鞘瘤。术后无感染，无死亡。疼痛视觉模拟评分(Visual Analogue Scale, VAS)术前0～6分，中位数4分，术后1周0分48例，1分7例。2例术后新发节段性感觉减退。术后随访6～60个月，平均25.4月，未见肿瘤复发，未见脊柱不稳定或畸形，2例术后新发感觉减退者术后6个月均恢复正常。结论 对于椎管内硬膜下神经鞘瘤，纵行切开包膜行包膜内分块切除，有望保留载瘤神经，改善神经功能预后。更多还原

【Abstract】 Objective To explore the feasibility of preserving the tumor-bearing nerve during microsurgery for intraspinal subdural schwannomas. Methods A retrospective analysis was performed on clinical data of 55 patients with intraspinal subdural schwannomas who underwent intralesional resection while preserving the tumor-bearing nerve between September 2018 and December 2023. There were 36 cases of lumbar schwannomas, 17 cases of cervical schwannomas, and 2 cases of thoracic schwannomas. All the surgeries were carried out under a microscope. After exposing the tumor, the capsule was longitudinally incised along the long axis of the nerve root, and the tumor was dissected and removed beneath the capsule. The tumor-bearing nerve was preserved in all the patients. Results All the operations were successfully accomplished. Among the 55 tumors, 54 were solid which were completely resected, and 1 was cystic degeneration which received a subtotal resection. The operation time was 85-180 min, with an average of 109.0 min. Postoperative pathological examinations confirmed schwannomas in all the patients. There were no postoperative infections or deaths. The Visual Analog Scale(VAS) score was 0-6(median, 4) before surgery and 0 in 48 patients and 1 in 7 patients at 1 week after surgery. Segmental sensory impairment occurred postoperatively in 2 cases. During the postoperative follow-ups for 6-60 months(average, 25.4 months), no spinal instability, deformity, or tumor recurrence was observed. The 2 patients with sensory impairment recovered at 6 months after surgery. Conclusion For intraspinal subdural schwannomas, it is promising to preserve part of the tumor-bearing nerve by longitudinally incising the capsule and performing piecemeal intralesional resection, which leads to better neurological functional outcomes.更多还原