intraspinal tumor resection

Intraspinal tumor resection is a kind of resection for the treatment of epidural, extramedullary, intramedullary and intramedullary. Incision and laminectomy, resection of the tumor, and posterior root severing. Even if the patient is older, it can better tolerate the characteristics of surgery. Therefore, once diagnosed as a spinal canal tumor, regardless of the severity of spinal cord compression, surgery should be promptly treated, but for high paraplegia, respiratory insufficiency should pay attention to prevent and control lung infection, especially for the elderly. Treatment of diseases: spinal cord compression Indication Symptoms and signs of spinal cord compression, general examinations such as lumbar puncture, X-ray and other features such as myelography, CT scan, magnetic resonance imaging or spinal angiography confirmed that the spinal canal occupying lesions were compressed by the spinal cord. Preoperative preparation 1. Non-urgent patients should start skin preparation before 3 days, and then disinfect and dress before surgery. If you are in an emergency, you should prepare your skin carefully and disinfect it. 2. Prevent the occurrence of hemorrhoids. If it has already occurred, he should be treated properly before surgery. 3. If the patient has urinary tract infection or high fever, it is necessary to control acute infection, and surgery should be performed after the body temperature drops. 4. For high paraplegia, respiratory insufficiency, should pay attention to prevention and control of lung infections, especially for the elderly. 5. Anemia patients should receive a small number of blood transfusions before surgery, and blood preparation during surgery is about 400ml. Surgical procedure 1, incision and laminectomy: lateral or prone position. The incision is designed centered on the center of the tumor, and the surgical procedure is similar to that of spinal canal exploration. The tumor is seen after the removal of the lamina by myelography or clinical localization, and the upper and lower end of the tumor is enlarged until the upper and lower end of the tumor has been revealed. 2. Resection of the tumor: If the tumor is a benign tumor after the tumor is exposed, it will be peeled off from the upper or lower pole of the tumor. If it is a dural tumor, the dura mater attached to the tumor should be removed together, and the defect should be repaired with fascia. In the case of a neurofibromatosis, the attached nerve root is cut off if it is determined that it cannot be retained. If it protrudes into the intervertebral foramen, it should be explored whether it protrudes into the intervertebral foramen and becomes a dumbbell-shaped tumor. Malignant tumors and dural adhesions are mostly extensive and tight, and there is more oozing during resection. It is difficult to complete resection, and most of them can be removed for decompression purposes. If necessary, take a piece for frozen section inspection. After the resection is started, the tumor is removed along the dura mater by scissors, curettes, living tissue, etc., and the bleeding is stopped by bipolar coagulation and gelatin sponge compression. If the tumor has spread to the ventral side of the dura, gently push the dura mater and remove it with a biopsy or curette. After the majority of metastatic cancer is removed, plus laminectomy, postoperative radiotherapy or chemotherapy can be performed. The sacral spine muscle is sutured in 2 to 3 layers, the subcutaneous tissue and skin are tightly sutured, and the drainage tube is not placed, so as to prevent the tumor from spreading along the drainage tube. 3, the posterior root cut: such as tumor compression or infiltration of nerve roots caused by severe pain, other methods of treatment ineffective, can be used for invasive spinal nerve root resection. The method is to cut the dura mater along the midline after the tumor is resected, and to isolate the posterior root of the invaded spinal nerve, which is easy after the dentate ligaments on both sides. Carefully separate the spinal nerve vessels from the posterior root to avoid injury, which is an important measure to avoid postoperative spinal cord ischemia. Then use a hemostat to squeeze and cut. The number of nerve roots cut off may depend on clinical needs, but should not be excessive. After completely stopping bleeding, the spinal cord was washed, the dura mater was sutured intermittently, and the other layers were contracted as described above.