Posterior cervical approach tumor resection

Dumbbell-shaped tumors account for 5.7% to 14.2% of tumors in the spinal canal. Deng Chuanzong et al. divided the tumor into three types: type I, the tumor was located outside the epidural and grew along the intervertebral foramen; type II, the tumor was located inside and outside the dura; type III, the tumor was located inside and outside the dura mater and Growing along the intervertebral foramen to the outside of the spinal canal. The schwannomas in dumbbell-shaped tumors account for about 90%, and others can be meningioma and osteochondroma. A part of the dumbbell-shaped tumor is located in the spinal canal, and a part is located outside the spinal canal. The two parts form the isthmus of the tumor at the intervertebral foramen, and the intervertebral foramen which are located therein are obviously enlarged. Curing disease: Indication Posterior neck approach for tumor resection for: The epidural tumor is small and has a long diameter of less than 4 cm. Contraindications 1. Aged, weak cardiovascular function, difficult to tolerate surgery. 2. Severe hypertension and diabetes are urgently needed. 3. Patients with acute inflammation in the whole body or surgical site. 4. Suspected malignant tumors are one of the following: 1 multiple tumors involving the spinal canal; 2 patients with secondary intraspinal tumors have metastases elsewhere; 3 complete paraplegia has been more than 1 month; 4 The body is cachexia, and there are huge acne and urinary tract infections. Preoperative preparation 1. General preparation of the whole body According to the condition and examination, actively improve the general condition of the patient, and give all necessary supplements and corrections. 2. Those with constipation, laxatives were given before surgery, and enema was given on the night before surgery. Those with dysuria should be catheterized before surgery and indwelling catheter. 3. The neck lesion affects the breathing. Before the operation, deep breathing, coughing and other training should be carried out. The aerosol inhalation can be started a few days before the operation, and antibiotics should be given if necessary. 4. If you need a prone position after surgery, you should perform prone position training in advance so that the patient can adapt to this position. 5. A sedative was given before the operation, and phenobarbital 0.1 g. 6. Fasting within 6-8 hours before surgery. 7. Prepare the surgical skin before surgery and clean the shaving. The range should be more than 15cm around the incision. Neck surgery should shave the occipital hair. 8. Give medication before anesthesia according to the needs of anesthesia. 9. Preoperative positioning should determine the position of the spine that is scheduled to remove the lamina. The easiest way is to locate according to the body surface markers. In order to avoid the error, it can be positioned according to the body surface marker, and then a type of lead is glued on the body surface of the corresponding spinous process. After taking the X-ray film, the surgical site is verified from the position of the lead on the X-ray film. Surgical procedure 1. Surgical incision, laminectomy and dural incision, all with the same procedure as laminectomy. 2. The posterior wall of the intervertebral foramen, which is enlarged by the tumor, that is, the adjacent superior and inferior articular processes are excised, and the incision of the dural incision is further cut transversely to the intervertebral foramen to facilitate the visualization of the isthmus of the tumor in the intervertebral foramen. 3. Partial resection of the tumor in the spinal canal and intervertebral foramen. After the tumor part of the spinal canal is found, it is free along the capsule and gently retracted outward. The solid tumor is best to make 2 to 3 needles through the tumor. The tumor is pulled outwards away from the spinal cord, and the tumor-bearing nerve root between the tumor and the spinal cord is found, and is cut by bipolar coagulation treatment. Then, the tumor traction line is pulled in the backward direction, and the tumor portion in the intervertebral foramen is gradually pulled out. If the tumor outside the spinal canal is small, the anterior pole and nerve root of the dumbbell-shaped tumor can be seen. McCormic (1996) believes that complete tumor resection can be completed in one phase as long as the epidural tumor extends within 4 cm. If the tumor outside the spinal canal is large, it is difficult to completely cut from the posterior. Only the tumor in the spinal canal and a part of the tumor in the intervertebral foramen can be removed. The remaining tumor remains for 3 weeks, and the second operation is performed. The residual tumor was removed by the approach. 4. The slit is sutured layer by layer.