anterolateral neck 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. Cervical spinal canal dumbbell tumors are also mostly schwannomas, which originate from the spinal nerve roots. The clinical symptoms are caused by root pain in the hands or upper limbs. Examination of sensory disturbances and paralysis below the obstruction plane can be seen. In severe cases, sphincter dysfunction can occur. In addition, the neck mass is another important feature of the disease. As the tumor's growth constraint is reduced after the intervertebral foramen is removed, the extrathoracic portion can be significantly enlarged compared with the intraspinal portion. If the inner part of the spinal canal is small and the compression symptoms are not obvious, sometimes the patient will have a neck pack. The block first goes to general surgery. In addition to clinical symptoms and signs, the diagnosis of dumbbell-shaped tumors should also refer to spinal X-ray examination and other special examinations. The intervertebral foramen of the corresponding segment can be seen in the spine X-ray of the cervical spinal canal dumbbell tumor. Bone destruction, pedicle distance widening, and proximal joints and even vertebral bodies are also eroded. Myelography can be of value in the diagnosis of this disease, that is, a double cup of mouth sign appears below the blocked end, the inside of the dura is divided into a large cup, and the outside of the dura is divided into small cups. The vertebral artery angiography shows that the artery is affected. The pressure is shifted forwards and inwards. CT and MRI examinations can show real images of tumors. Curing disease: Indication Anterior cervical approach tumor resection is applicable to: 1. The outer surface of the dura mater is larger and protrudes forward through the intervertebral foramen. It is estimated that the posterior approach is difficult to complete. 2. The first posterior surgery for residual isthmus and anterior tumor, or residual recurrence after surgery. Contraindications 1. The epidural tumor is small, and the posterior surgery can be completely cut. 2. Dumbbell-shaped tumors above 2, more post-operative surgery. 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 Anesthesia and position Intratracheal intubation was general anesthesia. In the supine position, the head is tilted 30° to the healthy side. Surgical procedure 1. Take the tumor as the center, make a oblique incision along the anterior border of the sternocleidomastoid muscle, and cut it together with the platysma. 2. The sternocleidomastoid muscle is pulled backwards, the carotid sheath is pulled forward, and the tumor above the neck 4 is protected against the accessory nerve. Find the sympathetic chain of the long side of the head and the long side of the long neck muscle, and pull it to the outside with a silk thread. 3. Cut the anterior cervical anterior muscle of the transverse process, expose the anterior root of the two transversely protruding holes above and below the tumor, bite the anterior root with a rongeur, open the transverse bulge, free the vertebral artery, and take the silk thread outward Open, you can find the tumor. 4. Peeling along the tumor capsule, avoiding the vertebral artery, completely cutting the tumor, and retaining some nerve roots under microsurgery. 5. After the tumor is resected, hemostasis is stopped, sutured layer by layer, and a rubber tube drainage is built in the incision. complication 1. Vertebral artery injury, brain stem and cerebellar insufficiency. 2. Parasynthesis injury, shoulder lift can not.