The surgical strategy of upper cervical dumbbell tumors

楊興海(Yang Xinghai，Dept Orthop，Changzheng Hosp，2nd Mil Med Univ，Shanghai 200003)…∥Chin J Clin Basic Orthop Res.－2010，2(3).－186～190

The surgical strategy of upper cervical dumbbell tumors

楊興海(Yang Xinghai，Dept Orthop，Changzheng Hosp，2nd Mil Med Univ，Shanghai 200003)…∥Chin J Clin Basic Orthop Res.－2010，2(3).－186～190

ObjectiveTo investigate the surgical strategy and prognosis of upper cervical dumbbell tumors.MethodsFrom January 2001 to December 2009，46 consecutive cases with upper cervical dumbbell tumor were retrospectively studied on clinical characteristics，surgical staging，operative approach，resection，stability reconstruction and therapeutic effect.This series consisted of 33 cases of schwannomas，9 neurofibromas and 4 malignant schwannomas.According to the surgical staging of cervical dumbbell tumors we designed previously，46 patients were assessed with 8 cases in stageⅠ，24 cases in stageⅡ，9 cases in stageⅢ，3 cases in stageⅣ and 2 cases in stageⅤ.Resection and reconstruction were performed for 36 patients through posteriolateral approach，and 10 patients through combined posteroanterior approaches.Posterior cervical screw-rod systems were used in 39 cases，while combined anterior and posterior fixation were performed in 3 cases and no fixation were carried out in 4 cases.ResultsVertebral artery injury occurred in one patient during operation Nineteen patients experienced cerebral spinal fluid leakage，2 of them developed intracranial infection and recovered after corresponding management.The following up period ranged from 6 to 125 months.Two cases with malignant schwannoma relapsed at 8 and 14 months after surgery，and received re-vision surgery later.Both patients deceased due to systemic failure from pulmonary metastasis at 21 and 38 months respectively.No evidence of local recurredce was found in other patients and follow-up was continued.ConclusionThe surgica management for upper cervical dumbbell tumors has many diffculties and risks，and the surgical staging is useful in the decision making process.Turmor resection and reconstruction could be accomplished through posterolateral or combined posteroanterior approach.Much care should be taken in prevention and management for complications，so as to improve curative effect.7 refs，2 figs.

(Authors)