摘要 目的：探讨高颈段髓外肿瘤手术的入路与技术。方法：15例高颈段髓外肿瘤患者，男9例，女6例，年龄20～73岁。其中髓外硬膜下肿瘤9例，髓外硬膜外肿瘤6例，哑铃形肿瘤8例。采用了3种入路进行手术，其中颈后中线入路11例，颈外侧入路3例，颈前方入路1例。结果：12例痊愈，1例术后无变化，1例于术后1月死于肿瘤复发，1例麻醉时呼吸停止，术后7天死亡。结论：多数高颈段髓外肿瘤可经颈后中线入路手术全切。颈外侧入路适于切除脊髓腹侧肿瘤和包绕椎动脉的椎旁肿瘤。手术入路的选择与手术的显露范围、肿瘤的大小与位置及肿瘤的性质有关。

    Surgical treatment of high cervical extramedullary tumors Song Ming, Shan Hongkuan. Department of Neurosurgery, The Third School of Clinical Medicine, Beijing Medical University, Beijing 100083

    Abstract Objective: To discuss the operative approaches and skills of high cervical extramedullary tumors. Methods: 15 cases of high cervical extramedullary tumor are reported. There were 9 males and 6 females. Patients' age ranged from 20 to 73 years. There were 9 cases of subdural-extramedullary tumors, 6 of epidural tumors and 8 of dumbbell tumors. Three surgical approaches were employed, posterior approach was adopted in 11 cases, lateral approach in 3 cases and anterior approach in 1 case. Results: After operation, 12 patients recovered; one patient had no change; one patient lost respiratory function during anesthesia and died 7 days after operation; and another one died for recurence of the tumor one month after operation. Conclusion: Most of cervical extramedullary tumors can be removed through posterior approach. Lateral approach is suitable to ventral spinal tumors and perivertebral tumors arounding vertebral artery. Surgical approach was chosen according to operative exposure, location, size and characteristics of the tumors.

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