Application of multidisciplinary cooperation in one-stage resection of cervical spinal canal communicating tumors via combined lateral and posterior median cervical approaches
Yin Yong1, Zhang Yu2, Wu Di1, Chen Jian2, Ni Laichun2, Yan Yaohua2, Yang Liu2, Da Peng1, Ni Haosheng1, Shi Wei2, Wu Hao1
1Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Nantong University, Nantong 226000, China; 2Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong 226000, China
Abstract：Objective This study aimed to investigate the clinical efficacy of one-stage resection of cervical spinal canal communicating tumor via combined posterior lateral cervical approaches. Methods Case series study. Twelve patients (three males and nine females) with cervical spinal canal communicating tumor were included. They were admitted to Affiliated Hospital of Nantong University from July 2015 to August 2022. The patients aged 33-74 (51.2 ± 11.9). Two patients had Toyama type Ⅱb, seven had type Ⅱc, and three had type Ⅲb. Four patients had tumors above the C2 segment, three in the C2-4 segments, and five in the C4-7 segments. All patients accepted combined posterior lateral cervical surgery. A classical posterior median approach was adopted in neurosurgery, and tumors located in the spinal canal and intervertebral foramen were excised after the corresponding vertebral plate was treated. In otolaryngology head and neck surgery, the cervical parotid gland approach was used for tumors located completely above the mandibular plane. A simple lateral cervical approach was performed for the other tumors. Tumors extending to the paravertebral cervical space were removed in the following sequence: first intraspinal canal and extraspinal canal, and then knocked together. The one-time full-resection rate, surgery time, intraoperative blood loss, postoperative neurological symptoms were observed, and spinal stability were evaluated by X-ray filmat 6 months after operation. Results The one-time total tumor resection rate was 12/12. Postoperative pathological diagnosis was schwannoma in 10 patients, chondroma in one patient, and neurofibroma in one patient. The surgery time was 215 (183, 315) min, and the hemorrhage volume was 120 (85, 188) mL. One patient suffered from leakage of cerebrospinal fluid after surgery, one patient suffered from local infection, and both were discharged after symptomatic treatment. Five patients wore cervical supports for 6-12 weeks after treatment of two segments and semi-lamina. After 6-90 months of follow-up, all patients returned to normal life without tumor recurrence. One of the 12 patients had no obvious relief of hand numbness, but their motion was normal after surgery, whereas other patients showed improvement in the symptoms of original nerve involvement. All patients were reexamined using the films of cervical spine after surgery, and no spinal deformity was found during the follow-up period. All patients had good spinal stability. Conclusion For communicating tumors involving the intraspinal and extraspinal cervical spinal canal, the approach combining otorhinolaryngology head and neck surgery and neurosurgery not only completely removes tumors in one stage but also minimizes damage to the important blood vessels and nerves of the head and neck and the instability of the cervical spine, demonstrating the advantages of multidisciplinary cooperation.
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Yin Yong, Zhang Yu, Wu Di, Chen Jian, Ni Laichun, Yan Yaohua, Yang Liu, Da Peng, Ni Haosheng, Shi Wei, Wu Hao. Application of multidisciplinary cooperation in one-stage resection of cervical spinal canal communicating tumors via combined lateral and posterior median cervical approaches. Chinese Journal of Anatomy and Clinics, 2023, 28(12): 793-798.
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2023, Vol. 28 
