目前针对脊髓受压的哑铃神经鞘瘤（DNST）的手术策略主要涉及全椎板切除术和单侧小关节切除术的广泛脊柱暴露，通常导致脊柱不稳定并需要融合，或分阶段手术分别处理椎管内和椎间孔外肿瘤成分。这项研究强调了 DNST 切除新方法的技术细微差别，以尽量减少脊柱不稳定并避免融合，同时促进安全、单阶段完全切除。对接受 DNST 切除的患者进行了回顾性图表审查。使用单侧骨膜下剥离术，进行半侧关节切开术和内侧小关节切除术。切除硬膜外肿瘤成分，然后对硬膜内肿瘤进行内部减压。神经根套管起点处的小水平切口可释放下方的硬脑膜狭窄，促进剩余硬膜内肿瘤的输送并允许切除起源神经根。超声检查证实肿瘤完全切除和脊髓搏动恢复，并排除硬膜内出血并发症。使用由脂肪移植物和密封剂支撑的硬脑膜替代物重建硬脑膜。纳入了 2014 年至 2021 年连续接受这种方法的 12 名患者。患者平均年龄为 53.5 岁，其中 58.3% 为男性。 9 个肿瘤为颈椎肿瘤，3 个肿瘤为腰椎肿瘤。 5 名患者出现脊髓病，4 名患者出现神经根病，4 名患者出现轴痛。两例术中出现短暂的神经监测信号变化。 11 个肿瘤被诊断为神经鞘瘤，1 个肿瘤被诊断为神经纤维瘤。所有患者均完成椎管内部分切除； 2 例有远端椎间孔外残留。在随访期间（中位时间 28.5 个月，范围 6-66 个月），没有患者出现复发、残留进展或脊柱不稳定的迹象。这项研究强调了 DNST 切除的技术考虑因素，重点关注肿瘤中心的方法，骨去除和韧带破坏最少。术中超声有助于确保该方法的安全性。版权所有 © 神经外科医生大会 2024。保留所有权利。

Current surgical strategies for dumbbell nerve sheath tumors (DNSTs) with cord compression have primarily involved wide spinal exposures with total laminectomy and unilateral facetectomy, often leading to spinal destabilization and requiring fusion, or staged procedures separately addressing the intraspinal and extraforaminal tumor components. This study highlights technical nuances of a novel approach for DNST resection to minimize spinal destabilization and avoid fusion while facilitating safe, single-stage complete resection.A retrospective chart review was conducted on patients undergoing DNST resection. Using unilateral subperiosteal dissection, hemilaminotomy and medial facetectomy procedures are performed. The extradural tumor component is resected, followed by internal decompression of the intradural tumor. A small horizontal incision at the origin of the nerve root sleeve releases the underlying dural stricture, facilitating delivery of the remaining intradural tumor and allowing section of the nerve root of origin. Ultrasonography confirms complete tumor resection and return of cord pulsation, and excludes intradural hemorrhagic complications. The dura is reconstructed using a dural substitute bolstered with fat graft and sealant.Twelve consecutive patients undergoing this approach from 2014 to 2021 were included. Mean patient age was 53.5 years, and 58.3% were male. Nine tumors were cervical and 3 were lumbar. Five patients presented with myelopathy, 4 with radiculopathy, and 4 with axial pain. Two cases had transient intraoperative neuromonitoring signal changes. Eleven tumors were diagnosed as schwannomas and 1 as neurofibroma. All patients had complete resection of the intraspinal component; 2 had far distal extraforaminal residual. No patient has had recurrence, progression of residual, or signs of spinal instability during follow-up (median 28.5 months, range 6-66 months).This study highlights technical considerations for DNST resection, focusing the approach at the center of the tumor, with minimal bone removal and ligamentous disruption. Intraoperative ultrasound is instrumental in the safety of this approach.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.