目的:探讨经前路颈动脉鞘内外联合入路手术治疗ToyamaⅡb和Ⅲb型颈椎管内外哑铃形肿瘤的效果及手术技巧。方法:2006年2月~2010年10月对17例ToyamaⅡb和Ⅲb型颈椎管内外哑铃形肿瘤患者采用经前路颈动脉鞘内外联合入路手术切除肿瘤、髂骨或钛网支撑植骨并钛板内固定重建颈椎稳定性,其中男9例,女8例,年龄34～53岁,平均43.6岁。ToyamaⅡb型9例,Ⅲb型8例。术前脊髓神经功能Frankel分级:C级3例,D级10例,E级4例。随访观察患者症状和神经功能改善情况。结果:17例患者均一期手术切除椎管内外肿瘤,手术过程顺利,手术时间90～170min,平均130min;失血量150～700ml,平均280ml。1例术后即刻出现前臂神经症状加重,予激素及脱水剂治疗3d后症状缓解,未出现其他严重并发症。17例随访10～48个月,平均18个月,患者局部疼痛和神经症状均有明显改善或缓解,末次随访时,7例患者脊髓神经功能Frankel分级改善1级,3例改善2级。1例恶性神经鞘瘤患者术后1年出现局部肿瘤复发而再次行后路手术切除,其余患者随访期间肿瘤无复发。结论:ToyamaⅡb和Ⅲb型颈椎管内外哑铃形肿瘤可经前路颈动脉鞘内外联合入路一次手术切除,手术创伤小,瘤体切除彻底,并发症少。 OBJECTIVE: To investigate the effect of surgical treatment of Toyama IIb and IIIb type dumbbells inside and outside the cervical spinal canal by anterior combined carotid intrathecal approach. METHODS: From February 2006 to October 2010, 17 cases of Toyama IIb and IIIb type dumbbell patients with internal and external cervical spinal canal tumors were treated with anterior cervical carotid intrathecal combined external and external approach to remove tumors, tibias, or titanium mesh grafts and titanium. The stability of the cervical spine was fixed by intraplate fixation, including 9 males and 8 females, aged 34-53 years old, with an average age of 43.6 years. There were 9 cases of Toyama IIb type and 8 cases of Type IIIb. Preoperative spinal nerve function Frankel classification: 3 cases of C grade, 10 cases of D grade, 4 cases of E grade. Follow-up observation of patients with symptoms and neurological improvement. Results: All the 17 patients underwent surgical resection of internal and external spinal canal. The operation was successful. The operation time was 90-170 minutes with an average of 130 minutes. The blood loss was 150-700 ml and the average was 280 ml. In 1 case, the symptoms of the forearm nerves were aggravated immediately, and the symptoms were relieved after 3 days of treatment with hormones and dehydrating agents. No other serious complications occurred. Seventeen patients were followed up for 10 to 48 months, with an average of 18 months. The patient’s local pain and neurological symptoms were significantly improved or relieved. At the final follow-up, the Frankel’s grade of spinal nerve function was improved by 1 in 7 patients and improved by 2 in 3 patients. One patient with malignant schwannomas had recurrence of the recurrence of local tumor at 1 year after operation and re-excision of the posterior approach was performed. The remaining patients had no recurrence during follow-up. Conclusion: Toyama IIb and IIIb type dumbbell tumors inside and outside the cervical canal can be removed by anterior approach combined with intracarotid sheath approach. The surgical trauma is small, and the tumor body is completely removed with few complications.