文章简介

出版社:Eur Spine J.

作   者:Yong Yu, Xuejian Wang, Xiaobiao Zhang, Fan Hu, Ye Gu, Tao Xie, Xiaoxing Jiang, Chun Jiang

编   号:doi: 10.1007/s00586-012-2605-4.

年   份:2013    点击量:989

文章摘要 全文翻译

Purpose

Transoral resection of the odontoid has been accepted as a standard procedure to decompress the cervicomedullary junction during the past several decades. The endoscopic transnasal odontoidectomy is emerging as a feasible surgical alternative to conventional microscopic transoral approach. In this article, we describe several operative nuances and pearls from our experience about this approach, which provided successful decompression.

目的

经口咽入路切除齿状突在过去几十年里已成为颈髓交界处的一种标准减压手术。经鼻内窥镜切除齿状突是一种新出现的可行的外科手术,可替代传统的显微镜下经口咽入路。根据我们采用这种方法实现成功减压的经验,本文报道了该种术式的优点及几个细节。

 

Methods

From September 2009 to April 2010, three consecutive patients with basilar invagination, of which the etiology was congenital osseous malformations, underwent endoscopic transnasal odontoidectomy. All patients presented with myelopathy. The last two cases also received occipitocervical fixation and bone fusion during the same surgical episode to ensure stability.

方法

自2009年9月至2010年4月,连续三例因先天性骨畸形导致颅底凹陷症患者,接受经鼻内窥镜下切除齿状突手术。所有患者均有脊髓病表现。后两例患者在手术过程中同时进行了枕颈固定和骨融合以确保稳定。

 

Results

All the patients were extubated after recovery from anesthesia and allowed oral food intake the next day. Cerebrospinal fluid rhinorrhea was found in the second case and cured by continuous lumber drainage of cerebrospinal fluid. No infection was noted. The average follow-up time was more than 24 months. Remarkable neurological recovery was observed postoperative in all patients.

结果

所有患者在麻醉清醒后拔管,并在第二天允许进食。第二例患者出现脑脊液鼻漏,通过脑脊液连续引流治疗。未出现感染。平均随访时间超过24个月。术后所有患者神经功能均显著改善。

 

Conclusion

The endoscopic transnasal odontoidectomy is a feasible approach for anterior decompression of pathology at the cervicomedullary junction. The advantages over the standard transoral odontoidectomy include elimination of risk of tongue swelling and teeth damaging, improvement of visualization, alleviation of prolonged intubation, reduction of need for enteral tube feeding and less risk of affecting phonation. The minimally invasive access and faster recovery associated with this technique make it a valid alternative for decompression of the ventral side of the cervicomedullary junction.

结论

经鼻内窥镜下齿状突切除术是在颈髓交界前路减压的一种可行方法。与标准经口咽切除齿状突相比,优点包括避免了舌头肿胀和牙齿损坏的风险、提高可视化、插管时间减少、减少了肠管饲法的必要、降低了发声受影响的风险。微创入路和快速恢复使这项技术成为颈髓交界腹侧减压的有效选择。