Bejjani G K, Sekhar L N, Riedel C J
Tristate Neurosurgical Associates-UPMC, Pittsburgh, Pennsylvania 15213, USA.
Surg Neurol. 2000 Aug;54(2):109-15; discussion 115-6. doi: 10.1016/s0090-3019(00)00255-x.
Modern cranial base approaches to the clivus and foramen magnum may threaten the stability of the cranio-cervical junction. This necessitates stabilization and fusion in some cases. We studied occipitocervical fusion after extreme lateral transcondylar approaches.
Twenty-seven patients underwent an extreme lateral transcondylar approach over a 2-year period. Two patients were excluded because of prior occipitocervical fusion. The pathological diagnosis was meningioma in ten patients, chordoma in six patients, neurofibroma in two, and 10 patients had other tumoral and nontumoral pathologies.
Eight patients required occipitocervical fusion and stabilization. Five of six patients with chordomas required fusion, whereas no patient with a meningioma underwent fusion. All the patients who were fused had more than 70% resection of their occipital condyle. No patient with resection of less than 70% of the occipital condyle required fusion. Significant interference of the surgical construct with follow-up imaging was seen only in the patient in whom a stainless steel Steinman pin was used.
One third of patients will require fusion after extreme lateral transcondylar approaches. Most patients with less than 70% resection of the condyle remain stable without need for surgical intervention, whereas complete resection necessitates fusion in most cases.
现代用于斜坡和枕骨大孔的颅底入路可能会威胁到颅颈交界区的稳定性。在某些情况下，这就需要进行稳定和融合操作。我们研究了经髁极外侧入路术后的枕颈融合情况。
在两年时间里，27例患者接受了经髁极外侧入路手术。2例因先前已行枕颈融合而被排除。病理诊断为脑膜瘤10例，脊索瘤6例，神经纤维瘤2例，另外10例患者有其他肿瘤性和非肿瘤性病变。
8例患者需要进行枕颈融合和稳定处理。6例脊索瘤患者中有5例需要融合，而脑膜瘤患者中无一人接受融合。所有接受融合的患者枕髁切除率均超过70%。枕髁切除率低于70%的患者均无需融合。仅在使用不锈钢斯氏针的患者中，随访影像显示手术结构受到明显干扰。
经髁极外侧入路术后，三分之一的患者需要进行融合。大多数枕髁切除率低于70%的患者保持稳定，无需手术干预，而在大多数情况下，完全切除则需要融合。
