Scholtes F, Signorelli F, McLaughlin N, Lavigne F, Bojanowski M W
Department of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
Minim Invasive Neurosurg. 2011 Aug;54(4):179-82. doi: 10.1055/s-0031-1283168. Epub 2011 Sep 15.
The expanded endonasal approach of the cranio-cervical junction provides comfortable working space while avoiding some of the disadvantages of the transoral route. We report a purely endonasal endoscopic resection of the odontoid process for basilar invagination in a patient with a Chiari type I malformation, without posterior decompression or fusion.
A 54-year-old female patient presented with cranial nerve and brainstem deficits. CT and MRI showed a Chiari type I malformation and compression of the medulla by basilar invagination of the odontoid process. The tip of the latter was displaced up to the bulbo-pontine sulcus. The odontoid process was resected via the expanded endoscopic endonasal approach, without additional posterior decompression or fusion. The post-operative course was uneventful, including the absence of velopharyngeal insufficiency. Neurological deficits regressed rapidly. The preoperative cervical pain virtually disappeared. At 9 months follow-up, the patient had normal activity with minimal residual neurological deficits. Post-op dynamic radiography and CT showed stability of the cranio-cervical junction.
Decompression of the bulbomedullary junction by purely endoscopic transnasal resection of the odontoid process is well tolerated and efficient. Immediate stabilization is not mandatory in all cases of congenital causes of basilar invagination.
颅颈交界区扩大经鼻入路可提供舒适的操作空间，同时避免经口入路的一些缺点。我们报告了1例I型Chiari畸形患者，采用单纯鼻内镜下齿状突切除术治疗基底凹陷，未行后路减压或融合。
一名54岁女性患者出现颅神经和脑干功能障碍。CT和MRI显示I型Chiari畸形，齿状突基底凹陷压迫延髓。齿状突尖端移位至延髓脑桥沟。通过扩大的鼻内镜经鼻入路切除齿状突，未行额外的后路减压或融合。术后过程顺利，包括无腭咽功能不全。神经功能障碍迅速恢复。术前颈部疼痛几乎消失。随访9个月时，患者活动正常，残留神经功能障碍轻微。术后动态X线摄影和CT显示颅颈交界区稳定。
单纯内镜经鼻切除齿状突减压治疗延髓脑桥交界区病变耐受性良好且有效。对于所有先天性基底凹陷病例，并非都必须立即进行稳定手术。
