Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena.
Acta Otorhinolaryngol Ital. 2011 Aug;31(4):248-52.
The endoscopic endonasal approach is emerging as a feasible alternative to the trans-oral route for the resection of the odontoid process, when the latter produces a compression of the brainstem and cervicomedullary junction. This type of approach has some advantages, such as excellent pre-vertebral exposure of the cranio-vertebral junction in patients with small oral cavities and the possibility to avoid the use of mouth retractors. A typical case of a 24-year-old male patient with a previous diagnosis of type I Arnold-Chiari Malformation, suffering from a posterior dislocation of the odontoid process causing severe anterior compression of the brainstem, is presented to stress the potential of this technique. Trans-nasal endoscopic removal of the odontoid process was performed and resolution of the ventral compression of the brainstem was achieved. This report demonstrates that in selected cases, an endoscopic endonasal approach should now be considered an excellent alternative to the traditional trans-oral approach.
经鼻内镜入路在切除枢椎齿状突时正逐渐成为一种可行的替代经口入路的方法，尤其是当经口入路会对脑干和颈髓连接部产生压迫时。这种入路方式有一些优点，例如在口腔较小的患者中能够极好地显露颅颈交界区的椎体前方，并且有可能避免使用口腔牵开器。本文报道了 1 例 24 岁男性患者，该患者先前诊断为 1 型Arnold-Chiari 畸形，患有齿状突后脱位，导致严重的脑干前方压迫，强调了该技术的潜力。经鼻内镜切除了齿状突，脑干腹侧压迫得到缓解。本报告表明，在选择病例中，经鼻内镜入路现在应被视为传统经口入路的一种极好替代方法。
