Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China.
J Neurosurg Spine. 2013 Nov;19(5):637-43. doi: 10.3171/2013.8.SPINE13120. Epub 2013 Sep 20.
Transoral microscopic odontoidectomy has been accepted as a standard procedure to treat basilar invagination over the past several decades. In recent years the emergence of new technologies, including endoscopic odontoidectomy and posterior reduction, has presented a challenge to the traditional treatment algorithm. In this article, the authors describe 1 patient with basilar invagination who was successfully treated with endoscopic transnasal odontoidectomy combined with posterior reduction. The purpose of this report is to validate the effectiveness of this treatment algorithm in selected cases and describe several operative nuances and pearls based on the authors' experience.
One patient with basilar invagination caused by a congenital osseous malformation underwent endoscopic transnasal odontoidectomy combined with posterior reduction in a single operative setting. The purely endoscopic transnasal odontoidectomy was first conducted with the patient supine. The favorable anatomical reduction was then achieved through a posterior approach after the patient was moved prone.
The patient was extubated after recovery from anesthesia and allowed oral food intake the next day. No complications were noted, and the patient was discharged 4 days after the operation. Postoperative imaging demonstrated excellent decompression of the anterior cervicomedullary junction pathology. The patient was followed up for 12 months and remarkable neurological recovery was observed.
The endoscopic transnasal odontoidectomy is a better minimally invasive approach for anterior decompression and can make the posterior reduction easier because the anterior resistant force is eliminated. The subsequent posterior reduction can make decompression of the ventral side of the cervicomedullary junction more effective because the C-2 vertebral body is pushed forward. A combination of these 2 approaches has the advantages of minimally invasive access and a faster patient recovery, and thus is a valid alternative in selected cases.
在过去几十年中，经口显微镜齿突切除术已被接受为治疗颅底凹陷症的标准手术。近年来，新技术的出现，包括内镜齿突切除术和后路复位，对传统的治疗方案提出了挑战。本文作者描述了 1 例采用内镜经鼻齿突切除术联合后路复位成功治疗颅底凹陷症的患者。本报告的目的是验证该治疗方案在特定病例中的有效性，并根据作者的经验描述一些手术细节和技巧。
1 例因先天性骨畸形导致的颅底凹陷症患者，在单次手术中接受了内镜经鼻齿突切除术联合后路复位。首先让患者仰卧位进行单纯内镜经鼻齿突切除术，然后再让患者俯卧位通过后路达到满意的解剖复位。
患者麻醉恢复后拔管，次日即可经口进食。无并发症发生，术后 4 天出院。术后影像学显示，前颈髓交界处病变减压效果良好。患者随访 12 个月，观察到显著的神经功能恢复。
内镜经鼻齿突切除术是一种更好的微创入路，用于前方减压，可以使后路复位更容易，因为消除了前方的阻力。随后的后路复位可以使颈髓交界处腹侧的减压更有效，因为 C2 椎体被向前推。这两种方法的结合具有微创入路和更快的患者康复的优点，因此在特定病例中是一种有效的替代方法。
