Fujiwara Yasushi, Manabe Hideki, Sumida Tadayoshi, Tanaka Nobuhiro, Hamasaki Takahiko
*Department of Orthopedic Surgery, Hiroshima City Asa Hospital, Asa-kita-ku, Hiroshima City, Japan §Department of Orthopaedic Surgery, National Hospital Organization Kure Medical Center, Chugoku Cancer Center ‡Department of Orthopaedic Surgery, Institute of Biomedical & Health Sciences, Hiroshima University †Department of Orthopedic Surgery, Saka Midorii Hospital.
J Spinal Disord Tech. 2015 Dec;28(10):363-9. doi: 10.1097/BSD.0000000000000335.
Retro-odontoid pseudotumors are noninflammatory masses formed posterior to the odontoid process. Because of their anatomy, the optimal surgical approach for resecting pseudotumors is controversial. Conventionally, 3 approaches are used: the anterior transoral approach, the lateral approach, and the posterior extradural approach; however, each approach has its limitations. The posterior extradural approach is the most common; however, it remains challenging due to severe epidural veins. Although regression of pseudotumors after fusion surgery has been reported, direct decompression and a pathologic diagnosis are ideal when the pseudotumor is large. We therefore developed a new microscopic surgical technique; transdural resection. After C1 laminectomy, the dorsal and ventral dura was incised while preserving the arachnoid. Removal of the pseudotumor was performed and both of the dura were repaired. The patient's clinical symptoms subsequently improved and the pathologic findings showed degenerative fibrocartilaginous tissue. In addition, no neurological deterioration, central spinal fluid leakage, or arachnoiditis was observed. Currently, the usefulness of the transdural approach has been reported for cervical and thoracic disk herniation. According to our results, the transdural approach is recommended for resection of retro-odontoid pseudotumors because it enables direct decompression of the spinal cord and a pathologic diagnosis.
齿突后假瘤是在齿突后方形成的非炎性肿块。由于其解剖结构，切除假瘤的最佳手术入路存在争议。传统上，采用三种入路：经口前路、外侧入路和后路硬膜外入路；然而，每种入路都有其局限性。后路硬膜外入路最为常用；然而，由于硬膜外静脉严重，该入路仍然具有挑战性。尽管有报道称融合手术后假瘤会消退，但当假瘤较大时，直接减压和病理诊断是理想的选择。因此，我们开发了一种新的显微外科技术；经硬膜切除术。在C1椎板切除术后，切开背侧和腹侧硬膜，同时保留蛛网膜。切除假瘤并修复两侧硬膜。患者的临床症状随后得到改善，病理结果显示为退行性纤维软骨组织。此外，未观察到神经功能恶化、脑脊液漏或蛛网膜炎。目前，经硬膜入路在颈椎和胸椎椎间盘突出症中的应用已见报道。根据我们的结果，推荐经硬膜入路切除齿突后假瘤，因为它能够直接减压脊髓并进行病理诊断。
