Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
J Neurosurg. 2016 Jul;125(1):196-201. doi: 10.3171/2015.5.JNS15176. Epub 2015 Nov 6.
OBJECT Far-lateral or extreme-lateral approaches to the skull base allow access to the lateral and anterior portion of the lower posterior fossa and foramen magnum. These approaches include a certain extent of resection of the condyle, which potentially results in craniocervical junction instability. However, it is debated what extent of condyle resection is safe and at what extent of condyle resection an occipitocervical fusion should be recommended. The authors reviewed cases of condyle resection/destruction with regard to necessity of occipitocervical fusion. METHODS The authors conducted a retrospective analysis of all patients in whom a far- or extreme-lateral approach including condyle resection of various extents was performed between January 2007 and December 2014. RESULTS Twenty-one consecutive patients who had undergone a unilateral far- or extreme-lateral approach including condyle resection were identified. There were 10 male and 11 female patients with a median age of 61 years (range 22-83 years). The extent of condyle resection was 25% or less in 15 cases, 50% in 1 case, and greater than 75% in 5 cases. None of the patients who underwent condyle resection of 50% or less was placed in a collar postoperatively or developed neck pain. Two of the patients with condyle resection of greater than 75% were placed in a semirigid collar for a period of 3 months postoperatively and remained free of pain after this period. At last follow-up none of the cases showed any clear sign of radiological or clinical instability. CONCLUSIONS The unilateral resection or destruction of the condyle does not necessarily result in craniocervical instability. No evident instability was encountered even in the 5 patients who underwent removal of more than 75% of the condyle. The far- or extreme-lateral approach may be safer than generally accepted with regard to craniocervical instability as generally considered and may not compel fusion in all cases with condylar resection of more than 75%.
目的
颅底远外侧或极外侧入路可到达颅颈交界区下部和后颅窝外侧和前侧。这些入路包括一定程度的髁突切除，这可能导致颅颈交界区不稳定。然而，对于何种程度的髁突切除是安全的，以及在何种程度的髁突切除需要推荐枕颈融合，目前仍存在争议。作者回顾了需要行枕颈融合的髁突切除/破坏病例。
方法
作者对 2007 年 1 月至 2014 年 12 月期间行单侧远外侧或极外侧入路并进行不同程度髁突切除的所有患者进行回顾性分析。
结果
共确定 21 例连续单侧行远外侧或极外侧入路并进行髁突切除的患者。其中男 10 例，女 11 例，中位年龄 61 岁（范围 22-83 岁）。15 例患者的髁突切除范围为 25%或更少，1 例为 50%，5 例为 75%以上。髁突切除 50%或更少的患者术后均未佩戴颈托，也未出现颈部疼痛。髁突切除>75%的 2 例患者术后佩戴半刚性颈托 3 个月，此后未再出现疼痛。末次随访时，所有病例均无明显影像学或临床不稳定迹象。
结论
单侧髁突切除或破坏不一定导致颅颈交界区不稳定。即使在 5 例髁突切除>75%的患者中也未发现明显不稳定。远外侧或极外侧入路在颅颈交界区不稳定方面可能比通常认为的更安全，对于髁突切除>75%的病例，并非都需要融合。
