Ozpinar Alp, Liu Jesse J, Whitney Nathaniel L, Tempel Zachary J, Choi Philip A, Andersen Peter E, Coppa Nicholas D, Hamilton D Kojo
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA.
World Neurosurg. 2016 Jun;90:372-379. doi: 10.1016/j.wneu.2016.02.115. Epub 2016 Mar 9.
En bloc resection of high-cervical chordomas is a technically challenging procedure associated with significant morbidity. Two key components of this procedure include the approach and the method of spinal reconstruction. A limited number of reported cases of en bloc resection of high-cervical chordomas have been reported in the literature.
We report a novel case using an expandable cage to reconstruct the anterior spinal column above C2 with fixation to the clivus. We also report a novel anterior approach to the high-cervical spine via a midline labiomandibular glossotomy. We detail the management of complications related to 2 instances of wound dehiscence and hardware exposure requiring two additional operations. The final surgical procedure involved explantation of the anterior cervical plate and use of a vascularized radial graft to close the posterior pharyngeal defect and protect the hardware. At 26-month follow-up, the patient remained disease free without any neurologic deficit.
We report the novel use of the midline labiomandibular glossotomy for surgical approach and reconstruction of the anterior column to the clivus with an expandable cage. The unique features of this operative strategy allowed the surgical team to tailor the construct intraoperatively, resulting in solid arthrodesis without significant neurologic sequelae.
Labiomandibular glossotomy for approach to high anterior cervical chordomas followed by craniospinal reconstruction to the clivus with an expandable cage represents a novel technique for managing high cervical chordomas.
高颈段脊索瘤的整块切除是一项技术上具有挑战性的手术，且伴有显著的发病率。该手术的两个关键部分包括手术入路和脊柱重建方法。文献中报道的高颈段脊索瘤整块切除病例数量有限。
我们报告了一例新颖的病例，使用可扩张椎间融合器重建C2以上的脊柱前路并固定至斜坡。我们还报告了一种通过中线唇下颌舌切开术进入高颈段脊柱的新颖前路手术方法。我们详细阐述了与2例伤口裂开和内固定物外露相关的并发症的处理，这需要额外进行两次手术。最终手术包括取出颈椎前路钢板，并使用带血管蒂的桡骨移植来封闭咽后壁缺损并保护内固定物。在26个月的随访中，患者无疾病复发，无任何神经功能缺损。
我们报告了中线唇下颌舌切开术在手术入路以及使用可扩张椎间融合器重建至斜坡的脊柱前路方面的新颖应用。这种手术策略的独特之处在于允许手术团队在术中调整植入物，从而实现牢固的关节融合，且无明显的神经后遗症。
唇下颌舌切开术用于高颈段前路脊索瘤的手术入路，随后使用可扩张椎间融合器进行至斜坡的颅颈重建，代表了一种治疗高颈段脊索瘤的新颖技术。
