Tominaga Hiroyuki, Setoguchi Takao, Nagano Satoshi, Kawamura Ichiro, Abematsu Masahiko, Yamamoto Takuya, Ishidou Yasuhiro, Matsuyama Kanehiro, Ijiri Kosei, Tanabe Fumito, Komiya Setsuro
Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima, Japan.
The Near-Future Locomotor Organ Medicine Creation Course (Kusunoki Kai), Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima, Japan.
Spinal Cord Ser Cases. 2016 Nov 10;2:16025. doi: 10.1038/scsandc.2016.25. eCollection 2016.
Retro-odontoid mass rarely occur in patients with noninflammatory retro-odontoid lesions without atlantoaxial instability. We describe a rare case of retro-odontoid mass without atlantoaxial instability operated on by a transdural approach.
The patient was an 83-year-old man who presented with a retro-odontoid mass causing symptomatic cervical myelopathy. Preoperative magnetic resonance imaging (MRI) revealed that the mass was severely compressing the spinal cord. We operated on it via a C1 laminectomy and performed tumor resection by a transdural approach. Pathological findings from the operative specimen confirmed the diagnosis; histopathological examination revealed that the mass contained fibrinoid material, and collagenous tissue with myxoid changes, but no granulation or a granulomatous lesion. Postoperative MRI confirmed spinal cord decompression. The patient's symptoms were alleviated, and he has not had a recurrence or cervical instability in the 7 years since his surgery.
We successfully used a transdural approach in the present case and have observed no recurrence for 7 years postoperatively. C1 laminectomy is reportedly beneficial, especially for elderly patients, given the risk of other surgical options using an anterior transoral approach or posterior fusion. However, most tumors do not attenuate after C1 laminectomy alone; hence, we think that tumor resection by the transdural approach is one effective method to perform enucleation of the tumor after C1 laminectomy.
在无寰枢椎不稳的非炎性齿状突后肿物患者中，齿状突后肿物很少见。我们描述了一例通过经硬脊膜入路手术治疗的无寰枢椎不稳的齿状突后肿物罕见病例。
患者为一名83岁男性，因齿状突后肿物导致症状性颈髓病就诊。术前磁共振成像（MRI）显示肿物严重压迫脊髓。我们通过C1椎板切除术对其进行手术，并经硬脊膜入路进行肿瘤切除。手术标本的病理结果证实了诊断；组织病理学检查显示肿物含有纤维蛋白样物质以及有黏液样改变的胶原组织，但无肉芽或肉芽肿性病变。术后MRI证实脊髓减压。患者症状缓解，自手术以来7年未复发或出现颈椎不稳。
我们在本病例中成功采用了经硬脊膜入路，术后7年未见复发。据报道，C1椎板切除术是有益的，特别是对于老年患者，考虑到采用经口前路或后路融合等其他手术选择存在风险。然而，大多数肿瘤仅行C1椎板切除术后不会缩小；因此，我们认为经硬脊膜入路切除肿瘤是C1椎板切除术后进行肿瘤摘除的一种有效方法。
