Yadav Yad Ram, Ratre Shailendra, Parhihar Vijay, Dubey Amitesh, Dubey Neil M
Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India.
Department of Radio-diagnosis, MPMRI Center, Jabalpur, Madhya Pradesh, India.
Neurol India. 2017 Mar-Apr;65(2):341-347. doi: 10.4103/neuroindia.NI_1276_16.
Although posterior approaches are being used frequently in most atlantoaxial dislocations (AAD), anterior decompression is also required in some patients in whom the C1-2 dislocation is not properly reduced by the posterior approach. Transnasal and transoral approaches need an additional posterior approach to perform atlantoaxial fusion. They also have an added risk of infection. The endoscopic transcervical approach can be used for single-stage cervical decompression and stabilization that includes an odontoidectomy and anterior fusion. It can be used both in reducible and irreducible AAD. Patients with a high basilar invasion, traumatic or other lesions involving the C1 or C2 facet joint, reducible AAD with Chiari malformation, and patients with a large mandible or a mandible angle lying below the C3 level even after the maximum neck extension, should not be subjected to this procedure. Preoperative X-ray, computed tomography (CT) scan with angiogram, and magnetic resonance imaging of the craniovertebral region should be done to assess the dislocation. The early results of an endoscopic transcervical approach were found to be safe and effective for decompression and fusion in our experience. There was no permanent complication. The procedure avoids a two-stage surgery; thus, odontoidectomy, if needed, can be performed in addition to the C1-2 fusion in a single stage.
尽管后路手术在大多数寰枢椎脱位（AAD）中被频繁使用，但对于一些经后路手术C1-2脱位未得到妥善复位的患者，仍需要进行前路减压。经鼻和经口手术需要额外的后路手术来进行寰枢椎融合。它们还增加了感染风险。内镜下经颈入路可用于包括齿状突切除术和前路融合的单阶段颈椎减压和稳定手术。它可用于可复位和不可复位的AAD。基底侵袭严重、有涉及C1或C2关节突关节的创伤性或其他病变、伴有Chiari畸形的可复位AAD以及即使在颈部最大限度伸展后下颌骨较大或下颌角位于C3水平以下的患者，不应接受此手术。术前应进行X线、带血管造影的计算机断层扫描（CT）以及颅颈区域的磁共振成像，以评估脱位情况。根据我们的经验，内镜下经颈入路的早期结果在减压和融合方面是安全有效的。没有永久性并发症。该手术避免了两阶段手术；因此，如果需要，在单阶段进行C1-2融合的同时还可进行齿状突切除术。
