Salle Henri, Cavalcanti Mendes George de Albuquerque, Gantois Clément, Lerat Justine, Aldahak Nouman, Caire François
Department of Neurosurgery, Limoges University Hospital, Limoges, France.
Department of Neurosurgery, Santacoop, Santa Efigênia, Belo Horizonte, Brazil.
World Neurosurg. 2017 Oct;106:266-276. doi: 10.1016/j.wneu.2017.06.162. Epub 2017 Jul 8.
Surgery of the craniocervical junction (CCJ) and clivus is technically demanding. For many years, we have used the submandibular retropharyngeal approach for surgery of the upper cervical spine, especially hangman fracture. We hypothesized that submandibular gland resection could offer a significant cranial enlargement of the operative field, up to the clivus. Our aim in this work was to assess the feasibility of an endoscope-assisted retropharyngeal approach to the CCJ and clivus.
Eight anatomic specimens were used, including 4 silicon-injected specimens. We performed a submandibular retropharyngeal approach with gland resection, and then we exposed the CCJ and clivus. We drilled the C2 vertebral body, odontoid process, C1 anterior arch, and the clivus. We noted 8 anatomic landmarks that were easily identified on each anatomic specimen. These measurements were designed to quantify the exposure of the clivus and CCJ after bone resection.
A submandibular approach was feasible in all specimens. The main dimensions of the area of dural exposure after bone drilling were as follows: mean width between C1 lateral masses, 19 mm (range, 17-20 mm); at the tip of the clival window, 18 mm (range, 16-20 mm); distance between the C3 vertebra and the tip of the window within the clivus, 57 mm (range, 55-60 mm).
An endoscopic submandibular retropharyngeal approach provides a simple and straightforward access to the CCJ. It also conveniently exposes the clivus. This technique could be added to the techniques used for this difficult surgery.
颅颈交界区（CCJ）和斜坡的手术在技术上要求很高。多年来，我们一直采用下颌下经咽后入路进行上颈椎手术，尤其是绞刑者骨折手术。我们推测，切除下颌下腺可显著扩大手术视野，直至斜坡。我们这项研究的目的是评估内镜辅助经咽后入路至CCJ和斜坡的可行性。
使用了8个解剖标本，包括4个注入硅胶的标本。我们采用切除腺体的下颌下经咽后入路，然后暴露CCJ和斜坡。我们钻开了C2椎体、齿突、C1前弓和斜坡。我们记录了在每个解剖标本上易于识别的8个解剖标志。这些测量旨在量化骨切除后斜坡和CCJ的暴露情况。
在下颌下入路在所有标本中均可行。钻孔后硬脑膜暴露区域的主要尺寸如下：C1侧块之间的平均宽度为19mm（范围为17 - 20mm）；在斜坡窗尖端为18mm（范围为16 - 20mm）；C3椎体与斜坡内窗尖端之间的距离为57mm（范围为55 - 60mm）。
内镜辅助下颌下经咽后入路为CCJ提供了一种简单直接的入路。它还能方便地暴露斜坡。该技术可补充用于这种复杂手术的技术中。
