Madhavan Karthik, Chieng Lee Onn, Gaynor Brandon G, Levi Allan D
J Neurosurg Spine. 2018 Mar;28(3):236-243. doi: 10.3171/2017.6.SPINE17429. Epub 2017 Dec 15.
Retro-odontoid cysts that arise from the tectorial membrane are uncommon lesions that can occur in elderly patients. They arise secondary to degenerative changes, including calcium pyrophosphate deposition within the ligaments. Surgical treatment is indicated when these lesions result in intractable pain, instability, and/or myelopathy. Several surgical techniques to treat this condition exist, but the optimal approach in elderly patients with comorbidities remains controversial. Here, the authors present a case series of 3 patients who underwent successful resection of a retro-odontoid lesion performed through a transdural approach. The patients were 70, 81, and 74 years old and presented with symptoms of cervical myelopathy. In consideration of their advanced age and the location of their lesion, resection via a posterior approach was considered. A 1- to 2-cm suboccipital craniectomy and C-1 and partial C-2 laminectomy were performed. These lesions could not be accessed via an extradural posterolateral approach, and so a transdural approach was performed. In the first 2 patients, a preexisting deformity prompted an instrumented fusion. In the third patient, only a lesion resection was performed. In each case, the dural opening was made using a paramedian ipsilateral-sided incision, and the lesion was resected through an incision in the anterior dura mater. Only the posterior dura was closed primarily. MR imaging evidence of excellent spinal cord decompression was evident in follow-up examinations. Transdural resection of retro-odontoid cysts is a viable option for treating asymmetrical ventral extradural cysts. Results from this case series suggest that such an approach is safe and feasible and can provide an alternative to open or endoscopic anterior transpharyngeal approaches.
源自覆膜的齿状突后囊肿是罕见病变，可发生于老年患者。它们继发于退行性改变，包括韧带内焦磷酸钙沉积。当这些病变导致顽固性疼痛、不稳定和/或脊髓病时，需进行手术治疗。治疗这种疾病有几种手术技术，但对于合并多种疾病的老年患者，最佳手术方法仍存在争议。在此，作者介绍了一组3例患者的病例系列，他们通过经硬脑膜入路成功切除了齿状突后病变。患者年龄分别为70岁、81岁和74岁，均表现为颈髓病症状。考虑到他们的高龄和病变位置，曾考虑通过后路进行切除。进行了1至2厘米的枕下颅骨切除术以及C1和部分C2椎板切除术。这些病变无法通过硬膜外后外侧入路到达，因此采用了经硬脑膜入路。在前2例患者中，由于存在先前的畸形，因此进行了器械辅助融合。在第3例患者中，仅进行了病变切除。在每种情况下，均使用同侧旁正中切口打开硬脑膜，并通过硬脑膜前部的切口切除病变。仅对硬脑膜后部进行了一期缝合。随访检查显示脊髓减压良好的磁共振成像证据。经硬脑膜切除齿状突后囊肿是治疗不对称腹侧硬膜外囊肿的可行选择。该病例系列的结果表明，这种方法安全可行，可为开放或内镜下经咽前路手术提供替代方案。
