Dubey Sudhir, Agrawal Amit
Division of Minimally Invasive Neurosurgery, Medanta Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India.
Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India.
Neurol India. 2018 Jan-Feb;66(1):168-173. doi: 10.4103/0028-3886.222851.
Cervicothoracic junction can be approached anteriorly, anterolaterally, posterolaterally, and posteriorly. The anterior approaches in this region best address the ventral vertebral body disease but may cause significant morbidity. Twelve patients with their disease process located ventral to the spinal cord in the cervicothoracic junction underwent expansile manubriotomy and corpectomy. Eleven patients underwent fusion. One patient underwent an oblique corpectomy. All patients had their disease process from T1 to T3 vertebral levels. After dissection, the manubrium was cut open in the midline until the sternal notch. Further manubrial cut was extended laterally to just below the second rib. A self-retaining retractor was placed and opened. This gave an additional exposure of 10 cm from the midline towards the right side. It also opened the thoracic inlet. The superior mediastinum was dissected. Brachiocephalic vessels were looped down and a plane was made between the carotid artery laterally, and the trachea and esophagus medially. The prevertebral fascia was reached and opened to access the vertebral body. The procedure could be carried out successfully in all the patients. A patient with uncontrolled diabetes mellitus and end-stage renal disease with pyogenic epidural abscess succumbed to her illness after 3 weeks. Expansile manubriotomy is technically feasible, less invasive, and least morbid of all the anterior approaches for accessing the anteriorly located disease process above the T4 vertebral level.
颈胸交界处可通过前路、前外侧、后外侧和后路进行手术。该区域的前路手术最适合处理椎体腹侧疾病，但可能会导致较高的发病率。12例颈胸交界处脊髓腹侧有病变的患者接受了扩大胸骨切开术和椎体次全切除术。11例患者接受了融合手术。1例患者接受了斜行椎体次全切除术。所有患者的病变均位于T1至T3椎体水平。解剖后，在胸骨中线切开胸骨柄直至胸骨切迹。进一步将胸骨柄切口向外侧延伸至第二肋下方。放置并打开一个自持牵开器。这使得从中线向右的额外暴露增加了10厘米。它还打开了胸廓入口。解剖上纵隔。将头臂血管向下套扎，并在外侧的颈动脉与内侧的气管和食管之间形成一个平面。到达并打开椎前筋膜以显露椎体。所有患者的手术均成功完成。1例患有无法控制的糖尿病和终末期肾病并伴有化脓性硬膜外脓肿的患者在3周后因病死亡了。扩大胸骨切开术在技术上是可行的，侵入性较小，是所有用于处理T4椎体水平以上前方病变的前路手术中发病率最低的。
