Robles Luis A, Mundis Greg M
Section of Neurosurgery, Hospiten, Puerto Vallarta, Mexico, USA.
San Diego Center for Spinal Disorders, La Jolla, California, USA.
World Neurosurg. 2019 Jan;121:100-110. doi: 10.1016/j.wneu.2018.10.011. Epub 2018 Oct 11.
Retro-odontoid pseudotumor (RP) can be caused by several diseases, especially rheumatoid arthritis, and is usually associated with the presence of atlantoaxial instability. On the other hand, a different group of patients have been identified in whom RP is observed without radiologic findings of atlantoaxial instability. The pathophysiology, clinical characteristics, and prognosis of this latter group of patients are not well described in the literature.
A PubMed and Scopus search adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed to include studies reporting patients with RP without radiologic instability (RPWRI). The data gathered from this review were analyzed to characterize RPWRI.
The search yielded 36 articles with a total of 62 patients. All studies were case reports and small case series. Different characteristics of RPWRI are described, including causes, pathophysiology, and treatment.
The results of this review show that RPWRI has different causes such as hypermobility, deposition of substances, and perhaps disc herniation. Depending on the cause of RPWRI, the pathophysiologic mechanism is different. Treatment should be tailored based on the primary cause of RP and the degree of compression of the cervicomedullary junction. Different degrees of improvement are usually observed after surgical treatment in these patients regardless of the treatment used, but a higher rate of mass regression was observed in those patients in whom the atlantoaxial joint was stabilized.
齿突后假瘤（RP）可由多种疾病引起，尤其是类风湿关节炎，通常与寰枢椎不稳有关。另一方面，已发现另一组患者，他们虽有齿突后假瘤，但无寰枢椎不稳的影像学表现。关于后一组患者的病理生理学、临床特征和预后，文献中描述较少。
按照PRISMA（系统评价和Meta分析的首选报告项目）指南在PubMed和Scopus数据库进行检索，纳入报告无影像学不稳的齿突后假瘤患者（RPWRI）的研究。对本次综述收集的数据进行分析，以描述RPWRI的特征。
检索到36篇文章，共62例患者。所有研究均为病例报告和小病例系列。文中描述了RPWRI的不同特征，包括病因、病理生理学和治疗方法。
本次综述结果表明，RPWRI有多种病因，如活动过度、物质沉积，可能还有椎间盘突出。根据RPWRI的病因，病理生理机制有所不同。治疗应根据RP的主要病因和颈髓交界处的受压程度进行调整。无论采用何种治疗方法，这些患者术后通常会有不同程度的改善，但寰枢椎关节稳定的患者肿块消退率更高。
