Perrini Paolo, Benedetto Nicola, Cacciola Francesco, Gallina Pasquale, Di Lorenzo Nicola
Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy.
Neurosurgical Department, Azienda Ospedaliera Universitaria "Santa Maria alle Scotte", Siena, Italy.
Acta Neurochir Suppl. 2019;125:235-240. doi: 10.1007/978-3-319-62515-7_33.
The transoral approach provides the most direct surgical corridor for treatment of congenital bony abnormalities that exert irreducible ventral compression of the cervicomedullary junction. In this paper, based on our experience with the transoral approach over the past three decades, we briefly describe the surgical strategies and the operative nuances that allow effective decompression of the craniovertebral junction (CVJ) while minimizing postoperative morbidity.
The surgical strategy is dictated by the type and severity of the malformation. Fibre-optic nasotracheal intubation obviates the necessity of preoperative tracheostomy, and avoidance of a soft-palate incision significantly reduces oropharyngeal morbidity. When feasible, the atlas-sparing technique minimizes postoperative instability. The transoral transatlas approach is generally required in patients with severe basilar invagination and allows wider exposure of the anterior CVJ at the price of a higher incidence of postoperative instability.
The transoral approach is extremely effective in providing excellent decompression of the anterior cervicomedullary junction in patients with fixed malformations. Tailoring the approach to the peculiar anatomy of each malformation reduces iatrogenic instability and minimizes postoperative complications.
经口入路为治疗对颈髓交界处造成不可复位性腹侧压迫的先天性骨异常提供了最直接的手术通道。在本文中，基于我们过去三十年经口入路的经验，我们简要描述了手术策略及手术细节，这些策略及细节能在使术后发病率降至最低的同时，有效解除颅颈交界区（CVJ）的压迫。
手术策略取决于畸形的类型和严重程度。纤维光学鼻气管插管避免了术前气管切开的必要性，避免软腭切口可显著降低口咽发病率。可行时，保留寰椎技术可使术后不稳定降至最低。严重基底凹陷患者通常需要经口经寰椎入路，该入路能更广泛地暴露CVJ前方，但术后不稳定发生率较高。
经口入路在为固定畸形患者提供出色的颈髓交界处前方减压方面极为有效。根据每种畸形的特殊解剖结构调整入路可减少医源性不稳定，并使术后并发症降至最低。
