Balak Naci, Baran Oguz, Denli Yalvac Emine Seyma, Esen Aydin Aysegul, Tanriover Necmettin
Department of Neurosurgery, Göztepe Education and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey.
Haseki Research and Training Hospital, Neurosurgery Clinic, Istanbul, Turkey.
J Clin Neurosci. 2019 May;63:267-271. doi: 10.1016/j.jocn.2019.01.019. Epub 2019 Feb 1.
The cervical oblique corpectomy (OC) approach has the advantages of no grafting or instrumentation necessities and theoretically maintains natural neck motions. However, the risk of cervical sympathetic trunk (CST) injury and Horner's syndrome is one of the main difficulties of this demanding surgical approach. The upper necks of 3 adult human cadavers (6 sides) were dissected under a Zeiss surgical microscope. OC was performed in a stepwise manner to simulate the surgical procedure. We specifically studied the technique of the protection of the CST during the cervical OC approach. The superior ganglion of the cervical sympathetic chain is located under the prevertebral fascia over the longus capitis muscle at the level of C3 transverse process, while the CST is situated under the prevertebral fascia over the longus colli muscle. The CST courses obliquely from superolateral to inferomedial. The ganglia and CST are carefully dissected; the fascia of the longus colli muscle is cut medially, preferably in the midline over the vertebrae, and the fascia lifted up. Then, the aponeurotic flap is gently retracted laterally to cover the sympathetic chain safely and secured with a 3/0 suture laterally. Preservation of the CST while performing cervical OC is essential to avoid postoperative Horner's syndrome. The placement of self-retaining retractors, particularly inferiorly, where the sympathetic chain is located more medially, is probably the main cause of its injury. Further studies are needed documenting the incidence of Horner's syndrome in the application of this technique to live patients.
颈椎斜行椎体切除术（OC）入路具有无需植骨或内固定的优点，并且理论上可维持颈部的自然活动。然而，颈交感干（CST）损伤及霍纳综合征的风险是这种高难度手术入路的主要难点之一。在蔡司手术显微镜下对3具成年人体尸体的上颈部（6侧）进行解剖。以逐步方式进行OC操作以模拟手术过程。我们专门研究了颈椎OC入路过程中保护CST的技术。颈交感链的上神经节位于C3横突水平头长肌上方的椎前筋膜下方，而CST位于颈长肌上方的椎前筋膜下方。CST从外上向内下斜行。小心解剖神经节和CST；在颈长肌筋膜内侧，最好是在椎体上方的中线处切开，并掀起筋膜。然后，将腱膜瓣轻轻向外侧牵开，以安全覆盖交感链，并在外侧用3-0缝线固定。在进行颈椎OC时保护CST对于避免术后霍纳综合征至关重要。放置自持牵开器，尤其是在交感链位置更偏内侧的下方，可能是其损伤的主要原因。需要进一步研究记录该技术应用于活体患者时霍纳综合征的发生率。
