Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Neurosurgery, Mayo Clinic College of Medicine, Jacksonville, Florida, USA.
Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
World Neurosurg. 2019 Jul;127:206-212. doi: 10.1016/j.wneu.2019.04.038. Epub 2019 Apr 10.
The craniovertebral junction (CVJ) may be affected by several diseases. It is an anatomically complex region, involving the osteoligamentous, vascular, and nervous structures, which makes surgery challenging. In a case of ventral compression, an anterior approach is preferable, although posterior fixation is often required. Anterior transmucosal approaches are associated with high rates of complications. However, decompression and fixation by the use of retropharyngeal extramucosal approaches may be challenging.
To investigate the feasibility of a single-stage, anterior, extramucosal submandibular (SM) approach modification to the CVJ for simultaneous decompression and stabilization.
This was a preliminary cadaveric feasibility study on 2 injected specimens. A variation of the SM approach with a short "boomerang" incision, microsurgical decompression of the ventral CVJ, and a new hybrid construct for an anterior atlantoaxial stabilization was investigated. The surgical approach, the decompression, and the instrumentation technique have been described. In addition, intraprocedural images and radiographs and also postprocedural computed tomographic images were collected. Furthermore, surgical exposure, working corridors and angles, and decompression grade were measured.
The SM approach provided wide exposure of the ventral CVJ and the possibility for instrumentation and decompression by removing the anterior arch of C1 and the odontoid process.
A single- stage anterior extramucosal SM approach for decompression and stabilization of the CVJ is feasible and could result in shorter surgical duration, avoiding the complications related to both the transmucosal approach and the prone position, although specific related risks exist. Mechanical investigation of this hybrid system and in vivo studies are needed to confirm our results.
颅颈交界区（CVJ）可能受到多种疾病的影响。该区域解剖结构复杂，涉及骨-韧带、血管和神经结构，这使得手术具有挑战性。在出现前侧压迫时，首选前路入路，尽管通常需要后路固定。经黏膜前路入路与较高的并发症发生率相关。然而，使用经咽后黏膜外入路进行减压和固定可能具有挑战性。
探讨一期前路、黏膜外下颌下（SM）入路改良治疗颅颈交界区同时进行减压和固定的可行性。
这是一项对 2 具注射标本进行的初步尸体可行性研究。我们研究了一种 SM 入路的变体，该入路采用短的“回旋镖”切口，对 CVJ 的前侧进行显微减压，并采用一种新的混合结构进行前路寰枢椎稳定。描述了手术入路、减压和器械技术。此外，还收集了术中图像和 X 线片以及术后 CT 图像。此外，还测量了手术暴露、工作通道和角度以及减压程度。
SM 入路提供了 CVJ 前侧的广泛暴露，并通过切除 C1 前弓和齿状突，实现了器械置入和减压的可能性。
一期前路黏膜外 SM 入路用于 CVJ 的减压和稳定是可行的，可缩短手术时间，避免经黏膜入路和俯卧位相关的并发症，尽管存在特定的相关风险。需要对这种混合系统进行机械研究和体内研究，以证实我们的结果。
