Alalade Andrew F, Ogando-Rivas Elizabeth, Forbes Jonathan, Ottenhausen Malte, Uribe-Cardenas Rafael, Hussain Ibrahim, Nair Prakash, Lehner Kurt, Singh Harminder, Kacker Ashutosh, Anand Vijay K, Hartl Roger, Baaj Ali, Schwartz Theodore H, Greenfield Jeffrey P
Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USA.
Department of Neurosurgery, The Walton Centre, Liverpool, United Kingdom.
World Neurosurg X. 2019 Jan 24;2:100010. doi: 10.1016/j.wnsx.2019.100010. eCollection 2019 Apr.
Ventral brainstem compression secondary to complex craniovertebral junction abnormality is an infrequent cause of neurologic deterioration in pediatric patients. However, in cases of symptomatic, irreducible ventral compression, 360° decompression of the brainstem supported by posterior stabilization may provide the best opportunity for improvement in symptoms. More recently, the endoscopic endonasal corridor has been proposed as an alternative method of odontoidectomy associated with less morbidity. We report the largest single case series of pediatric patients using this dual-intervention surgical technique. The purpose of this study was to evaluate the surgical outcomes of pediatric patients who underwent posterior occipitocervical decompression and instrumentation followed by endoscopic endonasal odontoidectomy performed to relieve neurologic impingement involving the ventral brainstem and craniocervical junction.
Between January 2011 and February 2017, 7 patients underwent posterior instrumented fusion followed by endonasal endoscopic odontoidectomy at our unit. Standardized clinical and radiological parameters were assessed before and after surgery. A univariate analysis was performed to assess clinical and radiologic improvement after surgery.
A total of 14 operations were performed on 7 pediatric patients. One patient had Ehlers-Danlos syndrome, 1 patient had a Chiari 1 malformation, and the remaining 5 patients had Chiari 1.5 malformations. Average extubation day was postoperative day 0.9. Average day of initiation of postoperative feeds was postoperative day 1.0.
The combined endoscopic endonasal odontoidectomy and posterior decompression and fusion for complex craniovertebral compression is a safe and effective procedure that appears to be well tolerated in the pediatric population.
继发于复杂颅颈交界区异常的腹侧脑干受压是儿科患者神经功能恶化的罕见原因。然而，在有症状的、不可复位的腹侧压迫病例中，后路稳定支持下的脑干360°减压可能为症状改善提供最佳机会。最近，内镜鼻内入路已被提议作为一种与之相关发病率较低的齿状突切除术替代方法。我们报告了使用这种双干预手术技术的儿科患者最大单病例系列。本研究的目的是评估接受枕颈后路减压及内固定，随后行内镜鼻内齿状突切除术以缓解涉及腹侧脑干和颅颈交界区神经压迫的儿科患者的手术结果。
2011年1月至2017年2月期间，7例患者在我院接受了后路内固定融合术，随后行鼻内镜下齿状突切除术。在手术前后评估标准化的临床和放射学参数。进行单因素分析以评估术后临床和放射学改善情况。
7例儿科患者共进行了14次手术。1例患者患有埃勒斯-当洛综合征，1例患者患有Chiari 1畸形，其余5例患者患有Chiari 1.5畸形。平均拔管日为术后第0.9天。术后开始进食的平均天数为术后第1.0天。
对于复杂颅颈压迫，联合内镜鼻内齿状突切除术及后路减压融合术是一种安全有效的手术，在儿科人群中似乎耐受性良好。
