Naito Kentaro, Yamagata Toru, Kawahara Shinichi, Ohata Kenji, Takami Toshihiro
Department of Neurosurgery, Osaka City University Graduate School of Medicine.
Department of Neurosurgery, Osaka City General Hospital.
Neurol Med Chir (Tokyo). 2019 Oct 15;59(10):392-397. doi: 10.2176/nmc.tn.2019-0060. Epub 2019 Aug 9.
Surgery for neoplastic or vascular lesions at the craniovertebral junction remains one of the major challenges for neurosurgeons, because of issues such as the complex functional anatomy and vascular structures. We present three cases in which the high cervical lateral approach was used to safely remove the cystic retro-odontoid pseudotumor, not associated with rheumatoid arthritis, severely compressing the spinal cord. The mean age of patients was 74.7 years (range, 73-77 years). Neurological condition was assessed based on the neurosurgical cervical spine scale. A high cervical lateral approach was applied to remove the pseudotumor safely. Mean duration of follow-up after surgery was 21.3 months (range, 18-24 months). Mean recovery rate was 77.8%. All patients showed acceptable or satisfactory functional recovery, although one patient (Case 2) developed mild paralysis of the facial and spinal accessory nerve on the surgical approach side, but that completely recovered within about 1 month after surgery. Postoperative assessment at the recent follow-up suggested no significant aggravation of neck movement. This technical note suggests that the high cervical lateral approach can be considered as a surgical option for cystic retro-odontoid pseudotumor, not associated with rheumatoid arthritis, severely compressing the spinal cord. Safe management of the vertebral artery is one of the key considerations.
由于颅颈交界区存在复杂的功能解剖结构和血管结构等问题，对该部位的肿瘤性或血管性病变进行手术仍是神经外科医生面临的主要挑战之一。我们报告了3例采用高位颈椎外侧入路安全切除囊性齿突后假瘤的病例，这些假瘤与类风湿关节炎无关，但严重压迫脊髓。患者的平均年龄为74.7岁（范围73 - 77岁）。根据神经外科颈椎量表评估神经功能状态。采用高位颈椎外侧入路安全切除假瘤。术后平均随访时间为21.3个月（范围18 - 24个月）。平均恢复率为77.8%。所有患者均显示出可接受或令人满意的功能恢复，尽管1例患者（病例2）在手术入路侧出现了轻度的面神经和副神经麻痹，但在术后约1个月内完全恢复。近期随访的术后评估显示颈部活动无明显加重。本技术说明表明，对于与类风湿关节炎无关、严重压迫脊髓的囊性齿突后假瘤，高位颈椎外侧入路可被视为一种手术选择。椎动脉的安全处理是关键考虑因素之一。
