Archer Jacob, Thatikunta Meena, Jea Andrew
1Section of Pediatric Neurosurgery, Riley Hospital for Children, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana; and.
2Department of Neurological Surgery, University of Louisville Hospital School of Medicine, Louisville, Kentucky.
J Neurosurg Pediatr. 2019 Oct 11;25(1):8-12. doi: 10.3171/2019.7.PEDS19337. Print 2020 Jan 1.
The transoral transpharyngeal approach is the standard approach to resect the odontoid process and decompress the cervicomedullary spinal cord. There are some significant risks associated with this approach, however, including infection, CSF leak, prolonged intubation or tracheostomy, need for nasogastric tube feeding, extended hospitalization, and possible effects of phonation. Other ventral approaches, such as transmandibular and circumglossal, endoscopic transcervical, and endoscopic transnasal, are also viable alternatives but are technically challenging or may still traverse the nasopharyngeal cavity. Far-lateral and posterior extradural approaches to the craniocervical junction require extensive soft-tissue dissection. Recently, a posterior transdural approach was used to resect retro-odontoid cysts in 3 adult patients. The authors present the case of a 12-year-old girl with Down syndrome and significant spinal cord compression due to basilar invagination and a retro-flexed odontoid process. A posterior transdural odontoidectomy prior to occiptocervical fusion was performed. At 12 months after surgery, the authors report satisfactory clinical and radiographic outcomes with this approach.
经口经咽入路是切除齿突并解除颈髓压迫的标准入路。然而，该入路存在一些重大风险，包括感染、脑脊液漏、长时间插管或气管切开、需要鼻饲管喂养、住院时间延长以及对发声的可能影响。其他前路入路，如经下颌和经舌、内镜经颈和内镜经鼻入路，也是可行的替代方法，但技术上具有挑战性，或者可能仍需穿过鼻咽腔。颅颈交界区的远外侧和后硬膜外入路需要广泛的软组织解剖。最近，一种后经硬膜入路被用于3例成年患者切除齿突后囊肿。作者报告了1例12岁患有唐氏综合征的女孩，因基底凹陷和齿突后屈导致严重脊髓压迫。在枕颈融合术前进行了后经硬膜齿突切除术。术后12个月，作者报告该入路取得了满意的临床和影像学结果。
