University of Ottawa, Ottawa, Ontario, Canada.
Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
World Neurosurg. 2020 May;137:e406-e415. doi: 10.1016/j.wneu.2020.01.219. Epub 2020 Feb 5.
Odontoidectomy for basilar invagination and craniovertebral junction pathology traditionally has been performed using a transoral route. However, the endoscopic endonasal approach to the anterior craniovertebral junction may offer safer and more effective access when compared with transoral approaches. The objective of this study is to review the surgical outcomes and complications associated with endoscopic endonasal odontoidectomy.
This study is a retrospective chart review of all adult patients who underwent an endoscopic endonasal odontoidectomy at a single tertiary care center between January 2011 and May 2019.
Seventeen patients who underwent endoscopic endonasal odontoidectomy were included. The median age at admission was 67 years (range: 33-84 years) and 65% of the patients were female. One patient (1/17, 6%) had vertebral artery injury, which had to be coiled with no neurologic deficits, and 4 patients (4/17, 24%) had intraoperative CSF leaks with no postoperative leak. Fourteen (14/17, 82%) patients were extubated by postoperative day 1. Three patients (3/17, 18%) developed postoperative sinus infections and required antibiotics. Eight patients (8/17, 47%) developed transient postoperative dysphagia. One patient (1/17, 6%) had postoperative epistaxis and 1 patient (1/17, 6%) had postoperative lower cranial nerve symptoms. The median length of hospital stay was 13 days (range: 2-44 days).
Although the transoral approach has been the traditional route for anterior decompression of the craniovertebral junction, endoscopic endonasal odontoidectomy is a feasible and well-tolerated procedure associated with satisfactory patient outcomes and low morbidity.
传统上，通过经口入路对颅底凹陷症和颅颈交界区病变行寰椎切除术。然而，与经口入路相比，内镜经鼻入路对前颅颈交界区可能提供更安全、更有效的入路。本研究旨在回顾内镜经鼻寰椎切除术的手术结果和相关并发症。
本研究为回顾性病例系列研究，纳入 2011 年 1 月至 2019 年 5 月在单中心接受内镜经鼻寰椎切除术的所有成年患者。
共纳入 17 例行内镜经鼻寰椎切除术的患者。入院时的中位年龄为 67 岁（范围：33-84 岁），65%的患者为女性。1 例（1/17，6%）患者发生椎动脉损伤，予以血管内弹簧圈栓塞，无神经功能缺损；4 例（4/17，24%）患者术中发生脑脊液漏，无术后漏。14 例（14/17，82%）患者术后第 1 天拔管。3 例（3/17，18%）患者发生术后窦感染，需要抗生素治疗。8 例（8/17，47%）患者出现一过性术后吞咽困难。1 例（1/17，6%）患者发生术后鼻出血，1 例（1/17，6%）患者发生术后颅神经症状。中位住院时间为 13 天（范围：2-44 天）。
尽管经口入路一直是颅颈交界区前路减压的传统入路，但内镜经鼻寰椎切除术是一种可行且耐受良好的手术，患者结局满意，发病率低。
