Vivantes Neurochirurgie, Klinikum Neukoelln, Rudower Str. 48, 12351, Berlin, Germany.
Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
Eur Spine J. 2020 Dec;29(Suppl 2):162-170. doi: 10.1007/s00586-020-06405-8. Epub 2020 Apr 15.
The treatment of a retro-odontoid pseudotumor mass associated with severe spinal cord compression is challenging due to the complex regional anatomy. Here, we present an attractive treatment option involving a single-stage posterior transdural microsurgical resection followed by instrumented cervical reconstruction.
We describe three patients presenting with clinical signs of cervical myelopathy and an imaging finding of mucoid and fibrous soft or semi-soft retro-odontoid pseudotumor mass with significant spinal cord compression at the C1/C2 level. Given the severity of the symptoms, surgical decompression was planned and fusion was necessitated by the severe degenerative osteoarthritis seen at the C1/C2 level with signs of instability. Using a standard posterior approach to the spine, a suboccipital decompression by craniectomy and laminectomy of C1, C2 and C3 was performed. The masses were visualized and confirmed with ultrasound imaging, and intraoperative neurosurgical monitoring was applied. The dura was then opened from the level of C0-C2. Exiting C2-C3 nerve roots were identified and protected throughout the procedure, and the dentate ligament was cut to facilitate access. Incision of the anterior dura provided easy access to the lesion for resection without any spinal cord retraction. Multiple intraoperative samples were sent to pathology for tissue diagnosis. The dura was closed with sutures and an overlay of fibrin sealant with collagen matrix sponge. The fusion procedures were performed using a standard occipital cervical plate and screws technique with contoured titanium rods.
The posterior cervical transdural approach is a safe alternative procedure for mucoid and fibrous soft or semi-soft retro-odontoid pseudotumor mass removal. Preoperative CT scan can evaluate tissue characteristics and distinguish between a soft or ossified mass in front of the spinal cord. Local anatomical conditions facilitate less bleeding and adhesions, together with less spinal cord traction, in the intradural space. Cranio-cervical and suboccipital stabilization can be easily and safely performed with this exposure.
由于复杂的区域解剖结构，治疗与严重脊髓压迫相关的 Retro-odontoid 假瘤肿块具有挑战性。在这里，我们提出了一种有吸引力的治疗选择，包括单阶段后路经硬脑膜显微切除，然后进行器械化颈椎重建。
我们描述了 3 名患者，他们表现出颈椎脊髓病的临床体征，影像学检查发现 C1/C2 水平有粘液性和纤维性软或半软 Retro-odontoid 假瘤肿块，脊髓压迫明显。鉴于症状的严重程度，计划进行手术减压，并且由于 C1/C2 水平严重退行性骨关节炎和不稳定迹象，需要融合。使用标准后路脊柱入路，进行颅后窝减压，行 C1、C2 和 C3 的颅骨切除术和椎板切除术。通过超声成像对肿块进行可视化和确认，并应用术中神经外科监测。然后从 C0-C2 水平打开硬脑膜。在整个过程中识别和保护 C2-C3 神经根，切断齿状韧带以方便进入。切开前硬脑膜可方便地进入病变部位进行切除，而无需脊髓回缩。多次术中样本被送往病理科进行组织诊断。硬脑膜用缝线缝合，并在纤维蛋白密封剂上覆盖胶原基质海绵。融合过程采用标准枕颈钢板和螺钉技术，使用塑形钛棒。
后路颈椎经硬脑膜入路是一种安全的替代方法，可用于粘液性和纤维性软或半软 Retro-odontoid 假瘤肿块切除。术前 CT 扫描可评估组织特征，并区分脊髓前方的软或骨化肿块。局部解剖条件有利于减少硬脑膜内空间的出血和粘连，以及对脊髓的牵引。通过这种暴露，可轻松、安全地进行颅颈和颅后窝稳定。
