Viola Árpád, Kozma István, Süvegh Dávid
Department of Neurotraumatology, Semmelweis University, Fiumei út 17, 1081, Budapest, Hungary.
Department of Neurosurgery and Neurotraumatology, Péterfy Hospital - Manninger Jenő National Traumatology Institution, Fiumei út 17, 1081, Budapest, Hungary.
BMC Surg. 2021 Apr 19;21(1):199. doi: 10.1186/s12893-021-01198-z.
Our objective was to develop a new, minimally invasive surgical technique for the resolution of craniovertebral junction pathologies, which can eliminate the complications of the previous methods, like liquor-leakage, velopharyngeal insufficiency and wound-dehiscence associated with the transoral or lateral approaches.
During the first stage of the operation, three patients underwent occipito-cervical dorsal fusion, while the fourth patient received C1-C2 fusion according to Harms. C1-C2 decompressive laminectomy was performed in all four cases. Ventral C1-C2 decompression with microscope assisted minimally invasive anterior submandibular retropharyngeal key-hole approach (MIS ASR) method was performed in the second stage. The MIS ASR-similarly to the traditional anterior retropharyngeal surgery-preserves the hard and soft palates, yet can be performed through a 25 mm wide incision with the use of only one retractor.
The MIS ASR approach was a success in all four cases, there were no intra- and postoperative complications. This method, compared to the transoral approach, provided on average 23% (4.56 cm/6.05 cm) smaller dural decompression area; nonetheless, the entire pathology could be removed in all cases. After the surgery, all patients have shown significant neurological improvement.
Based on the outcome of these four cases we think that the MIS ASR approach is a safe alternative to the traditional methods while improving patient safety by reducing the risk of complications.
我们的目标是开发一种新的微创手术技术来解决颅颈交界区病变，该技术能够消除先前方法的并发症，如经口或外侧入路相关的脑脊液漏、腭咽功能不全和伤口裂开。
在手术的第一阶段，3例患者接受枕颈后路融合术，而第4例患者根据哈姆斯法进行C1-C2融合术。所有4例患者均行C1-C2减压性椎板切除术。在第二阶段采用显微镜辅助微创下颌下咽后钥匙孔入路（MIS ASR）方法进行C1-C2腹侧减压。MIS ASR与传统的咽后前路手术类似，保留了硬腭和软腭，但仅通过一个25毫米宽的切口使用一个牵开器即可完成手术。
MIS ASR入路在所有4例患者中均获成功，无术中及术后并发症。与经口入路相比，该方法的硬脑膜减压面积平均小23%（4.56厘米/6.05厘米）；尽管如此，所有病例的全部病变均能被切除。术后所有患者的神经功能均有显著改善。
基于这4例患者的结果，我们认为MIS ASR入路是传统方法的一种安全替代方案，同时通过降低并发症风险提高了患者的安全性。
