Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan.
Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan.
World Neurosurg. 2022 Sep;165:27-44. doi: 10.1016/j.wneu.2022.06.024. Epub 2022 Jun 11.
Although posterior procedures are used for most cases of basilar invagination, transoral decompression is an important tool in complex deformities with severe degeneration and neural compression.
Consecutive patients who underwent transoral odontoidectomy for basilar invagination and atlantoaxial dislocation at the neurosurgical unit of Lady Reading Hospital Peshawar between June 2016 and January 2022 were retrospectively included. Preoperative and postoperative neurological, clinical, and radiological parameters were recorded and compared.
Of the 33 patients included in this study, 22 were men and 11 were women. The mean age was 23.4 years ±8.4 years (mean ± standard deviation). The most common presenting symptoms were gait abnormalities and neck pain. A total of 28 patients were treated for the first time, while 5 patients had prior posterior fusion. The mean distance of the tip of the dens above the chamberlain line was 8.9 ± 4.2 mm, while the mean anterior atlantodental interval was 6.5 ± 2.1 mm. Seven patients had an anomalous course of vertebral artery on at least one side. A total of 28 patients improved significantly, while 5 patients did not improve at the follow-up. The mean follow-up was 8.5 months ±6.3 (mean ± standard deviation). The mean Nurick and Modified Japanese Orthopedic Association scores improved postoperatively (P < 0.05). Three patients underwent reoperation including one with vertebral artery injury. Three patients underwent tracheostomy.
With proper patient selection, transoral odontoidectomy can be safely performed in a limited-resource setting.
尽管后路手术被广泛应用于大多数颅底凹陷症病例，但对于严重退变和神经压迫的复杂畸形，经口减压术是一种重要的治疗手段。
回顾性分析了 2016 年 6 月至 2022 年 1 月在白沙瓦莱迪雷丁医院神经外科接受经口寰椎切除术治疗颅底凹陷症合并寰枢椎脱位的连续患者。记录并比较了患者术前、术后的神经、临床和影像学参数。
本研究共纳入 33 例患者，其中男性 22 例，女性 11 例，平均年龄 23.4±8.4 岁。最常见的首发症状是步态异常和颈部疼痛。28 例患者为首次治疗，5 例患者有后路融合史。齿状突尖至 Chamberlain 线的距离平均为 8.9±4.2mm，寰齿前间距平均为 6.5±2.1mm。7 例患者至少一侧椎动脉走行异常。28 例患者术后显著改善，5 例患者无改善。平均随访时间为 8.5±6.3 个月（均数±标准差）。Nurick 和改良日本骨科协会评分术后均有改善（P<0.05）。3 例患者再次手术，其中 1 例发生椎动脉损伤。3 例行气管切开术。
在资源有限的情况下，经口寰椎切除术可在适当的患者选择下安全实施。
