Dabboucy Baraa, Lahiani Wissem, Bresson Damien, Aldahak Nouman
Department of Neurosurgery, Faculty of Medicine, Lebanese University, Beirut, Lebanon.
Department of Neurosurgery, AP-HP, Henri Mondor Hospital, Créteil, France.
J Yeungnam Med Sci. 2023 Jan;40(1):96-101. doi: 10.12701/jyms.2022.00234. Epub 2022 Jul 20.
The endoscopic endonasal approach (EEA) to the craniovertebral junction (CVJ) has recently been considered a safer alternative and less invasive approach than the traditional transoral approach because the complications associated with the latter are avoided or minimized. Here, we present two challenging cases of CVJ pathologies. The first case involved os odontoideum associated with anterior displacement of the occipitocervical junction where the EEA was used, followed by C0-C1-C2 fusion using a posterior approach to decompress the CVJ, and was complicated by rhinorrhea and Candida albicans meningitis. The second case involved basilar invagination with syringomyelia previously treated using a posterior approach, where aggravation of neuropathic symptoms required combined treatment with EEA and occipitocervical fusion of C0-C2-C3-C4, with the postoperative course challenged by operative site infection requiring drainage with debridement and antibiotic therapy. The EEA is an alternative approach for accessing the CVJ in well-selected patients. Knowledge of EEA complications is crucial for the optimal care of patients.
经鼻内镜入路（EEA）治疗颅颈交界区（CVJ）疾病，近来被认为是一种比传统经口入路更安全、侵入性更小的替代方法，因为后者相关并发症得以避免或减少。在此，我们展示两例具有挑战性的CVJ疾病病例。第一例为齿突游离小骨合并枕颈交界区前移，采用EEA治疗，随后通过后路进行C0-C1-C2融合以减压CVJ，术后出现鼻漏和白色念珠菌性脑膜炎。第二例为基底凹陷合并脊髓空洞症，此前采用后路治疗，因神经症状加重，需联合EEA及C0-C2-C3-C4枕颈融合术，术后出现手术部位感染，需行清创引流及抗生素治疗。EEA是精心挑选患者治疗CVJ疾病的一种替代方法。了解EEA相关并发症对患者的最佳治疗至关重要。
