Basil Gregory W, Sprau Annelise C, Starke Robert M, Levi Allan D, Wang Michael Y
Department of Neurological Surgery, University of Miami, Miami, Florida.
J Neurosurg Case Lessons. 2021 Feb 15;1(7):CASE2055. doi: 10.3171/CASE2055.
The percutaneous, endoscope-assisted anterior cervical discectomy is a relatively new procedure, and because of its novelty, complications are minimal and pertinent literature is scarce. This approach relies on a sufficient anatomical understanding of the vital neurovascular structures in the operating workspace. Although complications are rare, they can be significant.
The patient presented with difficulty breathing following an anterior percutaneous cervical discectomy performed at an outpatient surgical center. Imaging revealed a prevertebral hematoma and multiple carotid pseudoaneurysms. Given the large prevertebral hematoma and concern for imminent airway collapse, the authors proceeded with emergent intubation and surgical evacuation of the clot.
The authors propose managing complications in a fashion similar to those for comparable injuries after classic anterior approaches. Definitive management of our patient's carotid injury would require stenting and, therefore, dual antiplatelet agents. Thus, the authors proceeded with the hematoma evacuation first. Additionally, careful dissection was needed to decrease further carotid damage. Thus, the authors made a more rostral incision to maintain the given stability of the carotid insult before the angiographic intervention to follow. It is the authors' hope that the technical pearls from this two-staged open hematoma evacuation and endovascular stenting may guide future presurgical and intraoperative planning and management of complications, should they arise.
经皮内窥镜辅助下颈椎前路椎间盘切除术是一种相对较新的手术，由于其新颖性，并发症极少且相关文献匮乏。该手术方法依赖于对手术操作区域内重要神经血管结构有充分的解剖学认识。尽管并发症罕见，但可能很严重。
该患者在门诊手术中心接受经皮颈椎前路椎间盘切除术后出现呼吸困难。影像学检查显示有椎前血肿和多个颈动脉假性动脉瘤。鉴于巨大的椎前血肿以及担心气道即将塌陷，作者进行了紧急插管并手术清除血凝块。
作者建议以类似于经典前路手术后类似损伤的处理方式来处理并发症。对我们患者的颈动脉损伤进行确定性治疗需要置入支架，因此需要使用双联抗血小板药物。因此，作者首先进行了血肿清除。此外，需要仔细解剖以减少对颈动脉的进一步损伤。因此，作者在进行后续血管造影干预之前，做了一个更靠上的切口，以维持颈动脉损伤的现有稳定性。作者希望，这种分两阶段进行的开放性血肿清除和血管内支架置入的技术要点，可能会在并发症出现时指导未来的术前和术中规划及并发症处理。
