Ye Jichao, Liu Bin, Li Jinteng, Zheng Guan, Duan Kaidi, Gao Liangbin, Zhang Chunyan, Huang Jingwen, Tang Yong
Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Orthopedics, Lishui People's Hospital, Li Shui, China.
Front Surg. 2023 Jan 6;9:973064. doi: 10.3389/fsurg.2022.973064. eCollection 2022.
Odontoidectomy aims to decompress the medulla oblongata and is usually performed through the classical transoral approach, which affects oropharynx and accompanied with high rate of complications comprising swallowing and respiratory tract. We have developed a minimal invasive method a standard cervical anterior approach: full-endoscopic trans-cervical odontoidectomy, which provides an alternative access for the resection of odontoid process and medulla oblongata decompression without traversing potentially contaminated cavities.
From 2018 to 2020, three patients with either odontoid process lesion or basilar invagination underwent full-endoscopic uniportal trans-cervical odontoidectomy with/without combining the posterior instrumentation. With fluoroscopic guidance, a uniportal endoscope sleeve was placed inside of the odontoid process; then odontoid process was gradually resected from the inside to outside under endoscopic monitoring. Postoperative images and clinical data were collected during post-op follow-up.
Patients were soon extubated after surgery when patients wake up from general anesthesia. There were no severely perioperative complications, especially dysphagia and airway obstruction, and the symptoms and neurological function was improved immediately after surgery. The final pathology of one patient with odontoid osteolytic lesion was confirmed as plasmacytoma. The postoperative CT scans proved that the range of odontoid process resection was consistent with the preoperative expectation.
In summary, our proposed endoscopic trans-cervical odontoidectomy provides a valid choice for non-oral approach, which would reduce postoperative approach related complications and accelerate postoperative recovery.
齿状突切除术旨在解除延髓压迫，通常通过经典经口入路进行，该入路会影响口咽，且并发症发生率高，包括吞咽和呼吸道并发症。我们开发了一种微创方法——标准颈前入路：全内镜经颈齿状突切除术，该方法为切除齿状突和解除延髓压迫提供了一种替代途径，无需穿过潜在污染腔隙。
2018年至2020年，3例患有齿状突病变或基底凹陷的患者接受了全内镜单孔经颈齿状突切除术，伴或不伴后路内固定。在荧光透视引导下，将单孔内镜套管置于齿状突内；然后在内镜监测下从内向外逐渐切除齿状突。术后随访期间收集术后影像和临床数据。
患者在全身麻醉苏醒后很快拔除气管插管。围手术期无严重并发症，尤其是吞咽困难和气道梗阻，术后症状和神经功能立即改善。1例齿状突溶骨性病变患者的最终病理确诊为浆细胞瘤。术后CT扫描证实齿状突切除范围与术前预期一致。
总之，我们提出的内镜经颈齿状突切除术为非经口入路提供了一种有效的选择，可减少术后入路相关并发症并加速术后恢复。
