Ottenhausen Malte, Greco Elena, Bertolini Giacomo, Gerosa Andrea, Ippolito Salvatore, Middlebrooks Erik H, Serrao Graziano, Bruzzone Maria Grazia, Costa Francesco, Ferroli Paolo, La Corte Emanuele
Department of Neurological Surgery, University Medical Center Mainz, 55131 Mainz, Germany.
Department of Radiology, Mayo Clinic, Jacksonville, FL 32224, USA.
Diagnostics (Basel). 2023 Apr 21;13(8):1502. doi: 10.3390/diagnostics13081502.
The craniovertebral junction (CVJ) is a complex transition area between the skull and cervical spine. Pathologies such as chordoma, chondrosarcoma and aneurysmal bone cysts may be encountered in this anatomical area and may predispose individuals to joint instability. An adequate clinical and radiological assessment is mandatory to predict any postoperative instability and the need for fixation. There is no common consensus on the need for, timing and setting of craniovertebral fixation techniques after a craniovertebral oncological surgery. The aim of the present review is to summarize the anatomy, biomechanics and pathology of the craniovertebral junction and to describe the available surgical approaches to and considerations of joint instability after craniovertebral tumor resections. Although a one-size-fits-all approach cannot encompass the extremely challenging pathologies encountered in the CVJ area, including the possible mechanical instability that is a consequence of oncological resections, the optimal surgical strategy (anterior vs posterior vs posterolateral) tailored to the patient's needs can be assessed preoperatively in many instances. Preserving the intrinsic and extrinsic ligaments, principally the transverse ligament, and the bony structures, namely the C1 anterior arch and occipital condyle, ensures spinal stability in most of the cases. Conversely, in situations that require the removal of those structures, or in cases where they are disrupted by the tumor, a thorough clinical and radiological assessment is needed to timely detect any instability and to plan a surgical stabilization procedure. We hope that this review will help shed light on the current evidence and pave the way for future studies on this topic.
颅颈交界区（CVJ）是颅骨与颈椎之间的一个复杂过渡区域。在这个解剖区域可能会遇到脊索瘤、软骨肉瘤和动脉瘤样骨囊肿等病变，这些病变可能使个体易发生关节不稳定。进行充分的临床和影像学评估对于预测任何术后不稳定情况以及是否需要固定至关重要。对于颅颈肿瘤手术后颅颈固定技术的必要性、时机和方式，目前尚无共识。本综述的目的是总结颅颈交界区的解剖结构、生物力学和病理学，并描述颅颈肿瘤切除术后可用的手术入路以及对关节不稳定的考虑因素。尽管一刀切的方法无法涵盖CVJ区域遇到的极具挑战性的病变，包括肿瘤切除导致的可能的机械不稳定，但在许多情况下，可以在术前评估根据患者需求定制的最佳手术策略（前路、后路或后外侧）。保留内在和外在韧带，主要是横韧带，以及骨结构，即C1前弓和枕髁，在大多数情况下可确保脊柱稳定。相反，在需要切除这些结构的情况下，或在它们被肿瘤破坏的情况下，需要进行全面的临床和影像学评估，以便及时发现任何不稳定情况并规划手术稳定程序。我们希望本综述将有助于阐明当前的证据，并为该主题的未来研究铺平道路。
