Kosaraju Nikitha, Lee Christine K, Qian Z Jason, Fernandez-Miranda Juan C, Nayak Jayakar V, Chang Michael T
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States.
David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, United States.
J Neurol Surg B Skull Base. 2024 Mar 1;86(1):82-91. doi: 10.1055/a-2257-5439. eCollection 2025 Feb.
Endonasal odontoidectomy (EO) is a procedure for addressing compressive pathology of the craniovertebral junction. While EO has been well established in adults, its complications and cervical fusion practices are less understood in pediatric patients, despite differences in sinonasal and craniocervical anatomy. This study summarizes and compares EO complications and need for cervical fusion in pediatric and adult patients. This was a systematic review and meta-analysis. Literature review was conducted using PubMed, Web of Science, and Embase to identify studies reporting complications post-EO in adult and pediatric patients. Complications were categorized as neurologic, swallowing, or respiratory. Complication and posterior fusion rates were compared using a random-effects model. A total of 738 articles were identified, of which 28 studies including 307 adult cases and 22 pediatric cases met inclusion criteria for systematic qualitative and quantitative review. The rates for adult and pediatric cases, respectively, were: respiratory complications 13.4 versus 9.1%, swallowing complications 12.1 versus 4.5%, neurologic complications 8.5 versus 9.1%, and cervical fusion rates 73.3 versus 86.4%. Across eight studies qualifying for meta-analysis, there were no differences in cervical fusion (odds ratio [OR]: 0.5, 95% confidence interval [CI]: [0.1, 2.1]), respiratory complications (OR: 3.5, 95% CI: [0.8, 14.5]), or swallowing complications (OR: 3.5, 95% CI: [0.5, 26.0]); however, pediatric patients had a higher rate of neurologic complications (OR: 5.2, 95% CI: [1.1, 25.0]). In EO, rates of aerodigestive complications and cervical fusion are similar in both populations. There may be an increased risk of neurologic complications in pediatric patients, although more high-quality studies are needed.
经鼻齿状突切除术（EO）是一种治疗颅颈交界区压迫性病变的手术方法。虽然EO在成人中已得到广泛应用，但由于小儿鼻窦和颅颈解剖结构的差异，其在小儿患者中的并发症及颈椎融合情况尚鲜为人知。本研究总结并比较了小儿和成人患者EO术后的并发症及颈椎融合需求。
这是一项系统评价和荟萃分析。通过PubMed、科学网和Embase进行文献检索，以确定报告成人和小儿患者EO术后并发症的研究。并发症分为神经、吞咽或呼吸相关并发症。采用随机效应模型比较并发症和后路融合率。
共检索到738篇文章，其中28项研究（包括307例成人病例和22例小儿病例）符合系统定性和定量评价的纳入标准。成人和小儿病例的发生率分别为：呼吸并发症13.4%对9.1%，吞咽并发症12.1%对4.5%，神经并发症8.5%对9.1%，颈椎融合率73.3%对86.4%。在八项符合荟萃分析条件的研究中，颈椎融合（优势比[OR]：0.5，95%置信区间[CI]：[0.1, 2.1]）、呼吸并发症（OR：3.5，95% CI：[0.8, 14.5]）或吞咽并发症（OR：3.5，95% CI：[0.5, 26.0]）方面无差异；然而，小儿患者的神经并发症发生率较高（OR：5.2，95% CI：[1.1, 25.0]）。
在EO手术中，两个群体的气道消化道并发症和颈椎融合率相似。小儿患者可能存在更高的神经并发症风险，不过仍需要更多高质量的研究。
