Garg Mayank, Sharma Raghavendra K, Janu Vikas, Agrawal Mohit, Jha Ashutosh, Khera Pushpinder, Jha Deepak K
Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Department of Neurosurgery, Dr. Ram Manohar Lohia Hospital, New Delhi, India.
J Neurol Surg B Skull Base. 2024 Feb 9;86(1):92-97. doi: 10.1055/a-2244-4761. eCollection 2025 Feb.
Instrumentation of C2 vertebra is considered the most difficult for young neurosurgeons and trainees due to its complex anatomical structures, variety of surgical approaches and techniques, and proximity to important neurovascular structures. Key points from a surgical perspective for midline posterior approach is described in the era of neuroradiological advancements. Computed tomography angiographies (CTAs) of a total of 92 patients were evaluated with special attention to the key findings for insertion of screws for craniovertebral junction (CVJ) fixations. All these patients were operated though midline posterior approach in past 4 years. CTAs included various CVJ disorders, which included traumatic ( = 14), congenital ( = 55), and rheumatoid arthritis ( = 2) patients. Established landmarks for screw insertion sites do not prove safe for congenital anomalous CVJ conditions. Instead of highlighting screw insertion entry points, part of the corridor, which is relevant, should be stressed up on. Midpoint of portion of bone segment medial to vertebral artery foramen should be the focus, which is important for pars interarticularis (and transarticular) and pedicle screws. A laminar screw should cross the midpoint of the lamina on each side.
由于C2椎体的解剖结构复杂、手术入路和技术多样以及靠近重要的神经血管结构，对于年轻神经外科医生和实习生来说，C2椎体的器械操作被认为是最困难的。在神经放射学进步的时代，描述了中线后路手术的手术要点。
共评估了92例患者的计算机断层血管造影（CTA），特别关注颅颈交界区（CVJ）固定螺钉插入的关键发现。所有这些患者在过去4年中均通过中线后路手术。
CTA包括各种CVJ疾病，其中包括创伤性（n = 14）、先天性（n = 55）和类风湿性关节炎（n = 2）患者。对于先天性异常CVJ情况，既定的螺钉插入部位标志并不安全。不应强调螺钉插入入口点，而应强调相关通道的一部分。
椎动脉孔内侧骨段部分的中点应作为重点，这对于关节突间部（和经关节）及椎弓根螺钉很重要。椎板螺钉应穿过每侧椎板的中点。
