Kingdom T T, Nockels R P, Kaplan M J
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco 94143-0342, USA.
Otolaryngol Head Neck Surg. 1995 Oct;113(4):393-400. doi: 10.1016/S0194-59989570074-9.
The transoral-transpharyngeal approach is a reliable and technically sound method for gaining anterior extradural exposure to the craniocervical junction. We report 23 patients undergoing this approach for pathology lying between the inferior clivus and third cervical vertebra. Pathology included 6 patients with congenital malformations of the odontoid process, 4 patients with basilar invagination caused by rheumatoid arthritis, 2 patients with atlantoaxial subluxation caused by Down's syndrome, and 1 each with Chiari I malformation, pseudogout of C1/C2, ossification of the posterior longitudinal ligament, and chronic dens dislocation caused by trauma. Malignant tumors included 4 chordomas, 2 giant cell tumors of C1-C3, and 1 chondrosarcoma. Orotracheal intubation without tracheotomy was used in 22 patients. Sixteen of these 22 patients were extubated either immediately or within 24 hours. Six complications occurred in 5 patients and included a palatal dehiscence in 2, delayed oropharyngeal hemorrhage, prolonged endotracheal intubation because of severe tongue edema, and 1 case each of meningitis and aspiration pneumonia responsive to intravenous antibiotics. No deaths, local infections, or postoperative cerebrospinal fluid leaks occurred. Neurologic symptoms of cord compression improved or stabilized in all patients. The transoral-transpharyngeal approach is an effective means for extradural decompression of the anterior craniocervical junction and for exposure of selected tumors at this site.
经口-经咽入路是一种可靠且技术上合理的方法，用于获得颅颈交界区硬膜外前方的显露。我们报告了23例接受此入路手术的患者，其病变位于斜坡下部至第三颈椎之间。病变包括6例齿状突先天性畸形患者、4例类风湿关节炎所致的基底凹陷患者、2例唐氏综合征所致的寰枢椎半脱位患者，以及各1例Chiari I畸形、C1/C2假性痛风、后纵韧带骨化和创伤所致慢性齿突脱位患者。恶性肿瘤包括4例脊索瘤、2例C1-C3巨细胞瘤和1例软骨肉瘤。22例患者采用了无需气管切开的经口气管插管。这22例患者中有16例在术后立即或24小时内拔管。5例患者出现了6种并发症，包括2例腭部裂开、延迟性口咽出血、因严重舌水肿导致的气管插管时间延长，以及各1例对静脉抗生素有反应的脑膜炎和吸入性肺炎。未发生死亡、局部感染或术后脑脊液漏。所有患者脊髓受压的神经症状均有改善或稳定。经口-经咽入路是颅颈交界区硬膜外减压以及显露该部位特定肿瘤的有效方法。
