Tuite G F, Veres R, Crockard H A, Sell D
Department of Surgical Neurology, The National Hospital for Neurology and Neurosurgery, London, England.
J Neurosurg. 1996 Apr;84(4):573-83. doi: 10.3171/jns.1996.84.4.0573.
Knowledge of the role and hazards of transoral surgery has expanded rapidly, but the application of this technique in children has been limited. To assess its usefulness, 27 pediatric patients who underwent transoral surgery between 1985 and 1994 were studied. Transoral surgery was performed for irreducible anterior neuraxial compression at the craniovertebral junction caused by basilar impression, atlantoaxial subluxation with pseudotumor, or chordoma. The patients ranged in age from 3 to 17 years. Symptomatic presentation varied widely, but 89% had significant neurological deficits before surgery. No patient with normal strength deteriorated after surgery. Of the 16 patients with a preoperative motor deficit, nine improved rapidly, three were unchanged, and four significantly worsened in the perioperative period. Those with mobile atlantoaxial subluxation were most vulnerable to surgically related neurological morbidity. Twenty-four patients were alive for long-term follow-up study (average 5.7 years, range 1-9.2 years). Of those with preoperative weakness, nine improved one Frankel grade, four remained the same, and one deteriorated from Frankel Grade D to C. Swallowing and speech worsened in five patients; this occurred only after resection of lesions above the foramen magnum (p<0.05) when rostral pharyngeal disruption resulted in velopharyngeal dysfunction. This study, unlike previous reviews of pediatric transoral operations, leads the authors to suggest that although transoral surgery can be effective, it also carries a significant risk of neurological injury in patients with symptomatic spinal cord compression and it is also associated with long-term swallowing and speech difficulties.
经口手术的作用及风险的相关知识迅速扩展，但该技术在儿童中的应用一直有限。为评估其效用，对1985年至1994年间接受经口手术的27例儿科患者进行了研究。经口手术用于治疗由基底压迹、伴有假瘤的寰枢椎半脱位或脊索瘤引起的颅颈交界部不可复位的前神经轴受压。患者年龄在3至17岁之间。症状表现差异很大，但89%的患者在手术前有明显的神经功能缺损。没有力量正常的患者在手术后出现恶化。在16例术前有运动功能缺损的患者中，9例迅速改善，3例无变化，4例在围手术期明显恶化。寰枢椎半脱位可活动的患者最易发生与手术相关的神经并发症。24例患者存活并接受长期随访研究（平均5.7年，范围1至9.2年）。在术前有肌无力的患者中，9例Frankel分级提高一级，4例保持不变，1例从Frankel D级恶化为C级。5例患者的吞咽和言语功能恶化；仅在切除枕大孔以上病变后出现这种情况（p<0.05），此时咽上部中断导致腭咽功能障碍。与以往对儿科经口手术的综述不同，本研究使作者认为，尽管经口手术可能有效，但对于有症状性脊髓压迫的患者，它也具有显著的神经损伤风险，并且还与长期的吞咽和言语困难相关。
