Endoscopic transcervical odontoidectomy for pediatric basilar invagination and cranial settling - Report of 4 cases

被引:50
作者
McGirt, Matthew J. [1 ]
Attenello, Frank J. [1 ]
Sciubba, Daniel M. [1 ]
Gokaslan, Ziya L. [1 ]
Wolinsky, Jean-Paul [1 ]
机构
[1] Johns Hopkins Univ Hosp, Dept Neurosurg, Baltimore, MD 21287 USA
关键词
basilar invagination; brainstem decompression; endoscopic odontoidectomy; myelopathy;
D O I
10.3171/PED/2008/1/4/337
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Pediatric basilar invagination and cranial settling have traditionally been approached through a transoral-transpharyngeal route with or without extended maxillotomy or mandibulotomy for resection of the anterior portion of C-1 and the odontoid. The authors hypothesize that application of a recently described endoscopic transcervical odontoidectomy (ETO) technique would allow an alternative approach for the treatment of ventral pathological entities at the craniocervical junction in pediatric patients. The authors performed ETO in a consecutive series of pediatric patients presenting with myelopathy or bulbar dysfunction resulting from basilar invagination or cranial settling. All clinical, radiographic, surgical, and follow-up data were prospectively collected. The initial experience with ETO in the pediatric population is analyzed and outcomes are reported. Three patients required ETO for basilar invagination and 1 required ETO with anterior C-1 arch and distal clivus resection for cranial settling. All patients presented with myelopathy. One patient was wheelchair bound with severe quadriparesis. The mean age was 14 +/- 3 years (mean +/- standard deviation [SD]) in the 2 male and 2 female patients. The ETO and posterior fusion were performed as a 2-stage procedure in 2 (50%) and as a single-stage procedure in 2 (50%) cases. Prolonged intubation or postoperative placement of a gastrostomy tube was not needed in any case. The postoperative hospitalization lasted 9 +/- 4 days (mean +/- SD). At last follow-up (mean 5 months), head and neck pain had resolved and motor strength had improved or stabilized in all cases. All 4 children were independently functioning and ambulatory at the last follow-up. In the authors' initial experience, ETO has allowed ventral brainstem decompression without the need for prolonged intubation, worsening dysphagia requiring enteral tube feeding, or prolonged hospitalization, and has resulted in cosmetically appealing results. The ETO technique allows an alternative approach for the treatment of ventral pathological entities at the craniocervical function in pediatric patients.
引用
收藏
页码:337 / 342
页数:6
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