Endoscopic Endonasal Approach to the Odontoid Pathologies

被引:24
作者
Zenga, Francesco [1 ]
Pacca, Paolo [1 ]
Tardivo, Valentina [1 ]
Pennacchietti, Valentina [1 ]
Garbossa, Diego [1 ]
Pecorari, Giancarlo [2 ]
Ducati, Alessandro [1 ]
机构
[1] Univ Turin, Dept Neurosci, Div Neurosurg, Cherasco, South Korea
[2] Univ Turin, Dept Surg Sci, ENT Div 1, Genoa, Italy
关键词
CVJ stability; Endonasal approach; Endoscopic; Odontoidectomy; CRANIOVERTEBRAL JUNCTION PATHOLOGY; TECHNICAL CASE-REPORT; CRANIOCERVICAL JUNCTION; RHEUMATOID-ARTHRITIS; DECOMPRESSION; SURGERY; BIOMECHANICS; EVOLUTION; ANATOMY; LINE;
D O I
10.1016/j.wneu.2016.02.011
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: Surgical anterior decompression represents the treatment of choice for symptomatic irreducible ventral craniovertebral junction (CVJ) compression. With the refinement of the endoscopic techniques, the endonasal route has been proposed as alternative to the classic transoral approach to CVJ. Some reports assess the effectiveness and safety of endoscopic endonasal approaches to CVJ pathologies. MATERIALS AND METHODS: From July 2011 to February 2014, 12 patients with symptomatic nonreducible ventral spinal cord compression underwent purely 3-dimensional endoscopic endonasal odontoidectomy in our department. The surgical technique is described. RESULTS: A good brainstem-medullary decompression was achieved in all patients. In 10 of 12 patients the endotracheal tube was removed just after the procedure with good recovery of the respiratory function. We report no cases of velopharyngeal insufficiency. In 5 of 12 patients the preservation of C1 anterior was achieved, without the need for posterior cervical fixation. DISCUSSION AND CONCLUSIONS: Endoscopic endonasal odontoidectomy has proven to be safe and effective in selected patients. Soft and hard palate preservation dramatically reduces the risk of postoperative velopharyngeal insufficiency. Moreover, the endonasal endoscopic approach provides a direct access to the dens. Three-dimensional high-definition endoscope, laser, and ultrasound bony curettes revealed to be useful tools for this approach that, however, remains a demanding one.
引用
收藏
页码:394 / 403
页数:10
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