Reconsideration of the transoral odontoidectomy in complex craniovertebral junction patients with irreducible anterior compression

被引：6

作者：

Wang X. ^{[1
]}

Ma L. ^{[1
]}

Liu Z. ^{[1
]}

Chen Z. ^{[1
]}

Wu H. ^{[1
]}

Jian F. ^{[1
]}

机构：

[1] Department of Neurological Surgery, Xuanwu Hospital, Capital Medical University, Beijing

来源：

Chinese Neurosurgical Journal | / 6卷 / 1期

关键词：

Atlantoaxial dislocation; Basilar invagination; Image-guided navigation; Odontoidectomy; Transoral approach;

D O I：

10.1186/s41016-020-00210-4

中图分类号：

学科分类号：

摘要：

Background: Although the single-stage posterior realignment craniovertebral junction (CVJ) surgery could treat most of the basilar invagination (BI) and atlantoaxial dislocation (AAD), there are still some cases with incomplete decompression of the spinal cord, which remains a technique challenging situation. Methods: Eleven patients were included with remained myelopathic symptoms after posterior correction due to incomplete decompression of the spinal cord. Transoral odontoidectomy assisted by image-guided navigation and intraoperative CT was performed. Clinical assessment and image measurements were performed preoperatively and at the most recent follow-up. Results: Eleven patients were followed up for an average of 47 months. Symptoms were alleviated in 10 of 11 patients (90.9%). One patient died of an unknown reason 1 week after the transoral approach. The clinical and radiological parameters pre- and postoperatively were reported. Conclusion: Transoral odontoidectomy as a salvage surgery is safe and effective for properly selected BI and AAD patients after inadequate indirect decompression from posterior distraction and fixation. Image-guided navigation and intraoperative CT can provide precise information and accurate localization during operation, thus enabling complete resection of the odontoid process and decompression of the spinal cord. © 2020 The Author(s).

引用

共 30 条

[1]

Lan S., Xu J., Wu Z., Xia H., Ma X., Zhang K., Et al., Atlantoaxial joint distraction for the treatment of basilar invagination: Clinical outcomes and radiographic evaluation, World Neurosurgery, 111, pp. e135-e141, (2018)

[2]

Ottenhausen M., Alalade A.F., Rumalla K., Nair P., Baaj A., Hartl R., Et al., Quality of life after combined endonasal endoscopic odontoidectomy and posterior suboccipital decompression and fusion, World Neurosurgery, 116, pp. e571-e576, (2018)

[3]

Chang P.Y., Yen Y.S., Wu J.C., Chang H.K., Ly F., Tu T.H., Et al., The importance of atlantoaxial fixation after odontoidectomy, J Neurosurg Spine, 24, 2, pp. 300-308, (2016)

[4]

Yin Y.-H., Tong H.-Y., Qiao G.-Y., Yu X.-G., Posterior reduction of fixed atlantoaxial dislocation and basilar invagination by atlantoaxial facet joint release and fixation: A modified technique with 174 cases, Neurosurgery, 78, 3, pp. 391-400, (2016)

[5]

Xia H., Yin Q.S., Ai F.Z., Ma X.Y., Wang J.H., Wu Z.H., Et al., Treatment of basilar invagination with atlantoaxial dislocation: Atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate (TARP) without odontoidectomy, Eur Spine J, 23, 8, pp. 1648-1655, (2014)

[6]

Iacoangeli M., Nasi D., Colasanti R., Pan B., Re M., Rienzo A., Et al., Endoscopic endonasal odontoidectomy with anterior C1 arch preservation in rheumatoid arthritis: Long-term follow-up and further technical improvement by anterior endoscopic C1-C2 screw fixation and fusion, World Neurosurgery, 107, pp. 820-829, (2017)

[7]

Fujii T., Platt A., Zada G., Endoscopic endonasal approaches to the craniovertebral junction: A systematic review of the literature, J Neurol Surg B, 76, 6, pp. 480-488, (2015)

[8]

Tun K., Kaptanoglu E., Cemil B., Karahan S.T., Esmer A.F., Elhan A., A neurosurgical view of anatomical evaluation of anterior C1-C2 for safer transoral odontoidectomy, Eur Spine J, 17, 6, pp. 853-856, (2008)

[9]

Lee J.Y.K., Lega B., Bhowmick D., Newman J.G., O'Malley B.W., Weinstein G.S., Et al., Da Vinci robot-assisted transoral odontoidectomy for basilar invagination, ORL J Otorhinolaryngol Relat Spec, 72, 2, pp. 91-95, (2010)

[10]

Zhang Q.H., Feng K., Bo Y., Guo H.C., Li M.C., Ge C., Et al., Transoral endoscopic odontoidectomy to decompress the cervicomedullary junction, Spine, 38, 14, pp. E901-E906, (2013)

← 1 2 3 →