Endoscopic image-guided odontoidectomy for decompression of basilar invagination via a standard anterior cervical approach

Journal of Neurosurgery: Spine - Tập 6 Số 2 - Trang 184-191 - 2007
Jean‐Paul Wolinsky1, Daniel M. Sciubba1, Ian Suk1, Ziya L. Gokaslan1
1Department of Neurosurgery, Johns Hopkins Medical Institutions, Baltimore, Maryland

Tóm tắt

✓Symptomatic irreducible basilar invagination has traditionally been approached through a transoral–transpharyngeal route with resection of the anterior portion of C-1 and the odontoid. Modification of this exposure with either a Le Fort osteotomy or a transmandibular osteotomy and circumglossal approach has increased the access to pathological conditions in this region. These traditional routes all require traversing the oral cavity and accepting the associated potential complications. The authors have developed a novel surgical approach, an endoscopic transcervical odontoidectomy, which allows access for resection of the odontoid and for brainstem and spinal cord decompression without traversing the oral cavity. In this paper they describe the technique and its advantages and present three cases in which patients underwent the endoscopic transcervical odontoidectomy for basilar invagination.Three consecutive patients (age range 42–74 years) who had irreducible basilar invagination underwent the endoscopic transcervical odontoidectomy. All were symptomatic and had neck pain and myelopathy. All were evaluated preoperatively and postoperatively with computed tomography and magnetic resonance imaging. In all cases the procedure resulted in complete decompression. There were no serious complications. No patient required prolonged intubation, tracheostomy, or enteral tube feeding. One patient had an intraoperative cerebrospinal fluid leak, which had no postoperative sequelae.The authors present an alternative surgical approach for treating ventral compression of the brainstem and spinal cord. The technique is safe and effective for decompression and provides a surgical route that can be added to the armamentarium of treatments for pathological conditions in this region.

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Tài liệu tham khảo

10.1007/s007010200029

10.1055/s-2008-1057101

Apfelbaum RI, 1992, Neurosurgical Operative Atlas, 2, 3, 189

Apfelbaum RI, 2000, J Neurosurg, 93, 227

10.1097/00006123-197809000-00012

10.1227/00006123-198106000-00006

10.3171/jns.2006.105.2.301

Bertrand J, 2000, Head Neck, 22, 323, 10.1002/1097-0347(200007)22:4<323::AID-HED2>3.0.CO;2-8

Bruneau M, 2006, Neurosurgery, 59, ONS20

Cantarella G, 1998, J Neurosurg Sci, 42, 51, 10.1097/00006123-199801000-00010

10.1007/s10143-004-0329-6

Crockard HA, 1991, Orthopade, 20, 140

Crockard HA, 1986, J Bone Joint Surg Br, 68, 350, 10.2106/00004623-198668030-00006

10.1227/01.NEU.0000097271.55741.60

10.1097/00006123-198106000-00007

10.1007/BF01401296

El-Khoury GY, 1980, Radiology, 137, 637, 10.1148/radiology.137.3.7444048

10.1097/01.bsd.0000169062.77005.78

10.1097/00006123-200211002-00009

10.1097/01.brs.0000179414.64741.7b

10.1097/00007632-200303010-00024

Horgan MA, 1999, Minim Invasive Neurosurg, 42, 142, 10.1055/s-2008-1053387

Hott JS, 2003, J Neurosurg, 98, 294

10.1097/00006123-199109000-00012

10.1097/00024720-200304000-00018

10.1227/01.NEU.0000163687.64774.E4

10.1016/S0194-5998(95)70074-9

10.3171/jns.1988.69.6.0895

10.3171/jns.1985.63.4.0500

10.3171/jns.1980.53.4.0444

Neugebauer R, 1991, Unfallchirurg, 94, 313

10.3171/spi.2004.1.3.0299

10.1097/00007632-199501150-00017

10.1097/00006123-200009001-00017

Robinson RA, 1960, American Academy of Orthopaedic Surgery: Instructional Course Lectures, 299

Sakou T, 1984, Clin Orthop Relat Res, 187, 134, 10.1097/00003086-198407000-00018

Salcman M, 1979, Spine, 4, 209, 10.1097/00007632-197905000-00006

10.3171/jns.1997.86.6.0950

10.1007/s00586-006-0092-1

10.1016/S0002-9610(05)80327-7

10.1097/00007632-200106150-00024

10.1097/01.brs.0000184306.19870.a8

10.1097/00024720-200208000-00004

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Journal of Neurosurgery: Spine

Tập 6 Số 2

184-191

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