经口咽入路行延髓-颈髓腹侧减压治疗颅颈交界区畸形

Microsurgical odontoidectomy via transoral transpharyngeal approach for craniovertebral junction malformation

目的探讨经口咽入路齿状突磨除行脑干腹侧减压的手术技巧及安全性。方法总结2006年1月-2008年12月间我院神经外科收治的85例颅颈交界区畸形患者,其中寰枢椎脱位伴或不伴齿状突型颅底陷入69例,单纯扁平颅底不伴脱位16例。MRI均显示有延髓、上颈髓腹侧受压;合并小脑扁桃体下疝44例,合并脊髓空洞36例。所有病例均在显微镜直视下经口咽入路切除齿状突,扁平颅底病例加斜坡下端磨除行脑干腹侧减压。结果83例术后10d内临床症状较术前改善,2例改善不明显,复查发现齿状突磨除不彻底,其中1例2次行齿状突磨除后症状消失。3例术中发现脑脊液漏,1例术中未发现漏但术后脑脊液感染发热,4例均经腰大池置管引流1周痊愈。本组无死亡病例。结论经口咽入路齿状突和斜坡下端磨除行脑干腹侧减压是一种安全、有效的治疗颅颈交界区畸形的手术选择。

Objective To study the microsurgical odontoidectomy via transoral transpharyngeal approach for craniovertebral junction malformation and its safety. Methods Craniovertebral junction malformation in 85 consecutive patients was treated with microsurgical odontoidectomy via transoral transpharyngeal approach for ventral neural decompression in our hospital from January 1, 2006 to December 31, 2008. Of the 85 patients, 69 had fixed atlantoaxial dislocation combined with or without basilar invagination and 16 had basilar impression. MR imaging showed anterior compression on brain stem and superior cervical spine in all patients, hindbrain impression in 44 patients, and syringomyelia in 36 patients. All the patients underwent microsurgical odontoidectomy via transoral transpharyngeal approach for the ventral neural decompression. Results Good recovery and improvement were found in 83 patients immediately after the operation, the remaining 2 patients had no clinical improvement because of the incomplete decompression. Cerebrospinal fluid leakage occurred in 4 patients and stopped 1 week after placement of a subarachnoid lumbar drain. No death occurred. Conclusion Transoral technique is a viable and useful option in the treatment of irreducible ventral craniocervical junction bony compression.