经口咽齿状突切除术10例分析

Transoral-transpharyngeal odontoidectomy:analysis of 10 cases

目的总结经口咽齿状突切除术的手术经验。方法回顾性分析10例齿状突压迫延髓及上颈髓腹侧病人的临床资料,其中单纯颅底凹陷4例,颅底凹陷伴Chiari畸形2例,颅底凹陷伴寰枕融合1例,下斜坡及齿状突后结缔组织增生1例,多种畸形复合2例。均采用经口咽入路齿状突切除减压手术。结果术后症状消失或明显缓解9例,因频发呼吸骤停而自动出院1例。术后随访9例,随访时间0.5~5年,未出现头痛、头晕及肢体运动功能障碍。结论经口咽齿状突切除术是治疗齿状突压迫延髓及上颈髓腹侧病变直接有效的手术方法。

Objective To review the surgical experiences with transoral-transpharyngeal odontoidectomy. Methods Clinical data of 10 patients with odontoid process oppressing the ventral side of the medulla oblongata and upper cervical cord were analyzed retrospectively, including basilar invagination in 4 cases, basilar invagination complicated by Chiari deformity in 2, basilar invagination complicated by atlantooccipital fusion in 1, hyperplasia of connective tissue behind lower clivus and odontoid process in 1 and multiple deformity in 2. All the patients underwent transoral-transpharyngeal odontoidectomy. Results Nine patients recovered without any symptoms or with symptoms ameliorated significantly, and the other one gave up therapy because of postoperative frequent apnea. A follow-up was performed for from 6 months to 5 years in 9 patients, and no cephalalgia, dizziness and limb movement disturbance were found. Conclusion Transoral-transpharyngeal odontoidectomy is a direct and effective method for patients with odontoid process oppressing ventral side of the medulla oblongata and upper cervical cord.