经口切除齿状突斜坡治疗颅颈交界区畸形6例体会

Treatment experience of craniovertebral malformation by transoral odontoid-clivusectomy:an analysis of 6 cases

目的探讨经口切除齿状突斜坡治疗颅颈交界区畸形的手术方法和疗效。方法 6例斜坡齿状突型颅颈交界处畸型,采用经口咽入路显微切除齿状突、斜坡下部及增生的结缔组织,解除其对延髓、颈髓腹侧压迫。随访半年以上,分析手术效果和并发症。结果症状明显好转2例(33.3%),减轻2例(33.3%),无效1例(16.7%),死亡1例(16.7%)。结论经口切除齿状突斜坡治疗颅颈交界区畸形可直接解除延髓、颈髓的压迫,效果良好。须重视围手术期处理,积极防治脑脊液漏等并发症。

Objective To evaluate the operative techniques and long-term results of transoral odontoid-clivusectomy in craniovertebral malformation patients.Methods The clinical data of 6 patients with craniovertebral malformation,who underwent odontoid-clivusectomy,were analyzed retrospectively.Surgery was performed to decompress the cervical cord and medulla oblongata ventrally by resecting the odontoid process,clivus partially and hyperplastic connective tissues.The patients had a minimum of 6 months of follow-up.Results The follow-up showed that 2 patients（33.3%） improved remarkably,2 patients（33.3%） improved,1 patient（16.7%） stabilized,and 1 patient（16.7%） died.Conclusion Transoral odontoid-clivusectomy is an effective and safe treatment of craniovertebral malformation by decompressing the cervical cord and medulla oblongata directly.More attention should be paid to avoid leakage of cerebrospinal fluid and other perioperative complications.