经口咽入路显微外科技术治疗颅颈区畸型

Transoral microsurgical treatment of craniocervical malformation

目的 总结经口咽入路颅颈区畸型的显微外科治疗的体会。 方法 分析 16例颅颈区畸型的围手术期处理包括抗生素应用、气管切开、静脉营养、颅骨牵引等及手术方法、术后并发症的处理、手术结果等。 结果 本组 16例颅颈区畸型 ,以颅底陷入为主的枕骨大孔区畸型 8例 ,慢性寰枢椎脱位 3例 ,齿状突骨折及脱位 2例 ,下斜坡脊索瘤 2例 ,颈髓腹侧肉芽肿 1例。其中 3例行二期植骨。随访半年～ 3年。 10例恢复轻体力劳动 ,4例生活自理 ,1例临床症状改善 ,1例死亡。 结论 采用显微外科技术经口咽入路治疗颅颈区前方病变可降低术后并发症和致残率。重视围手术期处理 ,预防术后伤口感染和脑脊液漏。二期植骨能增加颈椎稳定性。

Objective To discuss transoral microcervical treatment of 16 patients with craniocervical malformation. Methods Perioperative treatment including antibiotics, tracheotomy, intravenous nutrition was used in 16 patients. Results Eight patients had basilar impressions,3 chronic atlantoaxial dislocation and 2 odontoid fracture, 2 lower clivus chordoma, and 1 granuloma in the ventral part of the medulla oblongata. Three patients received bone graft. Follow up for 6-36 months showed that 14 patients resumed normal life but 1 died. Conclusions Pre craniocervical malformation can be treated by transoral approach microsurgically. Understanding microanatomy of this approach can reduce postoperative morbidity and complications. Perioperative treatment can prevent incision infection.Prevention of intraoperative CSF leakage must be emphasized.Bone graft can make craniocervical spine stable.