经口咽入路显微直视减压术治疗颅颈区畸形

Transoral microsurgical decompression to the craniocervical malformation

目的 探讨颅颈区畸形前路显微直视减压手术的方法和疗效。 方法 颅颈区畸形 45例 ,MRI表现为齿状突肥大 ,向后上方突出 ,斜坡陷入颅底 ,致颅底成角畸形 ,延髓及上颈段脊髓腹侧受压变形。其中 16例还伴有颅后窝容积减小、小脑扁桃体下疝及脊髓空洞症。采用经口咽入路显微直视下切除齿状突、斜坡下部及增生的结缔组织 ,解除其对延髓、颈髓的压迫。结果 痊愈 38例 (84.4% ) ,好转 4例 (8.9% ) ,无效 3例 (6 .7% )。手术并发症有脑脊液漏 2例 ,环枕脱位 1例 ,软腭裂开 1例。 结论 经口咽入路显微直视减压术是治疗以延髓、颈髓腹侧受压为主的颅颈区畸形的首选方法。

Objective To discuss the transoral microsurgical decompression technique and outcome of patients with craniocervical abnormalities Methods Fourty five patients with craniocervical abnormalities were diagnosed by MRI scanning Hypertrophic odontoid process and clivus invagination made an anterior compression to brain stem and superior cervical spinal cord in all of the patients Smaller volume of posterior fossa,Chiari malformation associated with syringohydromyelia was added in 16 of these patients Transoral microsurgical decompression was performed by remove of odontoid process,lower 1/3 of clivus and proliferate connective tissues Results Good recovery in 38 (84 4%),improvement in 4 (8 9%),and no changes in 3 (6 7%) The complications related to the surgery were cerebral spinal fluid leakage ( n =2),craniocervical junction dislocation ( n =1),and palate dehiscence ( n =1) Conclusion Transoral microsurgical decompression is the first selection of treatment for craniocervical abnormalities with ventral compression