经口咽入路显微外科治疗颅颈区畸形

Effect of microsurgical treatment on the craniovertebral junction abnormalities using transoral-transpharyngeal approach

目的 探讨颅颈区畸形经口咽入路显微直视减压手术的方法和疗效。方法 本组 5 8例颅颈区畸形患者 ,以颅底陷入为主的枕骨大孔区先天畸形 4 2例 (16例伴有颅后窝容积减小、小脑扁桃体下疝及脊髓空洞症 ) ,慢性环枢椎脱位 11例 ,齿状突骨折及脱位 5例。采用经口咽入路显微镜直视下切除齿状突、斜坡下部及增生结缔组织 ,解除其对延髓、颈髓的压迫 ;围手术期行气管切开、颅骨牵引、植骨固定等。结果 术后随访 0 .5～ 7年 ,症状明显好转 4 7例 ,减轻 7例 ,无效 3例 ,死亡 1例。结论 采用显微外科技术经口咽入路治疗颅颈区畸形 ,可降低术后并发症和致残率 ;重视围手术期处理可预防术后伤口感染和脑脊液漏 ;

Objective To explore the microsurgical techniques and effect of transoral transpharyngeal approach in treating craniovertebral junction abnormalities Methods 58 cases with craniovertebral junction abnormalities were analyzed retrospectively, 42 cases of which were primary basilar invagination from congenital craniovertebral junction malformation accompanied by tonsilar herniation and syringomyelia in 16 cases,11 cases were irreducible rheumatoid cranial settling and 5 cases were migration of odontoid fracture fragments Transoral transpharyngeal approach was applied for the removal of dentate process, lower part of the clivus and the overgrowth connective tiusse in order to make decompression to the medulla and upper cervical spinal cord Tracheotomy, cranial retraction and bone transplantation were carried out perioperatively Results All patients were followed up for 0 5~7 years postoperatively, and it was found the symptoms and signs were improved remarkably in 47 cases, improved 7 cases,no effect in 3 cases,and 1 died Conclusion Microsurgical decompression through transoral transpharyngeal approach is effective and safe for the treatment of craniovertebral junction abnormalities Perioperative management is important for the prevention of postoperative infection and CSF leakage Bone transplantation of the second stage can improve the craniocervical junction stability