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Reconsideration of the transoral odontoidectomy in complex craniovertebral junction patients with irreducible anterior compression

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中华神经外科杂志(英文) 2021年第1期6卷 28-35页

作者： Wang Xingwen Ma Longbing Liu Zhenlei Chen Zan Wu Hao Jian Fengzeng Department of Neurological Surgery Xuanwu Hospital Capital Medical University Beijing 100053 China

Background: Although the single-stage posterior realignment craniovertebral junction (CVJ) surgery could treat most of the basilar invagination (BI) and atlantoaxial dislocation (AAD), there are still some cases with incomplete decompression of the spinal cord, which remains a technique challenging ***: Eleven patients were included with remained myelopathic symptoms after posterior correction due to incomplete decompression of the spinal cord. Transoral odontoidectomy assisted by image-guided navigation and intraoperative CT was performed. Clinical assessment and image measurements were performed preoperatively and at the most recent ***: Eleven patients were followed up for an average of 47 months. Symptoms were alleviated in 10 of 11 patients (90.9%). One patient died of an unknown reason 1 week after the transoral approach. The clinical and radiological parameters pre- and postoperatively were ***: Transoral odontoidectomy as a salvage surgery is safe and effective for properly selected BI and AAD patients after inadequate indirect decompression from posterior distraction and fixation. Image-guided navigation and intraoperative CT can provide precise information and accurate localization during operation, thus enabling complete resection of the odontoid process and decompression of the spinal cord.

关键词： Transoral approach odontoidectomy Basilar invagination Atlantoaxial dislocation Image-guided navigation

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Endoscopic endonasal approach to the craniovertebral junction

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2022年第1期8卷 16-24页

作者： Ashleigh A.Halderman Samuel L.Barnett Department of Otolaryngology Head and Neck Surgery University of Texas Southwestern Medical CenterDallasTexasUSA Department of Neurological Surgery University of Texas Southwestern Medical CenterDallasTexasUSA

The surgical approach to lesions of the ventral craniovertebral junction(CVJ)has evolved significantly in the last several years with the advent of endoscopic skull base *** pathologies of the CVJ can result in irreducible compression of the cervicomedullary *** endoscopic endonasal approach lends itself well to this region due to the ventral location,and while there is a steep learning curve,is a safe and effective way to perform decompression of the cervicomedullary ***,we discuss the anatomy of the CVJ,preoperative evaluation and surgical considerations,our surgical approach,complications,and outcomes.

关键词： basilar invagination craniovertebral junction endonasal surgery endoscopic skull base surgery odontoidectomy

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Endoscopic endonasal approaches to the craniovertebral junction:The Otolaryngologist’s perspective

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2020年第2期6卷 94-99页

作者： Qasirn Husain Matthew H.Kim Ibrahirn Hussain Vijay K.Anand Jeffrey P.Greenfield Theodore H.Schwartz Ashutosh Kacker Department of Otolaryngology-Head&Neck Surgery Massachusetts Eye and Ear InfirmaryHarvard Medical School-BostonMAUSA Department of Otolaryngology-Head&Neck Surgery Weill Cornell Medical College e New YorkNYUSA Department of Neuroscience Weill Cornell Medical College-New YorkNYUSA

Objective:To review indications and techniques for the endoscopic endonasal approach to the craniovertebral junction(CVJ),analyze postoperative outcomes,and discuss important technical ***:A retrospective analysis was performed on all patients undergoing endonasal endoscopic approaches to the CVJ from May 2007 to June *** information,presenting symptoms,imaging results,treatment course,postoperative functional status,and followup were ***:There was a total of 30 patients in this series,with a mean follow-up of 11.7 *** average age was 33.6 years(range,5e75 years),with 18 females and 12 *** majority of patients(n Z 22,73.3%)had Chiari malformation type 1 with basilar invagination and symptomatic cervicomedullary compression as the indication for *** cerebrospinal fluid leak(CSF)was noted in 3 cases of odontoid resection and a single case of skull base *** were no postoperative CSF ***,81%of patients resumed regular diet by post-operative day 2(range,0e8 days).Severe postoperative dysphagia occurred in two cases with one requiring gastrostomy tube placement and another utilizing total parenteral nutrition for support prior to eventual *** average,patients were extubated by postoperative day 0.93(range 0e3 days),with 85%extubated by postoperative day 1.A tracheotomy was required in one ***:The endonasal endoscopic approach is a valuable technique for access to the CVJ with minimal disruption of respiratory and alimentary function.

关键词： odontoidectomy Craniovertebral junction Endoscopic skull base surgery

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