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首页> 外文期刊>Neurosurgical focus >Evolution from microscopic transoral to endoscopic endonasal odontoidectomy
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Evolution from microscopic transoral to endoscopic endonasal odontoidectomy

机译：从显微经口到内窥镜鼻腔齿状突切除术的演变

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Object: The goal of this study was to compare the indications, benefits, and complications between the endoscopic endonasal approach (EEA) and the microscopic transoral approach to perform an odontoidectomy. Transoral approaches have been standard for odontoidectomy procedures; however, the potential benefits of the EEA might be demonstrated to be a more innocuous technique. The authors present their experience with 12 consecutive cases that required odontoidectomy and posterior instrumentation. Methods: Twelve consecutive cases of craniovertebral junction instability with or without basilar invagination were diagnosed at the National Institute of Neurology and Neurosurgery in Mexico City, Mexico, between January 2009 and January 2013. The EEA was used for 5 cases in which the odontoid process was above the nasopalatine line, and was compared with 7 cases in which the odontoid process was beneath the nasopalatine line; these were treated using the transoral microscopic approach (TMA). Odontoidectomy was performed after occipital-cervical or cervical posterior augmentation with lateral mass and translaminar screws. One case was previously fused (Oc-C4 fusion). The senior author performed all surgeries. American Spinal Injury Association scores were documented before surgical treatment and after at least 6 months of follow-up. Results: Neurological improvement after odontoidectomy was similar for both groups. From the transoral group, 2 patients had postoperative dysphonia, 1 patient presented with dysphagia, and 1 patient had intraoperative CSF leakage. The endoscopic procedure required longer surgical time, less time to extubation and oral feeding, a shorter hospital stay, and no complications in this series. Conclusions: Endoscopic endonasal odontoidectomy is a feasible, safe, and well-tolerated procedure. In this small series there was no difference in the outcome between the EEA and the TMA; however, fewer complications were documented with the endonasal technique.
机译：目的：本研究的目的是比较内窥镜鼻腔内入路（EEA）和显微经口入路进行齿状突切除术的适应症，益处和并发症。经口腔入路已成为齿状突切除术的标准方法;然而，欧洲经济区的潜在好处可能被证明是一种更无害的技术。作者介绍了他们在12例需要进行齿状突切除和后路器械治疗的连续病例中的经验。方法：2009年1月至2013年1月，在墨西哥墨西哥城的国家神经病学和神经外科研究所诊断出连续12例颅底交界处不稳定性伴或不伴基底层内陷的病例。EEA用于5例有齿状突的病例将其与鼻op线以下相比较，并与7例齿状突位于鼻op线下方的病例进行比较;这些都使用经口显微方法（TMA）进行了治疗。枕骨颈或后路颈椎后路侧块加经椎板螺钉行椎弓根切除术。先前融合了1例（Oc-C4融合）。资深作者进行了所有手术。在手术治疗之前和至少随访6个月后记录了美国脊髓损伤协会的分数。结果：两组齿状突切除术后的神经功能改善相似。在经口组中，有2例术后有声困难，1例有吞咽困难，1例有术中CSF漏出。内窥镜手术需要更长的手术时间，更少的拔管和口服时间，更短的住院时间以及该系列手术的并发症。结论：内镜鼻腔齿状突切除术是一种可行，安全且耐受性良好的手术。在这个小系列中，EEA和TMA之间的结果没有差异。然而，鼻内镜技术的并发症较少。

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