Reconsideration of the transoral odontoidectomy in complex craniovertebral junction patients with irreducible anterior c
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(2020) 6:33
中华医学会神经外科学分会 CHINESE MEDICAL ASSOCIATION
CHINESE NEUROSURGICAL SOCIETY
RESEARCH
Open Access
Reconsideration of the transoral odontoidectomy in complex craniovertebral junction patients with irreducible anterior compression Xingwen Wang, Longbing Ma, Zhenlei Liu, Zan Chen, Hao Wu and Fengzeng Jian*
Abstract 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 situation. Methods: 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 follow-up. Results: 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 reported. Conclusion: 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. Keywords: Transoral approach, Odontoidectomy, Basilar invagination, Atlantoaxial dislocation, Image-guided navigation
Background Basilar invagination (BI) is the most common congenital malformation of the craniovertebral junction (CVJ), and it is characterized by protrusion of the odontoid process into the foramen magnum leading to ventral compression of the spinal cord [1–5]. BI is often associated with atlantoaxial dislocation (AAD), atlas assimilation, Chiari malformation, and other congenital anomalies [6, 7]. For * Correspondence: [email protected] Department of Neurological Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
the treatment of BI, direct transoral decompression followed by posterior instrumentation had traditionally been a standard treatment for decades [3, 4, 8–11]. Over the past decade, however, single-stage posterior realignment CVJ surgery to treat BI with AAD has been widely accepted as first-line treatment for this pathological entity, usually obviating the need for a transoral odontoidectomy. Good clinical and radiological outcomes have been reported in most patients with posterior-only treatment [4, 12–14]. However, a small proportion of patients continue to have persistent myelopathy because of
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