Why the Craniovertebral Junction?
Why the Craniovertebral Junction?
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DOI：
10.1007/978-3-319-62515-7_1
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发表时间：
2019-01-01
期刊：
影响因子：
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通讯作者：
Visocchi, Massimiliano
中科院分区：
文献类型：
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作者：
Visocchi, Massimiliano
颅椎交界处（CVJ）具有独特的解剖骨和神经血管结构。它不仅将颅底与颈椎下轴分开，而且提供了特殊的颅骨屈曲、伸展和轴向旋转模式。稳定性是由骨和韧带支撑的复杂组合提供的，允许大程度的运动。对 CVJ 解剖学和生理学的全面了解使我们能够更好地了解枕骨、寰椎和轴的仪器操作以及影响该区域的特定疾病。因此，为了预测和克服 CVJ 手术可能出现的解剖相关并发症，对该区域的血管、韧带和骨解剖结构进行审查，以及对颈椎这一解剖学上独特的部分的所有可能的手术方法进行审查，似乎是绝对必要的；此外，了解仪器的基本原理和该区域的运动学知识，因为它们与解剖学相互作用，似乎在术前规划中具有战略意义。CVJ 手术或 CVJ 专业在历史上被认为是无人区，最近作为具有挑战性的手术以及选择性顶级合格手术的象征而引起了人们的强烈关注。尽管自这项开创性手术开始以来已经过去了许多年，但处理位于 CVJ 前部的病变仍然是一个重要的领域。具有挑战性的神经外科问题。文献中提供了许多研究，旨在检查 CVJ 的前部和后部硬膜外和硬膜内方面的显微外科解剖结构，以及通过 360° 方法原理获得的所有可能的手术暴露的差异。在本文中，作者对个人经历、出版物以及最新的文献进行了简短但相当完整的概览。
The craniovertebral junction (CVJ) has unique anatomical bone and neurovascular structure architecture. It not only separates the skull base from the subaxial cervical spine but also provides a special cranial flexion, extension and axial rotation pattern. Stability is provided by a complex combination of osseous and ligamentous supports, which allow a large degree of motion. Perfect knowledge of CVJ anatomy and physiology allows us to better understand instrumentation procedures of the occiput, atlas and axis, and the specific diseases that affect the region. Therefore, a review of the vascular, ligamentous and bony anatomy of the region, in relation to all possible surgical approaches to this anatomically unique segment of the cervical spine, appears to be absolutely mandatory in order to preview and to overcome possible anatomy-related complications of CVJ surgery; moreover, knowledge of the basic principles of instrumentation and of the kinematics of the region, since they interact with the anatomy, seems to be strategic in preoperative planning.Historically considered a no man's land, CVJ surgery, or the CVJ specialty, has recently attracted strong consideration as a symbol of challenging surgery as well as selective top-level qualifying surgery.Although many years have passed since the beginning of this pioneering surgery, managing lesions situated in the anterior aspect of the CVJ still remains a challenging neurosurgical problem. Many studies are available in the literature, aiming to examine the microsurgical anatomy of both the anterior and posterior extradural and intradural aspects of the CVJ, as well as the differences in all possible surgical exposures obtained by the 360° approach philosophy. In this paper the author provides a short but quite complete at-a-glance tour of personal experience and publications and the more recent literature available.