Endoscopic Endonasal Odontoidectomy in the Hybrid Operating Room
Endoscopic Endonasal Odontoidectomy in the Hybrid Operating Room
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DOI：
10.1016/j.wneu.2019.07.197
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发表时间：
2019-11-01
影响因子：
2
通讯作者：
Hongo, Kazuhiro
中科院分区：
文献类型：
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作者：
Ogiwara, Toshihiro;Miyaoka, Yoshinari;Hongo, Kazuhiro
背景技术背景：鼻内镜下经鼻入路治疗颅颈交界区（CVJ）已被广泛采用和接受，尤其是在切除齿状突治疗颅底凹陷症时。然而，由于这是一种历史上不成熟的手术，因此存在齿突切除不足和手术并发症（包括血管损伤）的问题。在这里，我们报告的内窥镜鼻内齿状突切除术（EEO）在混合手术室（hOR），以提高其安全性和reliability.CASE描述：一个70岁的男子提出了2个月的历史脊髓病步态障碍和吞咽障碍。神经影像学分析显示延髓压迫与基底动脉内陷有关。患者在后路内固定后在hOR接受EEO。根据hOR，术中确认截骨范围和解剖方向。术后病程顺利，术后症状得到改善。结论：hOR的应用可以使EEO安全和精确地用于CVJ的前路减压。据我们所知，这是描述EEO在hOR中的临床经验的第一例病例报告。
BACKGROUND: The endoscopic endonasal approach for the craniovertebral junction (CVJ), instead of the microscopic transoral approach, has been widely adopted and accepted, especially in resection of the odontoid process for basilar invagination. However, there is concern regarding insufficient resection of odontoid and surgical complications, including vessel injuries, because this is a historically immature procedure. Here, we report a surgical case of endoscopic endonasal odontoidectomy (EEO) in the hybrid operating room (hOR) for improvement of its safety and reliability.CASE DESCRIPTION: A 70-year-old man presented with a 2-month history of myelopathic gait disturbance and swallowing disturbance. Neuroimaging analysis indicated medulla oblongata compression associated with basilar invagination. The patient underwent EEO in the hOR after posterior instrumented fixation. With the hOR, the extent of bone resection and anatomic orientation were confirmed intraoperatively. Postoperative course was uneventful, and symptoms were improved after surgery.CONCLUSIONS: The application of the hOR may make the EEO safe and precise for anterior decompression of the CVJ. To our knowledge, this is the first case report describing clinical experience of EEO in the hOR.