颅底凹陷症外科治疗的手术入路研究进展_West China Medical Journal

Authors：

吕超亮 ,  宋跃明

Corresponding author：

宋跃明, Email: lvchaolianggk@163.com

Keywords：

颅底凹陷症; 手术入路; 综述

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【摘要】　颅底凹陷症（basilar invagination，BI）是颅颈交界区（craniovertebral junction，CVJ）常见的先天性畸形。其外科治疗已有近一个世纪的历史，为达到有效的减压及坚强的内固定，多种手术入路陆续得到开展。如何正确选择手术入路对其治疗的安全性及疗效具有重要的意义。本文根据国内外近期文献综述了应用于颅底凹陷症患者不用手术入路的研究进展，总结颅底凹陷症外科治疗的不同手术入路特点及适应证，以期对临床工作起到一定的指导作用。

Citation： 吕超亮,宋跃明. 颅底凹陷症外科治疗的手术入路研究进展. West China Medical Journal, 2011, 26(3): 467-470. doi: Copy

1.	Lorenzo DN, Fortuna A, Guidetti B. Craniovertebral junction malformation. Cranioradiological findings, long term results and surgical indications in 63 cases[J]. J Neurosurg, 1982, 57(5): 603-608.
2.	Erbengi A. Congenital malformations of the craniovertebral junction: classification and surgical treatment[J]. Acta Neurochir (Wien), 1994, 127(3-4): 180-185.
3.	Geol A, Ch M. Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation[J]. J Neurosurg (Spine 1), 2004, 1(3): 281-286.
4.	李宗平, 游潮, 万衡, 等. 复杂寰枕畸形的手术减压和内固定选择[J]. 华西医学, 2006, 21(4): 668-669.
5.	Goal A, Bhatjiwale M, Desai K. Basilar invagination: a study based on 190 surgically treated patients[J]. J Neuosurg, 1998, 88(6): 962-968.
6.	梁春阳, 戴宜武, 沈春森, 等. 复杂颅底凹陷畸形的外科治疗[J]. 临床神经外科杂志, 2009, 6(2): 66-68.
7.	肖其华, 黄思庆, 毛伯镛, 等. 原发性颅底凹陷症的临床特征[J]. 华西医学, 2007, 22 (2): 348-350.
8.	Kanavel AB. Bullet located between the atlas and the base of the skull: technique of removal through the mouth[J]. Surg Clin Chicago, 1917, 1: 361-366.
9.	Menezes AH. Primary craniovertebral anomalies and the hindbrain herniation syndrome (Chiari I): data base analysis[J]. Pediatr Neurosurg, 1995, 23(5): 260-269.
10.	Youssef AS, Guiot B, Black K, et al. Modifications of the transoral approach to the craniovertebral junction: anatomic study and clinical correlations[J]. Neurosurgery, 2008, 62(3): 145-154.
11.	Shaha AR, Johnson R, Miller J, et al. Transoral-transpharyngeal approach to the upper cervical vertebrae[J]. Am J Surg, 1993, 166(4): 336-340.
12.	Menezes AH. Surgical approaches: postoperative care and complications “transoral-transpalatopharyngeal approach to the craniocervical junction”[J]. Childs Nerv Syst, 2008, 24 (10): 1187-1193.
13.	Matthew J, McGirt, Frank J, et al. Endoscopic transcervical odontoidectomy for pediatric basilar invagination and cranial settling[J]. J Neurosurg, 2008, 1(4): 337-342.
14.	Leng LZ, Anand VK, Hartl R, et al. Endonasal endoscopic resection of an os odontoideum to decompress the cervicomedullary junction: a minimal access surgical technique[J]. Spine, 2009, 34(4): 139-143.
15.	Frempong BD, Faunce RG. Endoscopically assisted transoral-transpharyngeal approach to the cranio-vertebral junction[J]. Neurosurgery, 2003, 52(6): 1511-1512.
16.	陈新成, 刘宁, 朱风仪. 内镜下经口咽入路至颅颈交界应用解剖学研究[J]. 解剖学研究杂志, 2005, 27(4): 287-304.
17.	Husain M, Rastogi M, Ojha BK. Endoscopic transoralsurgery for ctaniovertebral junction anomalies. Techuical note[J]. Neurosurg Spine, 2006, 5(4): 367-373.
18.	Alfieri A, Jho HD, Tschabitscher M. Endoscopic endonasal approach to the ventral cranio-cervical junction: anatomical study[J]. Acta Neurochir (Wien), 2002, 144(3): 219-225.
19.	Laufer I, Greenfield JP, Anand VK, et al. Endonasal endoscopic resection of the odontoid process in a nonachondroplastic dwarf with juvenile rheumatoid arthritis: feasibility of the approach and utility of the intraoperative Iso-C three-dimensional navigation[J]. Neurosurg Spine, 2008, 8(4): 376-380.
20.	Magrini S, Pasquini E, Mazzatenta D. Endonasal endoscopic resection of an os odontoideum to decompress the cervicomedullary junction: a minimal access surgical technique[J]. Spine, 2009, 34(4): 139-143.
21.	刘钢, 翟翔, 张海, 等. 鼻内镜下经口咽人路处理颅颈交界区腹侧病变[J]. 中华耳鼻咽喉头颈外科杂志, 2007, 42(5): 334-336.
22.	Aghakhani N, Parker F, David P, et al. Long-term follow-up of chiari-related syringomyelia in adults: analysis of 157 surgically treated cases[J]. Neurosurgery, 2009, 64(2): 308-315.
23.	吕学明, 袁绍纪, 张荣伟, 等. 小脑扁桃体下疝切除术治疗Chiari畸形并脊髓空洞[J]. 中国临床神经外科杂志, 2010, 15(3): 174-176.
24.	宋跃明, 饶书城, 代禧祚. 枕骨大孔扩大治疗上颈椎与颅底先天性畸形伴寰枢关节脱位的远期疗效[J]. 中国脊柱脊髓杂志, 1995, 5(3): 108-110.
25.	宋跃明, 黄思庆, 龚全, 等. 经枕颈后外侧人路行畸形齿突切除术[J]. 中华骨科杂志, 1999, 19(10): 581-584.
26.	Karam YR, Menezes AH, Traynelis VC. Posterolateral approaches to the craniovertebral junction[J]. Neurosurgery, 2010, 66(3): 135-140.
27.	Fiolle J, Delmas J. The surgical exposure of the deep seated blood vessels[M]. London: William Heineman, 1921: 68-82.
28.	Dickman CA, Spetzler RF, Sonntag VK. Surgery of the Craniovertebral Junction[M]. New York: Thieme, 1998: 535-544.
29.	Kratimenos GP, Crockard HA. The far lateral approach for ventrally placed foramen magnum and upper cervical spine tumours[J]. Brit J Neurosurg, 1993, 7(2): 129-140.
30.	Matsuno A, Nakashima M, Murakami M, et al. Microsurgical excision of a retro-odontoid disc hernia via a far-lateral appreach: successful treatment of a rare cause of myelopathy: case report[J]. Neurosurg, 2004, 54(4): 1015-1018.
31.	Al-Mefty O, Borba LA, Aoki N, et al. The transcondylar approach to extradural nonneoplastic lesions of the craniovertebral junction[J]. J Neurosurg, 1996, 85(4): 1-6.
32.	沈健康, 殷玉华, 周玉濮. 远外侧枕下入路临床应用的初步经验[J]. 中华外科杂志, 2001, 39 (3): 209-211.
33.	Ture U, Pamir MN. Extreme lateral-transatlas approach for re-section of the dens of the axis[J]. J Neurosurg, 2002, 96(Suppl 1): 73-82.
34.	闫明, 王超, 周海涛. 对经颈侧方入路行脊髓腹侧减压治疗寰枢关节前脱位的评价[J]. 中国脊柱脊髓杂志, 2005, 15(8): 471-474.

1. 　Lorenzo DN, Fortuna A, Guidetti B. Craniovertebral junction malformation. Cranioradiological findings, long term results and surgical indications in 63 cases[J]. J Neurosurg, 1982, 57(5): 603-608.
2. 　Erbengi A. Congenital malformations of the craniovertebral junction: classification and surgical treatment[J]. Acta Neurochir (Wien), 1994, 127(3-4): 180-185.
3. 　Geol A, Ch M. Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation[J]. J Neurosurg (Spine 1), 2004, 1(3): 281-286.
4. 　李宗平, 游潮, 万衡, 等. 复杂寰枕畸形的手术减压和内固定选择[J]. 华西医学, 2006, 21(4): 668-669.
5. 　Goal A, Bhatjiwale M, Desai K. Basilar invagination: a study based on 190 surgically treated patients[J]. J Neuosurg, 1998, 88(6): 962-968.
6. 　梁春阳, 戴宜武, 沈春森, 等. 复杂颅底凹陷畸形的外科治疗[J]. 临床神经外科杂志, 2009, 6(2): 66-68.
7. 　肖其华, 黄思庆, 毛伯镛, 等. 原发性颅底凹陷症的临床特征[J]. 华西医学, 2007, 22 (2): 348-350.
8. 　Kanavel AB. Bullet located between the atlas and the base of the skull: technique of removal through the mouth[J]. Surg Clin Chicago, 1917, 1: 361-366.
9. 　Menezes AH. Primary craniovertebral anomalies and the hindbrain herniation syndrome (Chiari I): data base analysis[J]. Pediatr Neurosurg, 1995, 23(5): 260-269.
10. 　Youssef AS, Guiot B, Black K, et al. Modifications of the transoral approach to the craniovertebral junction: anatomic study and clinical correlations[J]. Neurosurgery, 2008, 62(3): 145-154.
11. 　Shaha AR, Johnson R, Miller J, et al. Transoral-transpharyngeal approach to the upper cervical vertebrae[J]. Am J Surg, 1993, 166(4): 336-340.
12. 　Menezes AH. Surgical approaches: postoperative care and complications “transoral-transpalatopharyngeal approach to the craniocervical junction”[J]. Childs Nerv Syst, 2008, 24 (10): 1187-1193.
13. 　Matthew J, McGirt, Frank J, et al. Endoscopic transcervical odontoidectomy for pediatric basilar invagination and cranial settling[J]. J Neurosurg, 2008, 1(4): 337-342.
14. 　Leng LZ, Anand VK, Hartl R, et al. Endonasal endoscopic resection of an os odontoideum to decompress the cervicomedullary junction: a minimal access surgical technique[J]. Spine, 2009, 34(4): 139-143.
15. 　Frempong BD, Faunce RG. Endoscopically assisted transoral-transpharyngeal approach to the cranio-vertebral junction[J]. Neurosurgery, 2003, 52(6): 1511-1512.
16. 　陈新成, 刘宁, 朱风仪. 内镜下经口咽入路至颅颈交界应用解剖学研究[J]. 解剖学研究杂志, 2005, 27(4): 287-304.
17. 　Husain M, Rastogi M, Ojha BK. Endoscopic transoralsurgery for ctaniovertebral junction anomalies. Techuical note[J]. Neurosurg Spine, 2006, 5(4): 367-373.
18. 　Alfieri A, Jho HD, Tschabitscher M. Endoscopic endonasal approach to the ventral cranio-cervical junction: anatomical study[J]. Acta Neurochir (Wien), 2002, 144(3): 219-225.
19. 　Laufer I, Greenfield JP, Anand VK, et al. Endonasal endoscopic resection of the odontoid process in a nonachondroplastic dwarf with juvenile rheumatoid arthritis: feasibility of the approach and utility of the intraoperative Iso-C three-dimensional navigation[J]. Neurosurg Spine, 2008, 8(4): 376-380.
20. 　Magrini S, Pasquini E, Mazzatenta D. Endonasal endoscopic resection of an os odontoideum to decompress the cervicomedullary junction: a minimal access surgical technique[J]. Spine, 2009, 34(4): 139-143.
21. 　刘钢, 翟翔, 张海, 等. 鼻内镜下经口咽人路处理颅颈交界区腹侧病变[J]. 中华耳鼻咽喉头颈外科杂志, 2007, 42(5): 334-336.
22. 　Aghakhani N, Parker F, David P, et al. Long-term follow-up of chiari-related syringomyelia in adults: analysis of 157 surgically treated cases[J]. Neurosurgery, 2009, 64(2): 308-315.
23. 　吕学明, 袁绍纪, 张荣伟, 等. 小脑扁桃体下疝切除术治疗Chiari畸形并脊髓空洞[J]. 中国临床神经外科杂志, 2010, 15(3): 174-176.
24. 　宋跃明, 饶书城, 代禧祚. 枕骨大孔扩大治疗上颈椎与颅底先天性畸形伴寰枢关节脱位的远期疗效[J]. 中国脊柱脊髓杂志, 1995, 5(3): 108-110.
25. 　宋跃明, 黄思庆, 龚全, 等. 经枕颈后外侧人路行畸形齿突切除术[J]. 中华骨科杂志, 1999, 19(10): 581-584.
26. 　Karam YR, Menezes AH, Traynelis VC. Posterolateral approaches to the craniovertebral junction[J]. Neurosurgery, 2010, 66(3): 135-140.
27. 　Fiolle J, Delmas J. The surgical exposure of the deep seated blood vessels[M]. London: William Heineman, 1921: 68-82.
28. 　Dickman CA, Spetzler RF, Sonntag VK. Surgery of the Craniovertebral Junction[M]. New York: Thieme, 1998: 535-544.
29. 　Kratimenos GP, Crockard HA. The far lateral approach for ventrally placed foramen magnum and upper cervical spine tumours[J]. Brit J Neurosurg, 1993, 7(2): 129-140.
30. 　Matsuno A, Nakashima M, Murakami M, et al. Microsurgical excision of a retro-odontoid disc hernia via a far-lateral appreach: successful treatment of a rare cause of myelopathy: case report[J]. Neurosurg, 2004, 54(4): 1015-1018.
31. 　Al-Mefty O, Borba LA, Aoki N, et al. The transcondylar approach to extradural nonneoplastic lesions of the craniovertebral junction[J]. J Neurosurg, 1996, 85(4): 1-6.
32. 　沈健康, 殷玉华, 周玉濮. 远外侧枕下入路临床应用的初步经验[J]. 中华外科杂志, 2001, 39 (3): 209-211.
33. 　Ture U, Pamir MN. Extreme lateral-transatlas approach for re-section of the dens of the axis[J]. J Neurosurg, 2002, 96(Suppl 1): 73-82.
34. 　闫明, 王超, 周海涛. 对经颈侧方入路行脊髓腹侧减压治疗寰枢关节前脱位的评价[J]. 中国脊柱脊髓杂志, 2005, 15(8): 471-474.

West China Medical Journal

颅底凹陷症外科治疗的手术入路研究进展

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