Artikel
Minimal invasive approach for small ventrally located intradural lesions of the craniovertebral junction
Suche in Medline nach
Autoren
-
Sven O. Eicker
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
-
Klaus Christian Mende
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
-
Lasse Dührsen
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
-
Manfred Westphal
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
-
Nils Ole Schmidt
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
| Veröffentlicht: | 2. Juni 2015 |
|---|
Gliederung
Text
Objective: The surgical management of lesions ventrally to the neuroaxis at the level of the craniovertebral junction (CVJ) and upper cervical spine is challenging. Here, we describe a minimal invasive dorsal approach for small ventrally located intradural lesions at the CVJ as an alternative for the more extensive classic transoral or variants of suboccipital approaches.
Method: Between 2012 and 2014 six symptomatic patients with small lesions of the ventral aspect at the level of the CVJ were treated in our institution using a minimal invasive dorsal approach. The radio-anatomical distance of the posterior atlanto-occipital membrane and the posterior atlanto-axial ligament was assessed in our treated patients and in 100 non-treated persons based on computerized tomography.
Results: We treated six patients (mean age 54,7 years) with a clinical presentation of mild neurological symptoms, which disappeared after surgical resection. Minimal invasive dorsal surgical access was performed using tubular systems and utilizing the natural space between C0/C1 and in one case between C1/C2 without the necessity of removal of bony structures. The postoperative course in all six patients was uneventful. The neuropathological findings confirmed a meningotheliomatous meningioma (WHO grade I) in five cases and an extramedullary cavernous hemangioma in one case. MRI confirmed complete resection of all lesions. The atlantooccipital distance ranged from 3 mm to 17 mm (mean 8.98 mm) in supine neutral position. The atlantoaxial distance ranged from 5 mm to 17 mm (mean 10.56 mm) without a significant difference between females and males (atlantooccipital p = 0.14 and atlantoaxial p = 0.72).
Conclusions: Our study demonstrates that the minimal invasive dorsal approach using the space beween C0/C1 or C1/2 provides a direct and sufficient exposure for the safe surgical resection of small ventrally located intradural lesions at the level of CVJ while reducing the necessity of musculoskeletal preparation to the minimum.
