Artikel
The posterior cervical transdural approach with cranio-cervical stabilization is a safe and feasible technique for retro-odontoid mass pseudotumor resection in C1/C2 instability – a series of 2 cases
Suche in Medline nach
Autoren
-
Markus Schomacher
- Vivantes Klinikum Neukölln, Klinik für Neurochirurgie, Berlin, Deutschland
-
Fan Jiang
- Toronto Western Hospital, University Health Network, Division of Orthopaedic Surgery and Spinal Program Department of Surgery, Toronto, Kanada
-
Christopher D Witiw
- Toronto Western Hospital, University Health Network, Division of Orthopaedic Surgery and Spinal Program Department of Surgery, Toronto, Kanada
-
Michael G. Fehlings
- Toronto Western Hospital, University Health Network, Division of Neurosurgery and Spinal Program Department of Surgery, Toronto, Kanada
| Veröffentlicht: | 18. Juni 2018 |
|---|
Gliederung
Text
Objective: The treatment of a retro-odontoid pseudotumor mass associated with severe cord compression is challenging because the complex regional anatomy. Transoral resection followed by posterior fusion is often advocated. We present here an attractive option involving a single stage posterior transdural microsurgical resection followed by instrumented cervical reconstruction.
Methods: We describe 2 cases of female patients with clinical signs of cervical myelopathy and evidence of retro-odontoid pseudotumor masses with significant spinal cord compression at C1/C2-level. Evidence for cranio-cervical and C1/C2-instability in imaging diagnostics (CT, CT-myelographs/MRI) was seen. Lesions were located centrally with posterolateral relationship to the spinal cord. Fusion was necessitated by severe degenerative osteoarthritis at C1/C2-level with signs of instability.
Patients were prone positioned fixed in mayfield clamp. After midline incision a suboccipital decompression and a C1-, C2- and C3-laminectomy were done. The masses were visualized with ultrasound imaging. Then the dura was opened from C0 to C2 levels. After opening of the arachnoid-membrane, the exiting C2-C3 nerve roots could be identified and the dentate-ligament was cut to facilitate access. The masses were covered by a thin anterior dural layer. After incision sucessful resection with rongeurs, forceps and ultrasonic suction was possible. On histopathology, degenerated fibro-connective tissue without signs of inflammation or malignancy was seen. Dura was closed with sutures and overlay of fibrin sealant with collagen matrix sponge. Fusion procedures were performed with occipital plate, C1 lateral-mass, C2 pedicle-, C3 lateral mass screws and contoured titanium rods partial-covered with morsalized bone graft. Recording of motor and somatosensory evoked potentials showed signals at over 50% of baseline levels at all times.
Results: Post-surgery, both patients showed good neurological recovery. Cervical CT-scans showed good cervical alignment and placed material, no evidence of postoperative hematoma. Patients were discharged in stable condition to the rehabilitation facility.
Conclusion: The posterior cervical transdural approach is a safe alternative procedure for retro-odontoid pseudotumor mass removal. Regional anatomical conditions facilitate less bleeding and adhesions in the intradural space. Cranio-cervical- and suboccipital stabilization can be easily and safely performed through this exposure.
