| BackgroundCervical vertebral body tumor is rare and usually not associated with readily discernible clinical signs.And the early clinical symptoms are usually non-specific.So there is no obvious clinical symptoms of patients of cervical vertebral body tumor in early stage and they liable to be mistaken for other cervical disorders;and often tend to be ignored by patients.Often medical care is sought at an advanced stage on development of signs and symptoms of spinal cord compression.Levine,et al reported 9 cases of cervical tumor,among which 95%of cases had localized pain,37%had cervical radicular pain,29%had torticollis,14%had a sensory disturbance and 7%had limited movement disorders.Globally,the resection of cervical vertebral body tumor is considered to be the most effective treatment.There are three main traditional surgical approaches to cervical vertebral lesions:anterior approach,posterior approach and combined anterior-posterior approach.All three approaches involve considerable dissection and associated surgical trauma with a risk of serious complications including damage to important blood vessels and nerves in the neck.In malignant cervical tumors,surgical treatment is challenging and prone to relapse,with a particularly poor prognoses in children.it is a subject of being discussed among clinicians that how to expose and remove cervical vertebral body lesions safely and effectively.In recent years,due to its safety,reliability and lesser associated trauma,minimally invasive surgical technique is gradually being adopted for treatment of cervical vertebral lesions in clinic.With the development of nasal endoscope technology,endoscopic techniques and skull base surgery,the therapeutic application of nasal endoscopic surgery has been further expanded.To the best of our knowledge,there are no reports in literature describing nasal endoscopic resection of tumor of cervical vertebral body through intraoral approach.Inspired by successful resection of chordoma and odontoid lesions,we measured atlantoaxial of 20 cases of fresh cadaveric heads and necks with CT to abtain the detailed anatomy parameters and performed operation of cervical vertebral body and related areas to study its anatomy via endoscopic intraoral approach in 10 cases of fresh cadaveric heads and necks perfused.we present the eight reported cases that underwent endoscopic resection of benign lesions of cervical vertebrae through an intraoral approach in this paper.This paper mainly discusses the surgical characteristics,intraoperative surgical skills and prevention of intraoperative and postoperative complications of endoscopic resection of cervical vertebral body benign lesions,and explore the feasibility of nasal endoscopic intraoral approach for resection of benign lesions of the cervical vertebral body.Objective:To explore the feasibility of nasal endoscopic intraoral approach for resection of benign lesions of the cervical vertebral body and evaluate the reliability by clinical practice.Materials and methods:To abtain the detailed anatomy parameters,the atlantoaxial of 20 cases of fresh cadaveric heads and necks was measured with CT,including length of anterior arch of atlas,the thickness of anterior tubercle of atlas,atlas lateral horizontal diameter,atlas lateral sagittal diameter,spacing of atlas transverse process the inside hole,and spacing of atlas lateral transverse process hole etc;and operation of cervical vertebral body and related areas was performed via endoscopic intraoral approach in 10 cases of fresh cadaveric heads and necks perfused to provide more detailed anatomical data for clinic.From October 2013 to October 2015,We reviewed eight cases(5 males,3 females)with age range 5-42 years(mean:20 years)who underwent endoscopic resection of benign lesions of the cervical vertebral body using an intraoral approach in the department of Otolaryngology of Shenzhen the Second People's Hospital.Amongst the study subjects,6 patients had neck pain,2 had headache,2 complained of a sense of head instability,2 complained of a sense of neck motion restriction,1 complained of a sense of neck motion discomfort.7 had eosinophilic granuloma,and 1 had lipoma.All patients underwent computed tomography(CT)of the cervical spine(enhanced axial,coronal and sagittal planes)and cervical magnetic resonance imaging(MRI)pre-and post-operatively to assess the lesion location,range and relationship with the surrounding structures.There were five cases with violation of atlantoaxial vertebrae and three cases of infringement of the third cervical vertebrae,both of which had not invaded the endorhachis and spinal cord.Five patients underwent preoperative 3D reconstruction and 3D printed models,which contributed to preoperative preparation of the treatment design and communication with patients and their families.Written informed consent was obtained from all patients prior to operation.Result:CT results of atlantoaxial of 20 cases of fresh cadaveric heads and necks showed:length of anterior arch of atlas 19.6 ±2.6 mm,the thickness of anterior tubercle of atlas 8.1 ±0.7 mm,atlas lateral horizontal diameter(left/right)12.8±2.6 mm/12.8 ± 1.9 mm,atlas lateral sagittal diameter(left/right)14.9±2.4 mm/15.2 ±1.6 mm,spacing of atlas transverse process the inside hole 47.1 ± 1.5 mm,spacing of atlas lateral transverse process hole 60.6 ± 1.6 mm,spacing of axis transverse process the inside hole 29.1 ± 1.5 mm,spacing of axis lateral transverse process hole 44.2 ±1.8 mm.Results of operation via endoscopic intraoral approach in 10 cases of fresh cadaveric heads and necks perfused showed:? The atlantoaxial ventral could be exposed via endoscopic intraoral approach,including atlantoaxial vertebral body;the anterior arch of atlas,lateral mass,odontoid process and vertebral artery.?Superior border of anterior arch of atlas or lower clivus can be conventionally exposed above while C2/3 intervertebral disk or upper of C3 centrum can be exposed below.The security boundary on both sides can be defined as the lateral margin of joint of atlantoaxial lateral mass in the atlas level and the lateral margin of axial vertebral body in the axial level.It can meet the needs of surgery via endoscopic intraoral approach.In all 8 cases,the lesions were completely removed using a nasal endoscopic intraoral approach in a single procedure with no significant complications.Oral intake was started 8 hours postoperatively.Numeric rating scale(NRS)pain scores were used to evaluate the degree of pain,with an average score of 2.25 points from operation day after general anesthesia to the thrid days postoperatively.The average hospital stay was 6.5 days;stitch removal and discharge was done on the fifth postoperative day.The average hospital cost was approximately 8225 Yuan.The patients were followed up for 3 to 12 months.All five patients were examined by cervical computed tomography scan three months postoperatively,which revealed complete resection of lesion without any evidence of recurrence.Conclusion:Endoscopic resection of benign lesions of the cervical vertebral body through intraoral approach may offer the advantage of a convenient access,simple technology,fewer complications,shorter operative time and quicker postoperative recovery.It worth promoting. |
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