Posterior extradural transpedicular monolateral odontoidectomy (PETMO): a technical note.

IF 1 4区医学 Q4 CLINICAL NEUROLOGY

British Journal of Neurosurgery Pub Date : 2025-06-11 DOI:10.1080/02688697.2025.2516030

Giuseppe Emmanuele Umana, Gianluca Scalia, Angelo Spitaleri, Maurizio Passanisi, Salvatore Cicero

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引用次数: 0

Abstract

Background: Craniovertebral junction (CVJ) instability with irreducible basilar invagination (BI) and retroflexed odontoid poses a significant surgical challenge. Standard anterior decompression techniques-transoral or endoscopic transnasal-carry notable morbidity. Posterior approaches are rare and often invasive. We report the first clinical use of a purely posterior, extradural, transpedicular, monolateral odontoidectomy (PETMO) as a novel alternative in selected cases.

Methods: A 67-year-old woman with progressive myelopathy due to irreducible BI and os odontoideum underwent PETMO with occipitocervical fixation. The odontoid and os odontoideum were resected en bloc via a right C2 transpedicular corridor using an ultrasonic bone dissector. Intraoperative neurophysiological monitoring and micro-Doppler were employed.

Results: The patient showed steady neurological improvement, regaining independent ambulation at 1-year follow-up. Postoperative imaging confirmed complete resection, effective cervicomedullary decompression, and CVJ realignment.

Conclusion: PETMO offers a feasible posterior alternative for anterior CVJ decompression in selected patients with irreducible pathology and ligamentous insufficiency. It avoids the aerodigestive tract and minimizes neural and vascular manipulation. Though technically demanding, PETMO expands the surgical options for CVJ management and merits further investigation.

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后硬膜外经椎弓根单侧齿状突切除术（PETMO）：技术说明。

背景：颅颈交界（CVJ）不稳定伴不可救药的颅底内陷（BI）和齿状突后屈是外科治疗的重要挑战。标准前路减压技术-经口或经鼻内镜-有显著的发病率。后路入路罕见且常有侵入性。我们报告首次临床使用纯后，硬膜外，经椎弓根，单侧齿状突切除术（PETMO）作为一种新的选择在选定的情况下。方法：一名67岁的女性，由于无法复位的BI和缺失的齿状突而患有进行性脊髓病，接受了带枕颈固定的PETMO。齿状突和下颌齿状突经右C2经椎弓根通道采用超声解剖术整体切除。术中神经生理监测及微多普勒监测。结果：患者神经功能稳定改善，随访1年，恢复自主行走。术后影像学证实完全切除，有效的颈髓减压和CVJ调整。结论：PETMO是一种可行的后路选择，适用于病理不完全且韧带功能不全的CVJ前路减压。它避免了气消化道，最大限度地减少了神经和血管的操作。尽管技术上要求很高，PETMO扩大了CVJ治疗的手术选择，值得进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

British Journal of Neurosurgery 医学-临床神经学

CiteScore

2.30

自引率

9.10%

发文量

139

审稿时长

3-8 weeks

期刊介绍： The British Journal of Neurosurgery is a leading international forum for debate in the field of neurosurgery, publishing original peer-reviewed articles of the highest quality, along with comment and correspondence on all topics of current interest to neurosurgeons worldwide. Coverage includes all aspects of case assessment and surgical practice, as well as wide-ranging research, with an emphasis on clinical rather than experimental material. Special emphasis is placed on postgraduate education with review articles on basic neurosciences and on the theory behind advances in techniques, investigation and clinical management. All papers are submitted to rigorous and independent peer-review, ensuring the journal’s wide citation and its appearance in the major abstracting and indexing services.