{"title":"后硬膜外经椎弓根单侧齿状突切除术（PETMO）：技术说明。","authors":"Giuseppe Emmanuele Umana, Gianluca Scalia, Angelo Spitaleri, Maurizio Passanisi, Salvatore Cicero","doi":"10.1080/02688697.2025.2516030","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":1.0000,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Posterior extradural transpedicular monolateral odontoidectomy (PETMO): a technical note.\",\"authors\":\"Giuseppe Emmanuele Umana, Gianluca Scalia, Angelo Spitaleri, Maurizio Passanisi, Salvatore Cicero\",\"doi\":\"10.1080/02688697.2025.2516030\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":9261,\"journal\":{\"name\":\"British Journal of Neurosurgery\",\"volume\":\" \",\"pages\":\"1-8\"},\"PeriodicalIF\":1.0000,\"publicationDate\":\"2025-06-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"British Journal of Neurosurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1080/02688697.2025.2516030\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"British Journal of Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/02688697.2025.2516030","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Posterior extradural transpedicular monolateral odontoidectomy (PETMO): a technical note.
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.
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.
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