A posterolateral approach to occipitoatlantoaxial ventral lesions: a report of the long-term follow-up of 23 cases.

STUDY DESIGN: A retrospective study of consecutive patient series. OBJECTIVES: To report a technique of odontoidectomy using a transoccipitocervical posterolateral approach for occipitoatlantoaxial ventral lesions in a long-term follow-up study. SUMMARY OF BACKGROUND DATA: Occipitoatlantoaxial malformation and old traumatic dislocation usually cause compression of the high cervical spinal cord from a variety of different directions and angles, leading to high morbidity. The main objective of treatment is to relieve the anteroposterior compression and to restore the stability of the occipitocervical region. Currently, there are 2 approaches to perform the surgical procedure: (1) posterior decompression by suboccipital and occipitocervical fusion and internal fixation; and (2) decompression by a transoral approach to an odontoid resection. However, there are some short points, which need to be changed, such as the incomplete decompression (the former), narrow view, cerebrospinal fluid leakage, and the high infection rates. METHODS: From 1999 to 2006, 23 patients with occipitoatlantoaxial ventral lesions were treated using a transoccipitocervical posterolateral approach for decompression. The procedure included an expansion of the foramen magnum, a resection of the posterior arch of atlas, a lateral occipitocervical epidural exposure to the odontoid and the C2 vertebra, and an excision of the odontoid. Thus, an anteroposterior decompression and occipitocervical spinal fusion was achieved. Neurological function, daily living ability, and the work ability of patients were assessed in a follow-up study. RESULTS: A 28-year-old woman died of respiratory and circulatory failure 10 hours after operation. The remaining patients survived without postoperative infection. The neurological injury in 17 patients did not deteriorate, whereas 5 patients had decreased sensation in the upper limbs, and the elbow flexor muscle strength in 2 patients declined by 1 grade on the operation side. Short-term follow-up (3-6 mo, 22 cases) indicated that 19 patients recovered normal sensation with decreased limb muscle tension. Motor function was improved by >1 grade (5 patients with postoperative nerve injury recovered to preoperative levels or better). Long-term follow-up (>4 y) of 15 patients (10 patients by clinic visit and 5 patients by correspondence) indicated that the occipitoatlantoaxial regions were stable without local discomfort or loss of nerve function. Fourteen patients were able to care for themselves and some patients regained their ability to work. One patient felt no significant improvement after surgery and had no improvement in the quality of life. CONCLUSIONS: Transoccipitocervical posterolateral approach to occipitoatlantoaxial ventral lesions provides a broad and sterile operating field to perform anteroposterior decompression and occipitocervical spinal fusion simultaneously. Neurological improvement is significant, and the long-term follow-up results are satisfactory.

MUCOSAL MICROVASCULAR ARCHITECTURE OF HUMAN STOMACH / 解剖学报

The arteries and/or the veins of 30 human stomaches (11 adults,19 infants)were perfused with coloured gelatin or methylmethacrylate.The specimens were madeinto section and spreading preparation,and cast,and studied under LM and SEM.The main results were as follows:1.Mucosal arterioles divided into 2kinds of branches,i.e.luminal arteriole and glandular arteriole,and hadanastomosis.Luminal capillaries which lay in lamina propria around gastric pitoriginated from the luminal arterioles and from the glandular capillaries.2.Mucosalcapillaries drained into mucosal venule at 3 levels,viz.the luminal surface,theglandular neck and the glandular base.There were 2 kinds of venular anastomosis:the anastomosis between the straight mucosal venulae at the level of the glandularneck or the base of the gastric pit,and the basal venular plexus which lay betweenthe muscularis mucosae and the base of gastric gland.3.Mucosal blood vesselsobserved on transverse section might be divided into 3 parts:base-body,neck-body,and gastric pit.In neck-body part the density of capillaries is the highest.4.Flat,round or elliptic impressions of endothelial nuclei can be seen on the cast ofmucosal venule under SEM.It was interesting that a pit was noted at the center ofeach impre-ssion.The importance of mucosal blood vessels in the mucosa is forprotection from invasion and damage effected by luminal contents.