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Microscopic Posterior Transdural Resection of Cervical Retro-Odontoid Pseudotumors
Yasushi Fujiwara1, Hideki Manabe, Tadayoshi Sumida
1*Department of Orthopedic Surgery, Hiroshima City Asa Hospital, Asa-kita-ku, Hiroshima City, Japan §Department of Orthopaedic Surgery, National Hospital Organization Kure Medical Center, Chugoku Cancer Center ‡Department of Orthopaedic Surgery, Institute of Biomedical & Health Sciences, Hiroshima University †Department of Orthopedic Surgery, Saka Midorii Hospital.
A novel transdural resection technique effectively removes retro-odontoid pseudotumors, offering direct spinal cord decompression and enabling accurate pathologic diagnosis. This minimally invasive approach improves patient outcomes without neurological complications.
Area of Science:
- Neurosurgery
- Spinal Surgery
Background:
- Retro-odontoid pseudotumors are noninflammatory masses posterior to the odontoid process.
- Optimal surgical resection approaches remain controversial due to anatomical challenges.
- Existing methods like posterior extradural approaches have limitations, including epidural vein interference.
Purpose of the Study:
- To introduce and evaluate a new microscopic surgical technique, transdural resection, for retro-odontoid pseudotumors.
- To assess the safety and efficacy of the transdural approach in providing direct decompression and obtaining tissue diagnosis.
Main Methods:
- Developed a transdural resection technique involving C1 laminectomy.
- Incised dorsal and ventral dura mater while preserving arachnoid layers.
- Removed pseudotumor, followed by dural repair.
Main Results:
- The transdural approach enabled direct spinal cord decompression and pseudotumor resection.
- Pathologic findings confirmed degenerative fibrocartilaginous tissue.
- The patient experienced improved clinical symptoms without neurological deterioration, CSF leakage, or arachnoiditis.
Conclusions:
- The transdural approach is a safe and effective method for resecting retro-odontoid pseudotumors.
- This technique facilitates direct decompression and pathological diagnosis, addressing limitations of conventional methods.
