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Posterolateral epidural supra-C2-root approach (PESCA) for biopsy of lesions of the odontoid process in same sitting after occipitocervical fixation and decompression—perioperative management and how to avoid vertebral artery injury

This study aims to describe the posterolateral epidural supra-C2-root approach (PESCA), which might be a good alternative to the transoral, anterolateral, and other posterolateral approaches for biopsy of lesions of the odontoid process (OP). The preoperative planning of PESCA included computerized...

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Autores principales: Haas, Patrick, Hauser, Till-Karsten, Kandilaris, Kosmas, Schenk, Sebastian, Tatagiba, Marcos, Adib, Sasan Darius
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8490265/
https://www.ncbi.nlm.nih.gov/pubmed/33428076
http://dx.doi.org/10.1007/s10143-020-01468-z
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author Haas, Patrick
Hauser, Till-Karsten
Kandilaris, Kosmas
Schenk, Sebastian
Tatagiba, Marcos
Adib, Sasan Darius
author_facet Haas, Patrick
Hauser, Till-Karsten
Kandilaris, Kosmas
Schenk, Sebastian
Tatagiba, Marcos
Adib, Sasan Darius
author_sort Haas, Patrick
collection PubMed
description This study aims to describe the posterolateral epidural supra-C2-root approach (PESCA), which might be a good alternative to the transoral, anterolateral, and other posterolateral approaches for biopsy of lesions of the odontoid process (OP). The preoperative planning of PESCA included computerized tomography (CT), CT-angiography, and three-dimensional reconstruction (if possible, even with three-dimensional print) to analyze the angle of the trajectory and the anatomy of the vertebral artery (VA). For PESCA, the patient is positioned under general anesthesia in prone position. In case of an osteolytic lesion with fracture of the OP, an X-ray is performed after positioning to verify anatomic alignment. In the first step, in case of instability and compression of the spinal cord, a craniocervical fusion and decompression is performed (laminectomy of the middle part of the C1 arc and removal of the lower part of the lateral C1 arc). The trajectory is immediately above the C2 root (and under the upper rest of the lateral part of C1 arc). Even if the trajectory is narrowed, it is possible to perform PESCA without relevant traction of the spinal cord. The vertical segment of V3 of the VA at the level of C2 is protected by the vertebral foramen, and the horizontal part of V3 is protected by the remnant upper lateral part of the C1 arc (in case of normal variants). PESCA might be a good choice for biopsy of selected lesions of the OP in same sitting procedure after craniocervical stabilization and decompression.
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spelling pubmed-84902652021-10-15 Posterolateral epidural supra-C2-root approach (PESCA) for biopsy of lesions of the odontoid process in same sitting after occipitocervical fixation and decompression—perioperative management and how to avoid vertebral artery injury Haas, Patrick Hauser, Till-Karsten Kandilaris, Kosmas Schenk, Sebastian Tatagiba, Marcos Adib, Sasan Darius Neurosurg Rev Technical Note This study aims to describe the posterolateral epidural supra-C2-root approach (PESCA), which might be a good alternative to the transoral, anterolateral, and other posterolateral approaches for biopsy of lesions of the odontoid process (OP). The preoperative planning of PESCA included computerized tomography (CT), CT-angiography, and three-dimensional reconstruction (if possible, even with three-dimensional print) to analyze the angle of the trajectory and the anatomy of the vertebral artery (VA). For PESCA, the patient is positioned under general anesthesia in prone position. In case of an osteolytic lesion with fracture of the OP, an X-ray is performed after positioning to verify anatomic alignment. In the first step, in case of instability and compression of the spinal cord, a craniocervical fusion and decompression is performed (laminectomy of the middle part of the C1 arc and removal of the lower part of the lateral C1 arc). The trajectory is immediately above the C2 root (and under the upper rest of the lateral part of C1 arc). Even if the trajectory is narrowed, it is possible to perform PESCA without relevant traction of the spinal cord. The vertical segment of V3 of the VA at the level of C2 is protected by the vertebral foramen, and the horizontal part of V3 is protected by the remnant upper lateral part of the C1 arc (in case of normal variants). PESCA might be a good choice for biopsy of selected lesions of the OP in same sitting procedure after craniocervical stabilization and decompression. Springer Berlin Heidelberg 2021-01-11 2021 /pmc/articles/PMC8490265/ /pubmed/33428076 http://dx.doi.org/10.1007/s10143-020-01468-z Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Technical Note
Haas, Patrick
Hauser, Till-Karsten
Kandilaris, Kosmas
Schenk, Sebastian
Tatagiba, Marcos
Adib, Sasan Darius
Posterolateral epidural supra-C2-root approach (PESCA) for biopsy of lesions of the odontoid process in same sitting after occipitocervical fixation and decompression—perioperative management and how to avoid vertebral artery injury
title Posterolateral epidural supra-C2-root approach (PESCA) for biopsy of lesions of the odontoid process in same sitting after occipitocervical fixation and decompression—perioperative management and how to avoid vertebral artery injury
title_full Posterolateral epidural supra-C2-root approach (PESCA) for biopsy of lesions of the odontoid process in same sitting after occipitocervical fixation and decompression—perioperative management and how to avoid vertebral artery injury
title_fullStr Posterolateral epidural supra-C2-root approach (PESCA) for biopsy of lesions of the odontoid process in same sitting after occipitocervical fixation and decompression—perioperative management and how to avoid vertebral artery injury
title_full_unstemmed Posterolateral epidural supra-C2-root approach (PESCA) for biopsy of lesions of the odontoid process in same sitting after occipitocervical fixation and decompression—perioperative management and how to avoid vertebral artery injury
title_short Posterolateral epidural supra-C2-root approach (PESCA) for biopsy of lesions of the odontoid process in same sitting after occipitocervical fixation and decompression—perioperative management and how to avoid vertebral artery injury
title_sort posterolateral epidural supra-c2-root approach (pesca) for biopsy of lesions of the odontoid process in same sitting after occipitocervical fixation and decompression—perioperative management and how to avoid vertebral artery injury
topic Technical Note
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8490265/
https://www.ncbi.nlm.nih.gov/pubmed/33428076
http://dx.doi.org/10.1007/s10143-020-01468-z
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