Transdural Approach for Resection of Craniovertebral Junction Cysts: Case Series

Neurosurgery, 2023 · DOI: 10.1227/neu.0000000000002255 · Published: March 1, 2023

Simple Explanation

This study explores a surgical technique, the transdural approach, for treating cysts at the craniovertebral junction (CVJ), the area where the skull meets the spine. The transdural approach involves accessing the cysts through the dura, the membrane surrounding the spinal cord, from the back of the neck. This method aims to relieve pressure on the spinal cord caused by these cysts. The study found that this approach was safe and effective in older patients with progressive myelopathy, a condition caused by spinal cord compression, while potentially avoiding complications associated with other surgical techniques.

Study Duration

Not specified

Participants

8 older patients

Evidence Level

Level IV, Retrospective observational study

Key Findings

1
The transdural approach resulted in improved Nurick scores, indicating reduced myelopathy, in the patients studied.
2
Postoperative imaging (CT and MRI) confirmed complete regression of retro-odontoid cysts in all patients at the final follow-up.
3
The study reports no intraoperative complications, suggesting the safety of the transdural approach in this patient population.

Research Summary

This retrospective study examined the outcomes of eight older patients who underwent transdural resection of craniovertebral junction (CVJ) cysts causing myelopathy. The results showed significant improvement in myelopathy scores and complete cyst regression, with no intraoperative complications, indicating the procedure's safety and effectiveness. The authors conclude that the posterior cervical transdural approach is a valuable option for treating older patients with CVJ cysts and progressive myelopathy, offering a less invasive alternative to other surgical methods.

Practical Implications

Surgical Planning

The transdural approach should be considered as a viable surgical option for treating CVJ cysts, especially in older patients with myelopathy.

Reduced Complications

This approach may offer a safer alternative to anterior or endoscopic transpharyngeal approaches, potentially reducing the risk of neurological complications and extended hospital stays.

Patient Selection

Careful patient selection is crucial, considering factors like cervical instability, deformity, and the symmetry of cord compression to determine the suitability of the transdural approach.

Study Limitations

1
The study is retrospective and limited by a small sample size from a single institution, which restricts the statistical power and generalizability of the findings.
2
The patient population was heterogeneous, with some patients requiring posterior fixation after transdural resection, indicating varying degrees of underlying instability.
3
The study lacks an operative video, which could have provided a more detailed understanding of the surgical technique.

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