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2015 ; 58
(3
): 236-41
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The Transmanubrial Approach for Cervicothoracic Junction Lesions : Feasibility,
Limitations, and Advantages
#MMPMID26539267
Park JH
; Im SB
; Jeong JH
; Hwang SC
; Shin DS
; Kim BT
J Korean Neurosurg Soc
2015[Sep]; 58
(3
): 236-41
PMID26539267
show ga
OBJECTIVE: We report on the technical feasibility and limitations of the
transmanubrial approach for cervicothoracic junction (CTJ) lesions and emphasize
the advantage of bisecting the upper part of the manubrium in an inverted
Y-shape. METHODS: Thirteen patients who underwent the fourteen transmanubrial
approach for various CTJ lesions were enrolled during 2005-2014. For the
evaluation of the accessibility for the CTJ lesion, we analyzed the two parallel
line defined as a straight line parallel to the inferior and superior plateau of
the upper and lower healthy vertebrae, the angle of the two parallel lines and
the distance from the sternal notch to lines at the sternum on preoperative
magnetic resonance images. Surgical limitations and perspectives, as well as
postoperative clinical outcomes were evaluated retrospectively. RESULTS: The CTJ
lesions were six metastases, three primary bone tumors, two herniated discs, and
one each of a traumatic dislocation with syrinx formation and tuberculous
spondylitis and ossification of the posterior longitudinal ligament. If two
parallel lines pass below the sternal notch, the manubriotomy should be
inevitably performed. The mean preoperative Visual analogue scale score was 8
(range, 5-10), which improved to 4 (range, 0-6) postoperatively. Seven cases
showed an increase in Frankel score postoperatively. CONCLUSION: The spatial
relationship between the sternal notch and the two parallel lines to the lesion
was rational to determine the feasibility of manubriotomy. The transmanubrial
approach for CTJ lesions can achieve favorable clinical outcomes by providing
direct decompression of lesion and effective reconstruction.