Back to Search
Start Over
Endoscopic endonasal transclival transodontoid approach for ventral decompression of the craniovertebral junction: operative technique and nuances
- Source :
- Neurosurgical Focus. 38:E17
- Publication Year :
- 2015
- Publisher :
- Journal of Neurosurgery Publishing Group (JNSPG), 2015.
-
Abstract
- The transoral approach is considered the gold-standard surgical route for performing anterior odontoidectomy and ventral decompression of the craniovertebral junction for pathological conditions that result in symptomatic cervicomedullary compression, including basilar invagination, rheumatoid pannus, platybasia with retroflexed odontoid processes, and neoplasms. Extended modifications to increase the operative corridor and exposure include the transmaxillary, extended “open-door” maxillotomy, transpalatal, and transmandibular approaches. With the advent of extended endoscopic endonasal skull base techniques, there has been increased interest in the last decade in the endoscopic endonasal transclival transodontoid approach to the craniovertebral junction. The endonasal route represents an attractive minimally invasive surgical alternative, especially in cases of irreducible basilar invagination in which the pathology is situated well above the palatine line. Angled endoscopes and instrumentation can also be used for lower-lying pathology. By avoiding the oral cavity and subsequently using a transoral retractor, the endonasal route has the advantages of avoiding complications related to tongue swelling, tracheal swelling, prolonged intubation, velopharyngeal insufficiency, dysphagia, and dysphonia. Postoperative recovery is quicker, and hospital stays are shorter. In this report, the authors describe and illustrate their method of purely endoscopic endonasal transclival odonotoidectomy for anterior decompression of the craniovertebral junction and describe various operative pearls and nuances of the technique for avoiding complications.
- Subjects :
- medicine.medical_specialty
Tomography Scanners, X-Ray Computed
Decompression
Pannus
Basilar invagination
Nose
Velopharyngeal insufficiency
Odontoid Process
medicine
Humans
Skull Base
Platybasia
business.industry
Endoscopy
General Medicine
Decompression, Surgical
medicine.disease
Magnetic Resonance Imaging
Dysphagia
Surgery
Retractor
Skull
medicine.anatomical_structure
Atlanto-Axial Joint
Neurology (clinical)
medicine.symptom
business
Subjects
Details
- ISSN :
- 10920684
- Volume :
- 38
- Database :
- OpenAIRE
- Journal :
- Neurosurgical Focus
- Accession number :
- edsair.doi.dedup.....f64a154bd9312a1dca1e437f4ea7035b
- Full Text :
- https://doi.org/10.3171/2015.1.focus14813