Endoscopic Endonasal Approach for Craniovertebral Junction Pathologic Conditions: Myth and Truth in Clinical Series and Personal Experience

Massimiliano Visocchi, Gaetano Paludetti, Alessandro Olivi, Francesco Signorelli, Mario Rigante, Chenlong Liao, Giuseppe Barbagallo

Risultato della ricerca: Contributo in rivistaArticolo in rivista

19 Citazioni (Scopus)

Abstract

Objective For many years, the microsurgical transoral approach has been accepted as the gold standard for anterior decompressions of the craniovertebral junction (CVJ). The introduction of the endoscopic endonasal approach (EEA) has gained wide recognition and overwhelming support in recent years, including for diseases of the CVJ. The aim of this study was to critically analyze and discuss all cases of CVJ diseases approached by means of an EEA so far reported in the literature, including our institutional experience consisting of 6 consecutive patients. Methods Six consecutive patients affected by CVJ disease underwent an EEA. Three patients had a tumor (2 chordomas and 1 myeloma) and 3 had impressio basilaris. Results Five patients had an uncomplicated postoperative course and 1 developed an intraoperative cerebrospinal fluid leak and subsequent meningitis and died 5 weeks after surgery. A total of 107 patients (including our 6) affected by CVJ disease and treated with EEA have been reported so far. Among these patients, cerebrospinal fluid leak was reported in 13 (12.4%), transient velopharyngeal incompetence in 6 (5.6%), postoperative epistaxis in 2 (1.86%), and respiratory dysfunction requiring a tracheostomy in 2 (1.86%). In our extended institutional series of more than 20 consecutive anterior decompressions for CVJ diseases (including transoral and transnasal microsurgical approaches), the only fatal complication was associated with EEA. Conclusions On the basis of the reviewed literature and our personal experience, the reported increased safety of the EEA needs to be reassessed and discussed.
Lingua originaleEnglish
pagine (da-a)122-129
Numero di pagine8
RivistaWorld Neurosurgery
Volume101
DOI
Stato di pubblicazionePubblicato - 2017

Keywords

  • Adolescent
  • Adult
  • Aged
  • Atlanto-Axial Joint
  • Craniovertebral junction
  • Decompression, Surgical
  • Endoscopy
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neurology (clinical)
  • Nose
  • Spinal Cord Injuries
  • Surgery
  • Transnasal approach
  • Transoral approach

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