TY - JOUR
T1 - Transoral approach to the craniovertebral junction: A neuronavigated cadaver study
AU - Signorelli, Francesco
AU - Costantini, Alessandro
AU - Stumpo, Vittorio
AU - Conforti, Giulio
AU - Olivi, Alessandro
AU - Visocchi, Massimiliano
PY - 2019
Y1 - 2019
N2 - More than 100 years after the first description by Kanavel of a transoral–transpharyngeal approach to remove a bullet impacted between the atlas and the clivus [1], the transoral approach (TOA) still represents the ‘gold standard’ for surgical treatment of a variety of conditions resulting in anterior craniocervical compression and myelopathy [2, 3]. Nevertheless, some concerns—such as the need for a temporary tracheostomy and a postoperative nasogastric tube, and the increased risk of infection resulting from possible bacterial contamination and nasopharyngeal incompetence [4–6]—led to the introduction of the endoscopic endonasal approach (EEA) by Kassam et al. [7] in 2005. Although this approach, which was conceived to overcome those surgical complications, soon gained wide attention, its clear predominance over the TOA in the treatment of craniovertebral junction (CVJ) pathologies is still a matter of debate [3]. In recent years, several papers have reported anatomical studies and surgical experience with the EEA, targeting different areas of the midline skull base, from the olfactory groove to the CVJ [8–19]. Starting from these preliminary experiences, further anatomical studies have defined the theoretical (radiological) and practical (surgical) craniocaudal limits of the endonasal route [20–25]. Our group has done the same for the TOA [26, 27] and compared the reliability of the radiological and surgical lines of the two different approaches. Very recently, a cadaver study, with the aid of neuronavigation, tried to define the upper and lower limits of the endoscopic TOA [28].
AB - More than 100 years after the first description by Kanavel of a transoral–transpharyngeal approach to remove a bullet impacted between the atlas and the clivus [1], the transoral approach (TOA) still represents the ‘gold standard’ for surgical treatment of a variety of conditions resulting in anterior craniocervical compression and myelopathy [2, 3]. Nevertheless, some concerns—such as the need for a temporary tracheostomy and a postoperative nasogastric tube, and the increased risk of infection resulting from possible bacterial contamination and nasopharyngeal incompetence [4–6]—led to the introduction of the endoscopic endonasal approach (EEA) by Kassam et al. [7] in 2005. Although this approach, which was conceived to overcome those surgical complications, soon gained wide attention, its clear predominance over the TOA in the treatment of craniovertebral junction (CVJ) pathologies is still a matter of debate [3]. In recent years, several papers have reported anatomical studies and surgical experience with the EEA, targeting different areas of the midline skull base, from the olfactory groove to the CVJ [8–19]. Starting from these preliminary experiences, further anatomical studies have defined the theoretical (radiological) and practical (surgical) craniocaudal limits of the endonasal route [20–25]. Our group has done the same for the TOA [26, 27] and compared the reliability of the radiological and surgical lines of the two different approaches. Very recently, a cadaver study, with the aid of neuronavigation, tried to define the upper and lower limits of the endoscopic TOA [28].
KW - Cadaver
KW - Cervical Vertebrae
KW - Humans
KW - Mouth
KW - Natural Orifice Endoscopic Surgery
KW - Neuroendoscopy
KW - Neuronavigation
KW - Nose
KW - Skull Base
KW - Cadaver
KW - Cervical Vertebrae
KW - Humans
KW - Mouth
KW - Natural Orifice Endoscopic Surgery
KW - Neuroendoscopy
KW - Neuronavigation
KW - Nose
KW - Skull Base
UR - http://hdl.handle.net/10807/206798
U2 - 10.1007/978-3-319-62515-7_8
DO - 10.1007/978-3-319-62515-7_8
M3 - Article
SN - 0001-6268
VL - 125
SP - 51
EP - 55
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
ER -