Endoscopic Approaches to the Craniovertebral Junction

Kshettry, Varun R.; Thorp, Brian D.; Shriver, Michael F.; Zanation, Adam M.; Woodard, Troy D.; Sindwani, Raj; Recinos, Pablo F.

doi:10.1016/j.otc.2015.08.003

Cited by 14 publications

(6 citation statements)

References 46 publications

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“…Odontoidectomy is possible via this surgical corridor, but it is insufficient for a total C2 corpectomy. EEA cannot be fully successful for lesions that extend laterally to the lower cranial nerves (30). In addition, EEA limits the feasibility of dural repair (61).…”

Section: █ Resultsmentioning

confidence: 99%

Endoscopic endonasal approaches to craniovertebral junction pathologies: a single-center experience

Kahiloğulları¹,

Eroğlu²,

Yakar³

et al. 2018

Turkish Neurosurgery

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AIM: To review our experience of using the endoscopic endonasal approach for clivus and odontoid pathologies as well as craniovertebral junction anomalies at our institution. MATERIAL and METHODS: We retrospectively evaluated 41 patients (21 male, 20 female; age range, 2-65 years) who underwent endoscopic endonasal procedures for craniovertebral junction pathologies between 2008 and 2017. RESULTS: Of the 41 patients, 27 had clivus lesions, 7 had odontoid lesions, 6 had basilar invagination, and 1 had rhinorrhea repair. Six patients underwent an additional posterior decompression/fusion either before or after the endonasal procedure. None of the patients required tracheostomy, and cerebrospinal fluid leakage was postoperatively detected in one patient. The patients' mean modified Rankin scale and visual analog scale scores were 3 and 4, respectively. The follow-up period ranged from 12 to 50 months. CONCLUSION: Although the microscopic transoral approach has been considered the gold standard for craniovertebral junction surgical management, endoscopic approaches are feasible, safe, and effective for addressing pathologies in this region, with developing technique and surgical experience.

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Section: █ Resultsmentioning

confidence: 99%

Endoscopic endonasal approaches to craniovertebral junction pathologies: a single-center experience

Kahiloğulları¹,

Eroğlu²,

Yakar³

et al. 2018

Turkish Neurosurgery

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“…The lateral FM region should be defined as the bilateral occipital area that runs laterally up to the jugular foramen (JF) and includes both the inside and the outside of the occipital bone. 10 DAVFs in this region form abnormal communications between dural branches of the external carotid artery (ECA) and vertebral artery (VA) in addition to the complex vein system of the craniovertebral junction. They are difficult to diagnose and treat.…”

Section: Definition Of the Lateral Fm Regionmentioning

confidence: 99%

Dural arteriovenous fistula of the lateral foramen magnum region: A review

et al. 2018

Interv Neuroradiol

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The lateral foramen magnum region is defined as the bilateral occipital area that runs laterally up to the jugular foramen. The critical vasculatures of this region are not completely understood. Dural arteriovenous fistulas that occur in this region are rare and difficult to treat. Therefore, we searched PubMed to identify all relevant previously published English language articles about lateral foramen magnum dural arteriovenous fistulas, and we performed a review of this literature to increase understanding about these fistulas. Four types of dural arteriovenous fistulas occur in the lateral foramen magnum region. These include anterior condylar confluence and anterior condylar vein dural arteriovenous fistulas, posterior condylar canal dural arteriovenous fistulas, marginal sinus dural arteriovenous fistulas, and jugular foramen dural arteriovenous fistulas. These dural arteriovenous fistulas share similar angioarchitectures and clinical characteristics. The clinical presentations of lateral foramen magnum dural arteriovenous fistulas include pulsatile tinnitus, intracranial hemorrhage, myelopathy, orbital symptoms, and cranial nerve palsy. Currently, head computed tomography, computed tomography angiography, magnetic resonance imaging, magnetic resonance angiography and digital subtraction angiography (DSA) are useful for diagnosing dural arteriovenous fistulas, and of these, DSA remains the “gold standard.” Most lateral foramen magnum dural arteriovenous fistulas need to be treated due to their aggressive symptoms, and transvenous embolization presents the best options. During treatment, it is critical to accurately place the microcatheter into the fistula point, and intraoperative integrated computed tomography and DSA data are very helpful. Other treatments, such as transarterial embolization, microsurgery or conservative treatment, can also be chosen. After appropriate treatment, most patients with lateral foramen magnum dural arteriovenous fistulas achieve satisfactory outcomes.

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“…While the first endoscopic endonasal surgery was performed in 1909, it required recent technological developments to become a feasible and reliable alternative. The current “four hands, two nostrils” technique offers the lowest rates of infection and comorbidities associated with trans-sphenoidal endoscopy, minimizes entry trauma, and affords greater area of exposure and surgical freedom [ 11 ]. A recent systematic review and meta-analysis found endoscopy to be associated with higher gross total tumor resection, lower rate of septal perforation in treating pituitary adenomas, and lower incidence rates of residual tumor in comparison to microsurgery [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Supracerebellar Infratentorial Endoscopic and Endoscopic-Assisted Approaches to Pineal Lesions: Technical Report and Review of the Literature

Snyder

Felbaum

Jean

et al. 2017

Cureus

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The pineal gland has a deep central location, making it a surgeon’s no man’s land. Surgical pathology within this territory presents a unique challenge and an opportunity for employment of various surgical techniques. In modern times, the microsurgical technique has been competing with the endoscope for achieving superior surgical results. We describe two cases utilizing a purely endoscopic and an endoscopic-assisted supracerebellar infratentorial approach in accessing lesions of the pineal gland. We also discuss our early learning experience with these approaches.

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Endoscopic Approaches to the Craniovertebral Junction

Cited by 14 publications

References 46 publications

Endoscopic endonasal approaches to craniovertebral junction pathologies: a single-center experience

Endoscopic endonasal approaches to craniovertebral junction pathologies: a single-center experience

Dural arteriovenous fistula of the lateral foramen magnum region: A review

Supracerebellar Infratentorial Endoscopic and Endoscopic-Assisted Approaches to Pineal Lesions: Technical Report and Review of the Literature

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