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

Kahiloğulları, Gökmen; Eroğlu, Ümit; Yakar, Fatih; Beton, Süha; Meço, Cem; Çağlar, Şükrü

doi:10.5137/1019-5149.jtn.23781-18.1

Cited by 3 publications

(7 citation statements)

References 34 publications

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“…Two patients died as a result of meningitis and pulmonary embolism, respectively. Our results were similar to largest case series in the last decade which has been published the outcomes of EEO and good brainstem medullary decompression was achieved in most of the patients [9][10][11][12][13][14][15][16][17][18] .…”

Section: Accepted Manuscriptsupporting

confidence: 90%

“…Of note, no tracheostomy was required in our series, whereas it may be required following Trans Oral Approach (TOA) due to prolonged intubation or tongue swelling, and subsequent gastrostomy may be indicated if the patient has difficulty swallowing. 9 However, the risk of respiratory arrest secondary to oversedation and possible aspiration is still persisting. 19 According to the aforementioned contents, we believe that the length of the hospital stay in EEO is lower than traditional oral approaches.…”

Section: Discussionmentioning

confidence: 99%

“…patient has difficulty swallowing. 9 . However, the risk of respiratory arrest secondary to oversedation and possible aspiration is still persisting 19 .According to the aforementioned contents, we believe that the length of the hospital stay in EEO is lower than traditional oral approaches.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Endoscopic Endonasal Approach to the Craniovertebral Junction Lesions: A Case Series of 18 Patients

Alijani

Namin

Emamhadi

et al. 2022

J Neurol Surg B Skull Base

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Introduction: Odontoid pathologies constitute a special category because they may lead to instability. Instability is defined by abnormal spinal alignment under physiologic conditions (loads) such as standing, walking, bending, or lifting. Since instability poses a risk of cord damage, surgical interventions may be required for durable long-term stabilization. This study demonstrates operative technique and results of endoscopic endonasal approach to the odontoid. Methods: We conducted a retrospective study involving 18 patients who underwent endoscopic endonasal odontoidectomy (EEO) due to Craniovertebral pathologies. Demographic data, clinical features of the patients, risk factors, intraoperative and postoperative complications were reported in this series. Results: Satisfactory outcomes achieved in 16 patients based on comparing modified Rankin scale before and after the surgery (P value= 0.0001). The mean duration for EEO was 232.6 ± 18.8 minutes. The mean blood loss during surgery was 386.67 ± 153.04 ml. The mean duration of hospital stay was seven days. All patients were extubated within a few hours after surgery. Against the backdrop of a successful anterior decompression in the aforementioned cases, intraoperative cerebrospinal fluid (CSF) leakage, postoperative meningitis, and pulmonary thromboembolism have emerged as devastating complications. However, two intraoperative CSF leakages were managed by direct dural repair and fat graft; two patients died due to postoperative meningitis and pulmonary thromboembolism 7 and 4 days after the second surgery. Conclusion: In conclusion, EEO can be effectively used for anterior decompression of the odontoid pathologies, despite the risk of complications.

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Section: Accepted Manuscriptsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic Endonasal Approach to the Craniovertebral Junction Lesions: A Case Series of 18 Patients

Alijani

Namin

Emamhadi

et al. 2022

J Neurol Surg B Skull Base

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“…Each approach has its advantages and disadvantages, it also has limitations in its exposure, surgeons must be familiar with various anteromedial approaches and their modifications, to select the best approach in each case [11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

“…The location and extent of the injury are determining factors in selecting an appropriate skull base approach. The transoral approach offers direct access to medial injuries of the craniovertebral junction with extradural location, such as chordomas, chondrosarcoma, giant cell tumor, rheumatoid or degenerative pannus [14,[16][17][18]. The report of 14 transoral cases by Crockard and colleagues in 1985 and 53 transoral cases by Hadley, Sonntag, and Spetzler in 1989 helped solidify the approach.…”

Section: Introductionmentioning

confidence: 99%

Endonasal Endoscopic and Transoral Approaches to the Craniovertebral Junction and the Clival Region

Piloto¹,

Hernández²,

Jiménez³

et al. 2021

JCRR

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Introduction: The transoral approach was first described by Kanavel in 1917 to treat injuries of the craniospinal junction. In 2002, Frempong-Boaudu reported 7 adults who underwent endoscopically assisted transoral surgery, this was the first report that endoscope was used in an assisted manner for transoral surgery. In 2005, Kassam published the first report of an EEA being used to perform an odontoidectomy. Method: A descriptive, retrospective and linear study was carried out in 16 patients who underwent surgery using the microsurgical and endoscopic transoral and Extended Endoscopic Endonasal approach in the period from January 2004 to May 2021. Results: The average age of the patients was 45 years and there was a predominance of the male sex (10) with the female one (6). The tumoral pathology (9), 6 cases with histological diagnosis of clivus cordroma and 1 patient with chondrosarcoma, two cases with Meningioma and cholesterol granuloma of clival localization, achieving gross total resection in 2 of them and in the rest subtotal resection, all improved neurological symptoms. Complications, partial dehiscence of the velopalatine surgical wound 1 case, 1 lesion of the left vertebral artery and 1 case decompensated Diabetes Mellitus and hemoneumothorax during stay in the ICU, which death 7 days after surgery and 1 CSF fistula. Conclusions: Both, the transoral and endonasal endoscopic approaches have their precise indications in each particular case, having their indications well defined. To achieve this, we must have neuroimaging studies and be able to correctly define the selection of the surgical approach.

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Single-institution comparative analysis for odontoid resection: posterior transaxis versus anterior transnasal approach

Doğan

Bayatli

Eray

et al. 2023

Neurosurgical Focus

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OBJECTIVE The resection of an upwardly migrated odontoid is most widely performed via an anterior endoscopic endonasal approach after the addition of posterior occipitocervical instrumentation. In patients with craniovertebral junction (CVJ) anomalies like basilar invagination (BI), surgery is usually achieved in two separate stages. However, the authors have recently introduced a novel posterior transaxis approach in which all the therapeutic goals of the surgery can be safely and effectively accomplished in a single-stage procedure. The aim of the current study was to compare the widely used anterior and the recently introduced posterior approaches on the basis of objective clinical results in patients who underwent odontoid resection for BI. METHODS Patients with BI who had undergone odontoid resection were retrospectively reviewed in two groups. The first group (n = 7) consisted of patients who underwent anterior odontoidectomy via the standard anterior transnasal route, and the second group (n = 6) included patients in whom the novel transaxis approach was performed. Patient characteristics, neurological conditions, and modified Rankin Scale (mRS) scores at admission were evaluated. Operative time, changes in intraoperative neurophysiological monitoring, blood loss during surgery, odontoid resection rate, postoperative complications, and mortality were compared between the patient groups. RESULTS Data were retrospectively reviewed for 13 patients who underwent odontoid resection, posterior CVJ decompression, and occipitocervical instrumentation at the Ankara University School of Medicine Department of Neurosurgery between 2009 and 2022. In the first group (n = 7), patients who underwent anterior odontoidectomy via the standard endonasal route, two serious complications were observed, pneumocephaly and basilar artery injury. In the second group (n = 6), patients in whom the novel transaxis approach was performed, only one complication was observed, occipital plate malposition. CONCLUSIONS This study represents the results of what is to the authors’ knowledge the first comparison of a novel approach with a widely used surgical approach to odontoid resection in patients with BI. The preliminary data support the successful utility of the transaxis approach for odontoid resection that meets all the operative therapeutic demands in a single-stage operation. Considering the diminished surgical risks and operative time, the transaxis approach may be regarded as a primary approach for the treatment of BI.

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

Cited by 3 publications

References 34 publications

Endoscopic Endonasal Approach to the Craniovertebral Junction Lesions: A Case Series of 18 Patients

Endoscopic Endonasal Approach to the Craniovertebral Junction Lesions: A Case Series of 18 Patients

Endonasal Endoscopic and Transoral Approaches to the Craniovertebral Junction and the Clival Region

Single-institution comparative analysis for odontoid resection: posterior transaxis versus anterior transnasal approach

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