Evolution from microscopic transoral to endoscopic endonasal odontoidectomy

Ponce-Gómez, Juan Antonio; Ortega-Porcayo, Luis Alberto; Soriano-Baron, Hector; Sotomayor-González, Arturo; Arriada-Mendicoa, Nicasio; Gómez-Amador, Juan Luis; Palma-Díaz, Marité; Coll, J

doi:10.3171/2014.7.focus14301

Cited by 83 publications

(66 citation statements)

References 35 publications

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“…Similarly, Ponce-Gómez and colleagues reported their own series of patients treated using both approaches and found comparable rates of neurological improvement after odontoidectomy, with less time to extubation and oral feeding, as well as shorter hospital stay in the endonasal group. 13 However, the direct comparison of transoral and endonasal endoscopic approaches should be looked at carefully. The studies reporting both approaches may be affected by selection bias, due to a different patient population and indications.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic endonasal approach for craniovertebral junction pathology: a review of the literature

Morales-Valero

Serchi

Zoli

et al. 2015

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OBJECT The transoral approach is the gold standard for ventral decompression of the brainstem caused by craniovertebral junction (CVJ) pathology. This approach is often associated with significant morbidity, related to swallowing and respiratory complications. The endoscopic endonasal approach was introduced to reduce the rate of these complications. However, the exact role of this approach in the treatment of CVJ pathology is not well defined. METHODS A comprehensive literature search was performed to identify series of patients with pathology of the CVJ treated via the endoscopie endonasal approach. Data on patient characteristics, indications for treatment, complications, and outcome were obtained and analyzed. RESULTS Twelve studies involving 72 patients were included. The most common indications for treatment were rheumatoid pannus (38.9%) and basilar invagination (29.2%). Cerebrospinal fluid leak was found in 18% of cases intraoperatively and 4.2% of cases postoperatively. One case of meningitis complicated by sepsis and death represents the procedure-related mortality of 1.4%. Of the patients without preoperative swallowing impairment, 95% returned to oral feeding on the 3rd postoperative day. Ninety-three percent of patients experienced improvement in neurological symptoms after the procedure. CONCLUSIONS The endonasal endoscopie approach is effective for the treatment of neural compression caused by CVJ pathology. It offers advantages such as lower rates of postoperative dysphagia and respiratory complications when compared with the more traditional transoral approach. However, these 2 approaches should be seen as complementary rather than alternatives. Patient-related factors as well as the surgeon’s expertise must be considered when making treatment decisions.

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Section: Discussionmentioning

confidence: 99%

Endoscopic endonasal approach for craniovertebral junction pathology: a review of the literature

Morales-Valero

Serchi

Zoli

et al. 2015

FOC

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“…82 Others have compared the approaches in cadavers. 3 The advantages of the EEA include a decrease in tongue and oropharyngeal swelling and lack of a need for soft-palate division.…”

Section: Comparison Of the Endoscopic Endonasal And Standard Transoramentioning

confidence: 99%

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Dlouhy

Dahdaleh

Menezes³

et al. 2015

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The craniovertebral junction (CVJ), or the craniocervical junction (CCJ) as it is otherwise known, houses the crossroads of the CNS and is composed of the occipital bone that surrounds the foramen magnum, the atlas vertebrae, the axis vertebrae, and their associated ligaments and musculature. The musculoskeletal organization of the CVJ is unique and complex, resulting in a wide range of congenital, developmental, and acquired pathology. The refinements of the transoral approach to the CVJ by the senior author (A.H.M.) in the late 1970s revolutionized the treatment of CVJ pathology. At the same time, a physiological approach to CVJ management was adopted at the University of Iowa Hospitals and Clinics in 1977 based on the stability and motion dynamics of the CVJ and the site of encroachment, incorporating the transoral approach for irreducible ventral CVJ pathology. Since then, approaches and techniques to treat ventral CVJ lesions have evolved. In the last 40 years at University of Iowa Hospitals and Clinics, multiple approaches to the CVJ have evolved and a better understanding of CVJ pathology has been established. In addition, new reduction strategies that have diminished the need to perform ventral decompressive approaches have been developed and implemented. In this era of surgical subspecialization, to properly treat complex CVJ pathology, the CVJ specialist must be trained in skull base transoral and endoscopic endonasal approaches, pediatric and adult CVJ spine surgery, and must understand and be able to treat the complex CSF dynamics present in CVJ pathology to provide the appropriate, optimal, and tailored treatment strategy for each individual patient, both child and adult. This is a comprehensive review of the history and evolution of the transoral approaches, extended transoral approaches, endoscopie assisted transoral approaches, endoscopie endonasal approaches, and CVJ reduction strategies. Incorporating these advancements, the authors update the initial algorithm for the treatment of CVJ abnormalities first published in 1980 by the senior author.

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“…18,28 Because the incision is made above the oropharynx and the oral cavity can be avoided without a transoral retractor or splitting of the soft palate, the endoscopic endonasal approach avoids the risk of tongue compression and subsequent swelling, tracheal swelling, velopharyngeal insufficiency, infection, and swallowing and breathing difficulties. 18,43,49 Postoperative recovery after endonasal skull base surgery is generally quicker, the hospital stays are shorter, and patients are fed orally and ambulate earlier in the postoperative period than patients who undergo transoral procedures. 6,14,18,43 The endoscopic endonasal approach for odontoidectomy has been investigated in cadaveric studies and in several clinical studies.…”

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confidence: 99%

Endoscopic endonasal transclival transodontoid approach for ventral decompression of the craniovertebral junction: operative technique and nuances

Liu

Patel²,

Goldstein³

et al. 2015

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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.

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Evolution from microscopic transoral to endoscopic endonasal odontoidectomy

Cited by 83 publications

References 35 publications

Endoscopic endonasal approach for craniovertebral junction pathology: a review of the literature

Endoscopic endonasal approach for craniovertebral junction pathology: a review of the literature

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Endoscopic endonasal transclival transodontoid approach for ventral decompression of the craniovertebral junction: operative technique and nuances

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