Full‐endoscopic technique for posterior fossa decompression in Chiari malformation type I: An anatomical feasibility study in human cadavers

Abstract

Although endoscope-assisted techniques have been described, a full-endoscopic approach is yet to be performed for posterior fossa decompression (PFD) in Chiari malformation type I (CM-I). This study aims to describe the full-endoscopic PFD technique and evaluate its feasibility. Five fresh-frozen anonymized adult human cadavers were operated on using an endoscope with an oval shaft cross-section with a diameter of 9.3 mm, a working length of 177 mm, and a viewing angle of 20 . It also had an eccentric working channel with a diameter of 5.6 mm, a light guide, a sheath for continuous irrigation, and a rod lens system. The instruments were introduced from the working channel. Posterior craniocervical structures were dissected, and PFD was achieved. The planned steps were performed in all five cadavers. The endoscope was introduced to the posterior craniocervical region, dissecting the structures to easily expose the suboccipital bone and C1 posterior arch. Important structures, such as the C1 posterior tubercle, rectus capitis posterior minor muscles, and posterior atlantooccipital membrane, were used as landmarks. PFD was feasible even with the dural opening. Using the full-endoscopic approach, posterior craniocervical structures can be reached, and PFD can be performed successfully. The instruments used are welldefined for spinal usage; thus, this full-endoscopic technique can be widely used in the surgical treatment of patients with CM-I.

Full-Endoscopic Technique for Posterior Fossa Decompression in Chiari Malformation

“…The purpose of minimally invasive surgery, in all fields, is to decrease this discomfort and provide faster recovery and return to work. 1,2,5 Full-endoscopic procedures are already widely used for spinal procedures, such as disk herniations and spinal stenoses. [6][7][8][9] In the literature, some authors have described minimally invasive and endoscopic techniques for PFD.…”

“…In our previous study, we demonstrated the feasibility of the full-endoscopic technique for PFD in human cadavers. 5 Here, we present the first cases of PFD in patients with CM performed through a full-endoscopic approach.…”

Fully endoscopic posterior fossa decompression for Chiari malformation type I: illustrative case

“…[18][19][20] The case we have described shows that surgery for CM-I can be performed as a fully endoscopic microsurgical procedure. Based on the clinical anatomical study by Dolas et al, 14 a similar operation was performed.…”

“… 12 , 13 One of the aims of minimally invasive techniques is to reduce surgical trauma to the cervical muscles, which directly impacts the rate and speed of postoperative patient recovery. Fully endoscopic surgery for posterior fossa decompression has thus far been described only in cadavers, 14 but the possibilities of endoscopic systems and instruments push the boundaries. We report the case of successful fully endoscopic posterior fossa decompression in a 30-year-old female patient with CM-I.…”