Full-Endoscopic Transcervical Ventral Decompression for Pathologies of Craniovertebral Junction: Case Series

Ohara, Yukoh; Nakajima, Yasuhiro; Kimura, Takaoki; Kikuchi, Nahoko; Sagiuchi, Takao

doi:10.14245/ns.2040172.086

Cited by 13 publications

(18 citation statements)

References 18 publications

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“…Primarily, because these techniques necessitate a ventral approach, extended postoperative intubation is often required for these patients, which may contribute to the longer mean hospital stays. 35 For example, Husain et al found an average length of stay of 7 days, which is markedly longer than our reported aggregate length of stay of 4.5 days. 35 Postoperative dysphagia has also been a demonstrated complication, which has required the use of total parenteral nutrition or other means of nutritional supplementation.…”

Section: Discussioncontrasting

confidence: 72%

Transdural Approach for Resection of Craniovertebral Junction Cysts: Case Series

2022

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BACKGROUND:Craniovertebral junction (CVJ) cysts, including retro-odontoid pseudotumors, are challenging pathologies to treat and manage effectively. Surgical intervention is indicated when these lesions result in progressive myelopathy, intractable pain, or instability.OBJECTIVE:To present a case series of older patients who underwent successful resection retro-odontoid lesions using transdural approach.METHODS:A single-center, retrospective observation study of older patients who underwent transdural resection of CVJ cysts at a single institution was performed. Summary demographic information, clinical presentation, perioperative and intraoperative imaging, and Nurick scores were collected and analyzed.RESULTS:Eight patients were included (mean age [±SD] 75.88 ± 9.09 years). All patients presented with retro-odontoid lesions resulting in severe cervical stenosis, cord compression, and myelopathy. The mean duration of surgery was 226 ± 83.7 minutes. The average intraoperative blood loss was 181.2 cc. The average hospital stay was 4.5 days ± 1.3 (range, 3-7 days). The average follow-up time was 12.5 ± 9.5 months. No intraoperative complications were encountered. The Nurick classification score for myelopathy improved at the final postoperative examination (2.38 ± 1.06 vs 1 ± 1.07). Three patients demonstrated a pre-existing deformity prompting an instrumented fusion. Both computed tomography and MRI evidence of complete regression of retro-odontoid cyst were noted in all patients on the final follow-up.CONCLUSION:Posterior cervical transdural approach for ventral lesions at the CVJ is a safe and effective means of treating older patients with progressive myelopathy. This technique provides immediate spinal cord decompression while limiting neurological complications commonly associated with open or endoscopic anterior transpharyngeal approaches.

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Section: Discussioncontrasting

confidence: 72%

Transdural Approach for Resection of Craniovertebral Junction Cysts: Case Series

2022

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“…Irreducible lesions require decompression at the side at which the compressions occur. The treatment algorithm was straightforward and convincing, which was supported by many published clinical series [ 2 , 7 , 23 , 26 - 33 ]. However, the surgical decision was always difficult because the reducibility was difficult to judge, especially for those patients in an acute stage.…”

Section: Discussionmentioning

confidence: 61%

“…The treatment algorithm was straightforward and convincing, which was supported by many published clinical series. 2,7,23,[26][27][28][29][30][31][32][33] However, the surgical decision was always difficult because the reducibility was difficult to judge, especially for those patients in an acute stage. Most patients in an acute stage were afraid of moving their head and neck due to severe neck pain and muscle spasm.…”

Section: Discussionmentioning

confidence: 99%

Measurement of Deformity at the Craniovertebral Junction: Correlation of Triangular Area and Myelopathy

Chang

et al. 2022

Neurospine

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Objective: Diseases of the craniovertebral junction (CVJ) are commonly associated with deformity, malalignment, and subsequent myelopathy. The misaligned CVJ might cause compression of neuronal tissues and subsequently clinical symptoms. The triangular area (TA), measured by magnetic resonance imaging/images (MRI/s), is a novel measurement for quantification of the severity of compression to the brain stem. This study aimed to assess the normal and pathological values of TA by a comparison of patients with CVJ disease to age- and sex-matched controls. Moreover, postoperative TAs were correlated with outcomes.Methods: Consecutive patients who underwent surgery for CVJ disease were included for comparison to an age- and sex-matched cohort of normal CVJ persons as controls. The demographics, perioperative information, and pre- and postoperative 2-year cervical MRIs were collected for analysis. Cervical TAs were measured and compared.Results: A total of 201 patients, all of whom had pre- or postoperative MRI, were analyzed. The TA of the CVJ deformity group was larger than the healthy control group (1.62 ± 0.57 cm2 vs. 1.01 ± 0.18 cm2, p < 0.001). Moreover, patients who had combined anterior odontoidectomy and posterior laminectomy with fixation had the greatest reduction in the TA (1.18 ± 0.58 cm2).Conclusion: In CVJ deformity, the measurement of the cervical TA could indicate the severity of brain stem compression. After surgery, the TA had a varying degree of improvement, which could represent the efficacy of surgery.

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“…Additionally, Yukoh Ohara et al also performed the similar procedure as us for odontoidectomy (14). Both of us used an "inside to outside" approach for odontoidectomy.…”

Section: Discussionmentioning

confidence: 99%

Full-endoscopic uniportal retropharyngeal odontoidectomy: A preliminary case report

Liu

et al. 2023

Front. Surg.

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Summary of background dataOdontoidectomy aims to decompress the medulla oblongata and is usually performed through the classical transoral approach, which affects oropharynx and accompanied with high rate of complications comprising swallowing and respiratory tract. We have developed a minimal invasive method via a standard cervical anterior approach: full-endoscopic trans-cervical odontoidectomy, which provides an alternative access for the resection of odontoid process and medulla oblongata decompression without traversing potentially contaminated cavities.MethodsFrom 2018 to 2020, three patients with either odontoid process lesion or basilar invagination underwent full-endoscopic uniportal trans-cervical odontoidectomy with/without combining the posterior instrumentation. With fluoroscopic guidance, a uniportal endoscope sleeve was placed inside of the odontoid process; then odontoid process was gradually resected from the inside to outside under endoscopic monitoring. Postoperative images and clinical data were collected during post-op follow-up.ResultPatients were soon extubated after surgery when patients wake up from general anesthesia. There were no severely perioperative complications, especially dysphagia and airway obstruction, and the symptoms and neurological function was improved immediately after surgery. The final pathology of one patient with odontoid osteolytic lesion was confirmed as plasmacytoma. The postoperative CT scans proved that the range of odontoid process resection was consistent with the preoperative expectation.ConclusionIn summary, our proposed endoscopic trans-cervical odontoidectomy provides a valid choice for non-oral approach, which would reduce postoperative approach related complications and accelerate postoperative recovery.

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Full-Endoscopic Transcervical Ventral Decompression for Pathologies of Craniovertebral Junction: Case Series

Cited by 13 publications

References 18 publications

Transdural Approach for Resection of Craniovertebral Junction Cysts: Case Series

Transdural Approach for Resection of Craniovertebral Junction Cysts: Case Series

Measurement of Deformity at the Craniovertebral Junction: Correlation of Triangular Area and Myelopathy

Full-endoscopic uniportal retropharyngeal odontoidectomy: A preliminary case report

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