Posterior midline approach to odontoidectomy

Erdogan, Koral; Solmaz, Serdar; Abbasoğlu, Bilal; Çağlar, Şükrü; Doğan, İhsan

doi:10.4103/jcvjs.jcvjs_12_22

Cited by 1 publication

(5 citation statements)

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“…3 Currently known and practiced surgical approaches to the craniocervical region include anterior transoral, posterior, and posterolateral approaches, which include the far lateral, extreme lateral, transatlas, and transcondylar approaches. 5 Such newly evolved surgical approaches (i.e., lateral, far lateral, extreme lateral) have tended to replace anterior to posterior approaches. The posterolateral approach has been used more frequently in cases requiring mobilization of the vertebral artery to decrease the risk of injury.…”

Section: Discussionmentioning

confidence: 99%

“…10 The transaxis approach helps the surgeon to access the odontoid process bilaterally and achieve posterior decompression and occipitocervical fusion in the same stage. 5 This approach also provides multidirectional exposure of the CVJ and the C1 and C2 vertebrae in a way that allows the neurosurgeon to relieve neural structure pressure circumferentially through a common access route. A key point and the initial step of this approach is identification of the C2 lamina and pedicle, as well as the junction of these two anatomical structures, and exposure of the inner, superior, and medial edges of the C2 lamina at this junction.…”

Section: Discussionmentioning

confidence: 99%

“…When we first suggested and published this approach, we named it the "posterior midline cervical approach." 5 Recently, when we considered that during the exposure of the inner, medial, and superior edges of the C2 lamina, just at the junction of the C2 lamina and pedicle, and the path from this point to the odontoid, our starting point was the second cervical vertebra, the axis, we concluded that naming this surgical technique the "transaxis approach" would be both descriptive and appropriate.…”

Section: Discussionmentioning

confidence: 99%

“…The technical principles, nuances, and steps of these two approaches are explained in detail in previously published related articles. 5,6 Nonetheless, because the transaxis approach presents a novel corridor for odontoidectomy, the important key points of this technique are reemphasized here, and the operative nuances are highlighted briefly in this section to increase the comprehensibility of this approach.…”

Section: Methodsmentioning

confidence: 99%

“…4 Recently, a novel posterior midline approach, with its revised current name, the transaxis approach, has been introduced in which all the therapeutic goals are safely and effectively accomplished in a single-stage surgical procedure. 5 The aim of the current study was to compare the most widely used anterior endonasal approach with the posterior transaxis approach to odontoid resection on the basis of objective clinical results in patients who underwent surgical treatment of BI.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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