Walk the Line. The Surgical Highways to the Craniovertebral Junction in Endoscopic Approaches: A Historical Perspective

Visocchi, Massimiliano; Iacopino, Domenico Gerardo; Signorelli, Francesco; Olivi, Alessandro; Maugeri, Rosario

doi:10.1016/j.wneu.2017.06.125

Cited by 18 publications

(4 citation statements)

References 50 publications

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“…More than 119 patients with CVJ disease treated with EEA have been reported in the literature. Among 107 of these patients, CSF leak (intraoperative and/or postoperative) was reported in 13 (12.1%), transient velopharyngeal incompetence, variably associated with nasal speech and swallowing impairment, was reported in 6 (5.6%), postoperative epistaxis was reported in 2 (1.9%), and respiratory dysfunction requiring tracheostomy was reported in 2 of them (1.9%) [ 15 ]. In a recent meta-analysis, neurologic outcomes improved by 94.0% after transnasal odontoidectomy, whereas none of the patients experienced worsening of neurologic outcomes after the procedure [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

The endoscopic transnasal approach to the lesions of the craniocervical junction: two case reports

Dabboucy¹,

Lahiani²,

Bresson³

et al. 2023

J Yeungnam Med Sci

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The endoscopic endonasal approach (EEA) to the craniovertebral junction (CVJ) has recently been considered a safer alternative and less invasive approach than the traditional transoral approach because the complications associated with the latter are avoided or minimized. Here, we present two challenging cases of CVJ pathologies. The first case involved os odontoideum associated with anterior displacement of the occipitocervical junction where the EEA was used, followed by C0-C1-C2 fusion using a posterior approach to decompress the CVJ, and was complicated by rhinorrhea and Candida albicans meningitis. The second case involved basilar invagination with syringomyelia previously treated using a posterior approach, where aggravation of neuropathic symptoms required combined treatment with EEA and occipitocervical fusion of C0-C2-C3-C4, with the postoperative course challenged by operative site infection requiring drainage with debridement and antibiotic therapy. The EEA is an alternative approach for accessing the CVJ in well-selected patients. Knowledge of EEA complications is crucial for the optimal care of patients.

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Section: Discussionmentioning

confidence: 99%

The endoscopic transnasal approach to the lesions of the craniocervical junction: two case reports

Dabboucy¹,

Lahiani²,

Bresson³

et al. 2023

J Yeungnam Med Sci

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“…Use of an endoscopic transoral approach for resection of tumors in the PPS is not new, and a similar concept has been also adopted for the management of anterior craniovertebral junction compressive pathologies. [17][18][19] Compared with open approaches (i.e., transcervical, transcervical-parotid, transmastoid-parotid, transcervical-parotid with mandibulectomy, and ITF approach), the endoscopic transoral approach demonstrates explicit advantages, including the avoidance of comorbidities such as esthetic defects or injury of the facial nerve and parotid gland. 20 However, the disadvantages of a transoral approach are also significant and should be considered, including the potential of postoperative infection and abscess formation in PPS, difficulty in controlling the great vessels, oropharyngeal fistula, and emergent postoperative airway obstruction.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Transoral Approach for Resection of Basal Cell Adenoma Arising in Parapharyngeal Space

London

et al. 2020

J Neurol Surg B Skull Base

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Objectives The clinical and radiological characteristics of the basal cell adenoma (BCA) and its association with the internal carotid artery (ICA) in the parapharyngeal space (PPS), have not been sufficiently explored. This study aims to analyze the characteristics of patients with BCA arising in the PPS and to evaluate the feasibility of a total resection via an endoscopic transoral corridor. Design and Main Outcome Measures The clinical, radiological, and histopathological characteristics of four patients with BCA arising in the PPS were retrospectively analyzed. The endoscopic transoral approach was performed for resection of BCA. Its technical nuances, perioperative comorbidities, and outcomes are introduced. Results The clinical presentation, symptoms, and signs of patients with BCA are variable. The tumor was lateral to the ICA in two patients and anterior to the ICA in the remaining two. All four BCA were successfully removed en bloc (n = 3) or by piecemeal (n = 1) via an endoscopic transoral approach. The ICA was not injured, and no additional nerve damage, venous bleeding, postoperative infection, or salivary gland fistula were encountered in any of the four patients. Cystic degeneration is the predominant appearance of BCA on MRI; however, they are difficult to differentiate from other lesions arising in the PPS. No recurrence was detected at the time of the study analysis. Conclusion BCA of the PPS could have variable relationships with the ICA. An endoscopic transoral approach can provide an adequate corridor for total resection of BCA in PPS with seemingly low morbidity.

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“…This approach is becoming an emerging option to standard microsurgical techniques for transoral approaches to CVJ because of the wider working channel than EEA. Furthermore, ETA gains more consensus because the literature focuses more on EEA-related side effects [ 112 ].…”

Section: Craniovertebral Junction (Cvj) Endoscopymentioning

confidence: 99%

“…However, the indication of this approach is relatively limited because the cadaveric study proved that the endoscopic exposure of the high anterior cervical area was very difficult [ 113 ]. The endoscopic transcervical approach is not so popular because there are potential complications, like injuries to cranial VII, IX, XII, superior laryngeal nerve, the carotid artery, and cervical instability [ 112 ].…”

Section: Craniovertebral Junction (Cvj) Endoscopymentioning

confidence: 99%

Evolution, Current Trends, and Latest Advances of Endoscopic Spine Surgery

Gunjotikar,

Pestonji,

Tanaka

et al. 2024

JCM

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Background: The aging of the population in developing and developed countries has led to a significant increase in the health burden of spinal diseases. These elderly patients often have a number of medical comorbidities due to aging. The need for minimally invasive techniques to address spinal disorders in this elderly population group cannot be stressed enough. Minimally invasive spine surgery (MISS) has several proven benefits, such as minimal muscle trauma, minimal bony resection, lesser postoperative pain, decreased infection rate, and shorter hospital stay. Methods: A comprehensive search of the literature was performed using PubMed. Results: Over the past 40 years, constant efforts have been made to develop newer techniques of spine surgery. Endoscopic spine surgery is one such subset of MISS, which has all the benefits of modern MISS. Endoscopic spine surgery was initially limited only to the treatment of lumbar disc herniation. With improvements in optics, endoscopes, endoscopic drills and shavers, and irrigation pumps, there has been a paradigm shift. Endoscopic spine surgery can now be performed with high magnification, thus allowing its application not only to lumbar spinal stenosis but also to spinal fusion surgeries and cervical and thoracic pathology as well. There has been increasing evidence in support of these newer techniques of spine surgery. Conclusions: For this report, we studied the currently available literature and outlined the historical evolution of endoscopic spine surgery, the various endoscopic systems and techniques available, and the current applications of endoscopic techniques as an alternative to traditional spinal surgery.

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Walk the Line. The Surgical Highways to the Craniovertebral Junction in Endoscopic Approaches: A Historical Perspective

Cited by 18 publications

References 50 publications

The endoscopic transnasal approach to the lesions of the craniocervical junction: two case reports

The endoscopic transnasal approach to the lesions of the craniocervical junction: two case reports

Endoscopic Transoral Approach for Resection of Basal Cell Adenoma Arising in Parapharyngeal Space

Evolution, Current Trends, and Latest Advances of Endoscopic Spine Surgery

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