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Endoscopic endonasal transclival transodontoid approach for ventral decompression of the craniovertebral junction: operative technique and nuances.
Neurosurg Focus. 2015 Apr; 38(4):E17.NF

Abstract

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.

Authors+Show Affiliations

Departments of 1 Neurological Surgery and.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25828493

Citation

Liu, James K., et al. "Endoscopic Endonasal Transclival Transodontoid Approach for Ventral Decompression of the Craniovertebral Junction: Operative Technique and Nuances." Neurosurgical Focus, vol. 38, no. 4, 2015, pp. E17.
Liu JK, Patel J, Goldstein IM, et al. Endoscopic endonasal transclival transodontoid approach for ventral decompression of the craniovertebral junction: operative technique and nuances. Neurosurg Focus. 2015;38(4):E17.
Liu, J. K., Patel, J., Goldstein, I. M., & Eloy, J. A. (2015). Endoscopic endonasal transclival transodontoid approach for ventral decompression of the craniovertebral junction: operative technique and nuances. Neurosurgical Focus, 38(4), E17. https://doi.org/10.3171/2015.1.FOCUS14813
Liu JK, et al. Endoscopic Endonasal Transclival Transodontoid Approach for Ventral Decompression of the Craniovertebral Junction: Operative Technique and Nuances. Neurosurg Focus. 2015;38(4):E17. PubMed PMID: 25828493.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic endonasal transclival transodontoid approach for ventral decompression of the craniovertebral junction: operative technique and nuances. AU - Liu,James K, AU - Patel,Jimmy, AU - Goldstein,Ira M, AU - Eloy,Jean Anderson, PY - 2015/4/2/entrez PY - 2015/4/2/pubmed PY - 2015/12/17/medline KW - CSF = cerebrospinal fluid KW - PNSF = pedicled nasoseptal flap KW - basilar invagination KW - craniovertebral junction KW - endoscopic endonasal transclival transodontoid approach KW - endoscopic skull base surgery KW - transnasal odontoidectomy SP - E17 EP - E17 JF - Neurosurgical focus JO - Neurosurg Focus VL - 38 IS - 4 N2 - 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. SN - 1092-0684 UR - https://www.unboundmedicine.com/medline/citation/25828493/Endoscopic_endonasal_transclival_transodontoid_approach_for_ventral_decompression_of_the_craniovertebral_junction:_operative_technique_and_nuances_ L2 - https://thejns.org/doi/10.3171/2015.1.FOCUS14813 DB - PRIME DP - Unbound Medicine ER -