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Endoscopic endonasal approach to the craniocervical junction: the importance of anterior C1 arch preservation or its reconstruction.
Acta Otorhinolaryngol Ital. 2016 Apr; 36(2):107-18.AO

Abstract

We report our experience with the endoscopic endonasal approaches (EEA) for different craniocervical junction (CCJ) disorders to analyse outcomes and demonstrate the importance and feasibility of anterior C1 arch preservation or its reconstruction. Between January 2009 and December 2013, 10 patients underwent an endoscopic endonasal approach for different CCJ pathologies at our Institution. In 8 patients we were able to preserve the anterior C1 arch, while in 2 post-traumatic cases we reconstructed it. The CCJ disorders included 4 cases of irreducible anterior bulbo-medullary compression secondary to rheumatoid arthritis or CCJ anomalies, 4 cases of inveterate fractures of C1 and/or C2 and 2 tumours. Pre- and postoperative neuroradiological evaluation was always obtained by magnetic resonance imaging (MRI), computed tomographic (CT) scanning and dynamic cranio-vertebral junction x-ray. Pre- and postoperative neurologic disability assessment was obtained by Ranawat classification for patients with rheumatoid arthritis and by Nurick classification for the others. At a mean follow-up of 31 months (range: 14-73 months), an improvement of at least one Ranawat or Nurick classification level was observed in 6 patients, while in another 4 patients neurological conditions were stable. Radiological follow-up revealed an adequate bulbo-medullary decompression in all patients and a regular bone fusion in cases of C1 and/or C2 fractures. In all patients spinal stability was preserved and none required subsequent posterior fixation. The endoscopic endonasal surgery provided adequate exposure and a low morbidity minimally invasive approach to the antero-medial located lesions of the CCJ, resulting in a safe, effective and well-tolerated procedure. This approach allowed preservation of the anterior C1 arch and the avoidance of a posterior fixation in all patients of this series, thus preserving the rotational movement at C0-C2 segment and reducing the risk of a subaxial instability development.

Authors+Show Affiliations

Department of Otorhinolaryngology, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy;Department of Neurosurgery, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy;Department of Neurosurgery, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy;Department of Neurosurgery, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy;Department of Neurosurgery, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy;Organi di Senso Department, University ''la Sapienza'', Rome, Italy.Department of Otorhinolaryngology, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy;Department of Otorhinolaryngology, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy;Department of Neurosurgery, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy;

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27196075

Citation

Re, M, et al. "Endoscopic Endonasal Approach to the Craniocervical Junction: the Importance of Anterior C1 Arch Preservation or Its Reconstruction." Acta Otorhinolaryngologica Italica : Organo Ufficiale Della Societa Italiana Di Otorinolaringologia E Chirurgia Cervico-facciale, vol. 36, no. 2, 2016, pp. 107-18.
Re M, Iacoangeli M, Di Somma L, et al. Endoscopic endonasal approach to the craniocervical junction: the importance of anterior C1 arch preservation or its reconstruction. Acta Otorhinolaryngol Ital. 2016;36(2):107-18.
Re, M., Iacoangeli, M., Di Somma, L., Alvaro, L., Nasi, D., Magliulo, G., Gioacchini, F. M., Fradeani, D., & Scerrati, M. (2016). Endoscopic endonasal approach to the craniocervical junction: the importance of anterior C1 arch preservation or its reconstruction. Acta Otorhinolaryngologica Italica : Organo Ufficiale Della Societa Italiana Di Otorinolaringologia E Chirurgia Cervico-facciale, 36(2), 107-18. https://doi.org/10.14639/0392-100X-647
Re M, et al. Endoscopic Endonasal Approach to the Craniocervical Junction: the Importance of Anterior C1 Arch Preservation or Its Reconstruction. Acta Otorhinolaryngol Ital. 2016;36(2):107-18. PubMed PMID: 27196075.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic endonasal approach to the craniocervical junction: the importance of anterior C1 arch preservation or its reconstruction. AU - Re,M, AU - Iacoangeli,M, AU - Di Somma,L, AU - Alvaro,L, AU - Nasi,D, AU - Magliulo,G, AU - Gioacchini,F M, AU - Fradeani,D, AU - Scerrati,M, Y1 - 2016/04/29/ PY - 2015/03/16/received PY - 2015/10/19/accepted PY - 2016/5/20/entrez PY - 2016/5/20/pubmed PY - 2017/9/1/medline KW - Anterior C1 arch preservation KW - C2 odontoidectomy KW - Endoscopic endonasal surgery KW - Spine instability SP - 107 EP - 18 JF - Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale JO - Acta Otorhinolaryngol Ital VL - 36 IS - 2 N2 - We report our experience with the endoscopic endonasal approaches (EEA) for different craniocervical junction (CCJ) disorders to analyse outcomes and demonstrate the importance and feasibility of anterior C1 arch preservation or its reconstruction. Between January 2009 and December 2013, 10 patients underwent an endoscopic endonasal approach for different CCJ pathologies at our Institution. In 8 patients we were able to preserve the anterior C1 arch, while in 2 post-traumatic cases we reconstructed it. The CCJ disorders included 4 cases of irreducible anterior bulbo-medullary compression secondary to rheumatoid arthritis or CCJ anomalies, 4 cases of inveterate fractures of C1 and/or C2 and 2 tumours. Pre- and postoperative neuroradiological evaluation was always obtained by magnetic resonance imaging (MRI), computed tomographic (CT) scanning and dynamic cranio-vertebral junction x-ray. Pre- and postoperative neurologic disability assessment was obtained by Ranawat classification for patients with rheumatoid arthritis and by Nurick classification for the others. At a mean follow-up of 31 months (range: 14-73 months), an improvement of at least one Ranawat or Nurick classification level was observed in 6 patients, while in another 4 patients neurological conditions were stable. Radiological follow-up revealed an adequate bulbo-medullary decompression in all patients and a regular bone fusion in cases of C1 and/or C2 fractures. In all patients spinal stability was preserved and none required subsequent posterior fixation. The endoscopic endonasal surgery provided adequate exposure and a low morbidity minimally invasive approach to the antero-medial located lesions of the CCJ, resulting in a safe, effective and well-tolerated procedure. This approach allowed preservation of the anterior C1 arch and the avoidance of a posterior fixation in all patients of this series, thus preserving the rotational movement at C0-C2 segment and reducing the risk of a subaxial instability development. SN - 1827-675X UR - https://www.unboundmedicine.com/medline/citation/27196075/Endoscopic_endonasal_approach_to_the_craniocervical_junction:_the_importance_of_anterior_C1_arch_preservation_or_its_reconstruction_ L2 - https://doi.org/10.14639/0392-100X-647 DB - PRIME DP - Unbound Medicine ER -