Endoscopic Approaches to the Craniovertebral Junction - 27/11/15

Doi : 10.1016/j.otc.2015.08.003

Varun R. Kshettry, MD ^a, Brian D. Thorp, MD ^b, Michael F. Shriver, BS ^c, Adam M. Zanation, MD ^b,^d, Troy D. Woodard, MD ^e,^f, Raj Sindwani, MD ^e,^f, Pablo F. Recinos, MD ^e,^f,^⁎
^a Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, 9500 Euclid Avenue, S73, Cleveland, OH 44195, USA
^b Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive #7070, Chapel Hill, NC 27599-7070, USA
^c Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
^d Department of Neurosurgery, University of North Carolina at Chapel Hill, 170 Manning Drive #7060, Chapel Hill, NC 27599-7060, USA
^e Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, A71, Cleveland, OH 44195, USA
^f Skull Base Surgery, Minimally Invasive Cranial Base and Pituitary Surgery Program, CCLCM, CWRU, 9500 Euclid Avenue, S-73, Cleveland, OH 44195, USA

^∗Corresponding author. Skull Base Surgery, Minimally Invasive Cranial Base and Pituitary Surgery Program, CCLCM, CWRU, 9500 Euclid Avenue, S-73, Cleveland, OH 44195.

Résumé

The endoscopic endonasal approach provides a direct surgical trajectory to anteriorly located lesions at the craniovertebral junction. The inferior limit of surgical exposure is predicted by the nasopalatine line, and the lateral limit is demarcated by the lower cranial nerves. Endoscopic endonasal odontoidectomy allows preservation of the soft palate, and patients can restart an oral diet on the first postoperative day. Treating the condition at the craniovertebral junction using this approach requires careful preoperative planning and endoscopic endonasal surgical experience with a 2-surgeon 4-handed approach combining expertise in otolaryngology and neurosurgery.

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Keywords : Endoscopic, Endonasal, Transnasal, Transclival, Craniovertebral, Craniocervical, Odontoidectomy, Foramen magnum