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New Trends in Craniovertebral Junction Surgery pp 51–55Cite as

Transoral Approach to the Craniovertebral Junction: A Neuronavigated Cadaver Study

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Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 125))

Abstract

More than 100 years after the first description by Kanavel of a transoral–transpharyngeal approach to remove a bullet impacted between the atlas and the clivus [1], the transoral approach (TOA) still represents the ‘gold standard’ for surgical treatment of a variety of conditions resulting in anterior craniocervical compression and myelopathy [2, 3]. Nevertheless, some concerns—such as the need for a temporary tracheostomy and a postoperative nasogastric tube, and the increased risk of infection resulting from possible bacterial contamination and nasopharyngeal incompetence [4–6]—led to the introduction of the endoscopic endonasal approach (EEA) by Kassam et al. [7] in 2005. Although this approach, which was conceived to overcome those surgical complications, soon gained wide attention, its clear predominance over the TOA in the treatment of craniovertebral junction (CVJ) pathologies is still a matter of debate [3]. In recent years, several papers have reported anatomical studies and surgical experience with the EEA, targeting different areas of the midline skull base, from the olfactory groove to the CVJ [8–19]. Starting from these preliminary experiences, further anatomical studies have defined the theoretical (radiological) and practical (surgical) craniocaudal limits of the endonasal route [20–25]. Our group has done the same for the TOA [26, 27] and compared the reliability of the radiological and surgical lines of the two different approaches. Very recently, a cadaver study, with the aid of neuronavigation, tried to define the upper and lower limits of the endoscopic TOA [28].

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Author information

Authors and Affiliations

  1. Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy

    Francesco Signorelli, Vittorio Stumpo, Giulio Conforti, Alessandro Olivi & Massimiliano Visocchi

  2. Institute of Radiology, Catholic University School of Medicine, Rome, Italy

    Alessandro Costantini

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  1. Francesco Signorelli
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  2. Alessandro Costantini
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  4. Giulio Conforti
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  5. Alessandro Olivi
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  6. Massimiliano Visocchi
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Editors and Affiliations

  1. Institute of Neurosurgery, Catholic University of Rome, Institute of Neurosurgery, Rome, Italy

    Massimiliano Visocchi

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Signorelli, F., Costantini, A., Stumpo, V., Conforti, G., Olivi, A., Visocchi, M. (2019). Transoral Approach to the Craniovertebral Junction: A Neuronavigated Cadaver Study. In: Visocchi, M. (eds) New Trends in Craniovertebral Junction Surgery. Acta Neurochirurgica Supplement, vol 125. Springer, Cham. https://doi.org/10.1007/978-3-319-62515-7_8

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  • DOI: https://doi.org/10.1007/978-3-319-62515-7_8

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