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The Endoscopic Endonasal Approach to Craniovertebral Junction Pathologies: Surgical Skills and Anatomical Study

  • Paolo Pacca
  • Valentina Tardivo
  • Giancarlo Pecorari
  • Diego Garbossa
  • Alessandro Ducati
  • Francesco Zenga
Chapter
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 125)

Abstract

Introduction: Surgical anterior decompression is the treatment of choice for symptomatic irreducible ventral craniovertebral junction (CVJ) compression. Along with the classic transoral approach, the endoscopic endonasal approach has evolved and is gaining growing success.

Materials and Methods: In this work we discuss the surgical technique, give a complete step-by-step description of dissection of the craniovertebral junction and report a specific case of endoscopic endonasal odontoidectomy with use of a high-definition (HD) three-dimensional (3D) endoscope.

Discussion: The extended endonasal approach exploits an anatomical corridor to the odontoid process, involving only a small incision in the nasopharynx and sparing palate integrity. The most important limitation of the technique is 2D visualization, which hinders correct recognition of anatomical structures.

Conclusion: The endoscopic endonasal route to the odontoid process has proven to be a feasible, safe and well-tolerated procedure. Anatomical study is very important for better understanding of the 3D anatomy of the CVJ and relation of critical neurovascular structures to specific bony and muscular landmarks.

Keywords

Odontoidectomy Endoscopic Endonasal approach CVJ stability Anatomical study 

References

  1. 1.
    Lopez AJ, Scheer JK, Leibl KE, Smith ZA, Dlouhy BJ, Dahdale NS. Anatomy and biomechanics of the craniovertebral junction. Neurosurg Focus. 2015;38:E2.CrossRefGoogle Scholar
  2. 2.
    Menezes AH, Traynelis VC. Anatomy and biomechanics of normal craniovertebral junction (a) and biomechanics of stabilization (b). Childs Nerv Syst. 2008;24:1091–100.CrossRefGoogle Scholar
  3. 3.
    Ponce-Gómez JA, Ortega-Porcayo LA, Soriano-Barón HE, Sotomayor-González A, Arriada-Mendicoa N, Gómez-Amador JL, Palma-Díaz M, Barges-Coll J. Evolution from microscopic transoral to endoscopic endonasal odontoidectomy. Neurosurg Focus. 2014;37(4):E15.CrossRefGoogle Scholar
  4. 4.
    Dickman CA, Crawford NR, Brantley A, Sonntag V. Biomechanical effects of transoral odontoidectomy. Neurosurgery. 1995;36(6):1146–53.CrossRefGoogle Scholar
  5. 5.
    Naderi S, Crawford NR, Melton MS, et al. Biomechanical analysis of cranial settling after transoral odontoidectomy. Neurosurg Focus. 1999;6:E7.PubMedGoogle Scholar
  6. 6.
    Shriver MF, Kshettry VR, Sindwani R, Woodard T, Benzel EC, Recino PF. Transoral and transnasal odontoidectomy complications: a systematic review and meta-analysis. Clin Neurol Neurosurg. 2016;148:121–9.CrossRefGoogle Scholar
  7. 7.
    Nayak JV, Gardner PA, Vescan AD, Carrau RL, Kassam AB, Snyderman CH. Experience with the expanded endonasal approach for resection of the odontoid process in rheumatoid disease. Am J Rhinol. 2007;21:601–6.CrossRefGoogle Scholar
  8. 8.
    Steinmetz MP, Mroz TE, Benzel EC. Craniovertebral junction: bio-mechanical considerations. Neurosurgery. 2010;66(3 Suppl):7–12.CrossRefGoogle Scholar
  9. 9.
    A Gladi M, Iacoangeli M, Specchia N, Re M, Dobran M, Alvaro L, Moriconi E, Scerrati M. Endoscopic transnasal odontoid resection to decompress the bulbo-medullary junction: a reliable anterior minimally invasive technique without posterior fusion. Eur Spine J. 2012;21(Suppl 1):S55–60.CrossRefGoogle Scholar
  10. 10.
    Magrini S, Pasquini E, Mazzatenta D, Frank G, et al. Endoscopic endonasal odontoidectomy in a patient affected by Down syndrome: technical case report. Neurosurgery. 2008;63:e373–4.CrossRefGoogle Scholar
  11. 11.
    Altieri R, Tardivo V, Pacca P, Pennacchietti V, Penner F, Garbossa D, Ducati A, Garzaro M, Zenga F. 3D HD endoscopy in skull base surgery: from darkness to light. Surg Technol Int. 2016;29:359–65.PubMedGoogle Scholar
  12. 12.
    Pennacchietti V, Garzaro M, Grottoli S, Pacca P, Garbossa D, Alessandro D, Zenga F. Three-dimensional endoscopic endonasal approach and outcomes in Sellar lesions: a single-center experience of 104 cases. World Neurosurg. 2016;89:121–5.CrossRefGoogle Scholar
  13. 13.
    Cavallo LM, Cappabianca P, Messina A, Esposito F, Stella L, de Divitiis E, et al. The extended endoscopic endonasal approach to the clivus and cranio-vertebral junction: anatomical study. Childs Nerv Syst. 2007;23:665–71.CrossRefGoogle Scholar
  14. 14.
    Cavallo LM, Messina A, Cappabianca P, Esposito F, de Divitiis E, Gardner P, Tschabitscher M. Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations. Neurosurg Focus. 2005;19:1–14.Google Scholar
  15. 15.
    Zenga F, Marengo N, Pacca P, Pecorari G, Ducati A. C1 anterior arch preservation in transnasal odontoidectomy using three-dimensional endoscope: a case report. Surg Neurol Int. 2015;6:192.CrossRefGoogle Scholar
  16. 16.
    Zenga F, Pacca P, Tardivo V, Pennacchietti V, Garbossa D, Pecorari G, Ducati A. Endoscopic endonasal approach to the odontoid pathologies. World Neurosurg. 2016;89:394–403.CrossRefGoogle Scholar
  17. 17.
    Agrawal A, Reyes PM. A novel technique of odontoidoplasty and C1 arch reconstruction: anatomical and biomechanical basis. Neurosurgery. 2011;68(1 Suppl Operative):103–13.PubMedGoogle Scholar
  18. 18.
    Zenga F, Villaret AB, Fontanella MM, Nicolai P. Endoscopic transnasal odontoidectomy using ultrasonic bone curette: technical case report. Neurol India. 2013;61:69–72.CrossRefGoogle Scholar
  19. 19.
    Jhawar S, Nunez M, Pacca P, Voscoboinik DS, Truong H. Craniovertebral junction 360°: a combined microscopic and endoscopic anatomical study. J Craniovertebr Junction Spine. 2016;7(4):204.CrossRefGoogle Scholar
  20. 20.
    Dasenbrock HH, Clarke MJ, Bydon A, Wolinsky J-P, et al. Endoscopic image-guided transcervical odontoidectomy: outcomes of 15 patients with basilar invagination. Neurosurgery. 2012;70:351–60.CrossRefGoogle Scholar
  21. 21.
    Kanavel AB. Bullet located between the atlas and the base of the skull: technique of removal through the mouth. Surg Clin Chicago. 1917;1:361–6.Google Scholar
  22. 22.
    Crockard HA. Transoral surgery: some lessons learned. Br J Neurosurg. 1995;9:283–93.CrossRefGoogle Scholar
  23. 23.
    Alfieri A, Jho HD, Tschabitscher M. Endoscopic endonasal approach to the ventral cranio-cervical junction: anatomical study. Acta Neurochir (Wien). 2002;144:219–35.CrossRefGoogle Scholar
  24. 24.
    Kassam AB, Snyderman C, Gardner P, Carrau R, Spiro R. The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report. Neurosurgery. 2005;57(Suppl 1):E213.PubMedGoogle Scholar
  25. 25.
    Messina A, Bruno MC, Coste A, Cavallo LM, de Divittis E, Cappabianca P, Tschabitscher M. Pure endoscopic endonasal odontoidectomy: anatomical study. Neurosurg Rev. 2007;30(3):189–94.CrossRefGoogle Scholar
  26. 26.
    De Almeida JR, Zanation AM, Snyderman CH, Carrau RL, Prevedello DM, Gardner PA, Kassam AB. Defining the nasopalatine line: the limit for endonasal surgery of the spine. Laryngoscope. 2009;119:239–44.CrossRefGoogle Scholar
  27. 27.
    Baird CJ, Conway JE, Sciubba DM, Prevedello DM, Quiñones-Hinojosa A, Kassam AB. Radiographic and anatomic basis of endoscopic anterior craniocervical decompression: a comparison of endonasal, transoral, and transcervical approaches. Neurosurgery. 2009;65(6 Suppl):158–64.PubMedGoogle Scholar
  28. 28.
    Castelnuovo P, Battaglia P, Bignami M, Dallan I. Endoscopic transnasal resection of anterior skull base malignancy with a novel 3D endoscope and neuronavigation. Acta Otorhinolaryngol Ital. 2012;32:189–91.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Paolo Pacca
    • 1
    • 2
  • Valentina Tardivo
    • 1
  • Giancarlo Pecorari
    • 3
  • Diego Garbossa
    • 1
  • Alessandro Ducati
    • 1
  • Francesco Zenga
    • 1
  1. 1.Division of Neurosurgery, Department of NeurosciencesUniversity of TurinTurinItaly
  2. 2.SC Neurochirurgia U, Presidio Molinette Dipartimento di Neuroscienze e Salute Mentale, Città della Salute e della ScienzaTurinItaly
  3. 3.1st ENT Division, Department of Surgical SciencesUniversity of TurinTurinItaly

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